DIETARY FOR THE SICK. 115 



bestowed on the subject of it. It is always necessary to treat the 

 patient, and sometimes what is seemingly necessary for his ail- 

 ment is very poor treatment for him, if too long kept up. We 

 especially note this in respect of the employment of wine and 

 stimulants, and in the conduct of cases of Bright's disease and of 

 chronic gout. 



I think well of the skim-milk treatment in cases of chronic 

 tubal nephritis. But it is not always well borne by the patient. 

 He may fail to be sufficiently nourished by it, and a time comes 

 when the diet must be altered. There is a large variety of foods 

 available in this condition : bread, biscuit, butter, light farinaceous 

 pudding, sometimes with egg in it, potatoes, spinach and other 

 green vegetables, with cooked fruit. The albuminuria is often 

 not materially increased in chronic cases if fish be given once a 

 day, or the yolks of two eggs be added to the diet. Fat bacon 

 may also be taken. And on alternate days we may sometimes 

 give a little mutton or chicken, without any apparent harm to 

 the disease, and with material benefit to the patient. The con- 

 dition of the urine must be carefully noted in making these 

 amendments. Certainly, in some cases, the " large white kidney " 

 is an expression of a frail and feeble constitution, and has not 

 always the same significance. A better level of general nutrition, 

 directed in relation to the renal adequacy, may much aid in help- 

 ing the kidneys to recovery. It is surely wrong to starve the 

 patient while aiming only to rid him of his ailment. Of course, 

 age, habits, constitution, and tissue-proclivity must be had regard 

 to in all such cases. 



The treatment of acute phases of dysentery by absolute milk 

 diet I believe to be excellent ; and I agree with those Indian au- 

 thorities who forbid the least addition of animal broth or of fari- 

 naceous matters to it, possibly for many consecutive weeks. 



In many cases of gout and gouty habit of body I often find in- 

 adequate diet prescribed, and a frail, painful condition of body as 

 the result. In such cases, again, each person is to be studied as to 

 his previous habits, inherited proclivities, and textural condition. 

 The prohibition of meat and wine is often bad, and gouty mani- 

 festations will be held in check, not seldom, by a good diet and 

 the use of some trustworthy wine. The tendency now is to make 

 all gouty persons avoid meat, and drink whisky in routine fash- 

 ion, or to take to water-drinking. The latter plan has its place, 

 but many sufferers from gout, in both sexes, are better with some 

 wine. If they starve themselves of what they formerly took, 

 perhaps in moderation, and of what their progenitors took per- 

 haps too freely, they will not so much have gout as gout will 

 have them as has been quaintly remarked. Such persons must 

 attain their highest level of good health, and live above their 



