o the feedings.

If during the second or third week of the cure the hunger becomes too
great for the patient to endure, a small piece of herring or stale
bread may be given.

Once a day a milk soup thickened with a cereal may be given. The above
diet is carried out from five to six weeks, after which the patient is
gradually returned to a normal diet. Milk, however, should still
constitute an important part of the diet. The Karell cure is modified
more or less to meet the condition of the patient, the amount of milk
administered in some cases being more and in others considerably less
than mentioned in the above regime.

~Limiting the Proteins.~--The extent of the damage caused by the
end-products of protein metabolism cannot be easily estimated, but it
is wise not to err on the side of an over-supply, since the retaining
of these materials in the body gives rise to a certain type of
intoxication (uremic poisoning).

~Relative Toxicity of the Animal Proteins.~--The difference between
the various animal proteins as to their relative toxicity has been the
subject of much discussion. As far as their nutrient value is
concerned, they are practically the same, that is, the protein of beef
and the protein of chicken show very similar analyses. The beef
contains, however, more extractives, which we know are high in purins.
These substances have proven detrimental to the welfare of a nephritic
patient.

~Selection and Preparation of Foods.~--For this reason the so-called
red meat is sometimes boiled instead of roasted, as the latter mode of
preparation increases the formation of purins on the brown outer
surfaces of the meat. Chicken and fish contain less purin bases and
for this reason are often included in the diet when beefsteak and
lamb chops are excluded. Meat soups and broths contain little nutrient
value, consisting as they do chiefly of water, salt, and extractives,
all of which are looked upon with disfavor, and classed with the
offending articles of food in the nephritic diet. Cream soups, except
bean or pea soup,[121] may be given in moderation. They are non-toxic
in character and of high nutrient value, furnishing a valuable
addition to the diet when the gastro-intestinal symptoms permit of
such addition.

CONVALESCENT NEPHRITIC DIET[122]

~Advisable Foods.~--The following foods are used in the formation of
diet for an advanced convalescent nephritic patient when not otherwise
contraindicated:

Cereals