nature; elaborate entrées, and made dishes of all kinds; also rich sweets and creams; cheese, dried fruits and nuts, likewise malt liquors, sweet and generous wines, such as sweet champagne, madeira, brown sherry, and port, must be prohibited.

Articles to be Used Sparingly.—They must use sparingly red meats, eggs, butter, sugar, cakes, puddings, milk and cream. They must be very moderate in their use of even light wines. If alcohol is taken at all, the safest form for many such patients is weak brandy or whisky and water. The diet may be arranged as follows:

Breakfast.-A small plate of very well-boiled oatmeal or hominy porridge and milk, followed by a cup of weak tea and a slice of toast with very little butter.

Or a bit of fresh white fish or a slice of bacon with the tea and toast as above.

In summer fresh ripe fruits, such as strawberries or gooseberries, and other fruits or plain salads in their season may be added.

Luncheon. Some vegetable soup with bread; or fish, with a little mashed potato or fresh green vegetable, bread and butter, with lettuce or watercress.

Beverage. A glass of claret in water, or one tablespoonful of spirit in a small tumblerful of water, or a glass of plain or of aërated water.

They may be allowed a cup of tea in the afternoon, with a slice of thin bread and butter, a rusk, or a plain biscuit. Dinner. (Two courses only, soup or fish, and meat, or meat and pudding.)

Plain soup, especially of the vegetable kinds, or fish, as sole, whiting, plaice, turbot.

Chicken, game, or tender mutton; mashed or grated potato and well-boiled green vegetables, such as spinach or stewed celery.

Any sort of plain milk-pudding, or shape and stewed fruit. Beverage as at luncheon.

Nothing after dinner but a glass of cold or of hot water, to be sipped before going to bed.

ACUTE CONGESTION OF THE LIVER.

Acute congestion of the liver has to be treated dietetically, in a very different way from the congestions that result from long-standing heart or lung disease. When the liver is acutely congested, besides the symptoms of disturbance in the hepatic functions already alluded to in speaking of functional derangements of that organ, there is enlargement, and usually some tenderness on pressure in the right hypochondrium. There is often also troublesome vomiting, owing to the irritable state of the stomach. So long as the symptoms are acute, the diet must be restricted, and the patient limited to the most simple forms of nourishment, such as milk diluted with an alkaline water, broths, beef-tea, weak tea, barley, or toast-water. If thirst be very troublesome, these latter may be sipped freely, or the patient may be allowed to suck small pieces of ice. The milk, broths, and beef-tea should be given in regulated quantities of a cupful every three hours, and to each supply should be added a teaspoonful of powdered biscuit or other farinaceous substance, such as arrowroot, sago, or tapioca.

Avoidance of Alcohol.-Except in cases where weakness renders it an absolute necessity, alcohol in every form should be withheld.

When, after rest in bed, with warm applications, and the use of cholagogues, and a diet as above sketched, the acute symptoms have passed off, the greatest care is still necessary in regard to what food the patient takes. The diet must be continued of the simplest kind, and for a long time the rules laid down in the section on functional disorders of the liver should be strictly adhered to. Most persons who have suffered from acute hepatic congestion do well to abstain thereafter from alcohol in any form.

INFLAMMATIONS OF THE LIVER (ACUTE AND CHRONIC HEPATITIS): MALIGNANT DISEASE AND MORBID GROWTHS IN THE LIVER.

Acute Stage. In the acute stages the diet should be limited to liquid foods in the simplest forms, as directed under the head of "Congestion of the liver" (p. 48).

In the early stages of chronic inflammations and of malignant disease, the patient's condition will be ameliorated by attention to the matter of diet. The directions already given for the dietetic treatment of functional disorders of the liver should be followed, with this caution, however, that the great need there is in such cases for maintaining the patient's strength should never be forgotten; and hence, while diet cannot be too simple, it should be as nutritious and sustaining as the impaired functional activity of the digestive organs will permit.

Alcohol.-In inflammations of the liver, the use of alcohol is contra-indicated unless the patient's strength be greatly reduced, as, for example, after the opening of an abscess. In malignant diseases, on the other hand, wine and other forms of alcohol may safely be given in such quantities as the circumstances of each case render necessary at the time.

DIET IN GRAVEL AND URIC ACID CALCULUS.

Uric Acid.-Excess of uric acid in the blood, and deposits of it in the urine, being very closely allied to the gouty state, it is not necessary to repeat all that is said regarding the dietetic treatment of that condition (see chap. on Gout), or of the treatment of disorders of the liver (p. 45), with which both are intimately associated. It may, however, here again be remarked that the diet must be restricted in quantity as well as in certain articles. The nitrogenous elements, especially red meats, must be used in great moderation; and all rich heavy dishes should be altogether excluded, among these being numbered pies, pastry, sweets,

D

sugar, and fruits containing much sugar. Alcohol, if permitted at all-and in some cases where it distinctly aids the digestive processes a small quantity is beneficial—should be given in diluted forms and free from admixture. Therefore, liqueurs, port, sherry, sweet champagne, and malt liquors are to be prohibited. Fish, white meats, with plenty of well-cooked green vegetables, and salads where they agree, should, along with a moderate amount of milk and of farinaceous substances, constitute the diet. Water is the best solvent and diuretic, but the quantity taken at meals should be restricted. Taken in moderation, between meals, and also the first thing in the morning and the last thing at night, it will not interfere with digestion.

In Children. -In the case of children and young persons who inherit the diathesis, a great deal may be done to prevent its fuller development in later life, by attention to these dietetic rules, combined with a simple active life, exercise in the open air, and suitable clothing.

OXALURIA.

Oxaluria may occur during the course of some chronic diseases, as, for instance, in phthisis, or it may appear temporarily in some persons after they have eaten such things as rhubarb, tomatoes, or unripe fruits. If persistent, it is associated with or dependent upon impaired digestion and imperfect assimilation of food.

No distinctive rules for diet, applicable to all cases of oxaluria, can be laid down, but in general it may be said that food should be moderate in quantity, and should not contain much nitrogenous material. The great point is to secure, as far as it is possible, in these persons complete assimilation, and thus prevent accumulation of waste matter. The diet that is most fully digested answers best, and the activity of the digestive organs should be promoted by fresh. air and open-air exercise.

CHAPTER IV.

GENERAL CONTENTS: Diabetes Mellitus-Simple Glycosuria-Polyuria (Diabetes Insipidus).

DIABETES MELLITUS.

IN no other disease, probably, are the beneficial effects of a well-chosen dietary so marked as in cases of diabetes; but in considering questions of diet in this connection, we require to keep clearly before our minds three very different conditions, namely—(1) diabetes mellitus; (2) simple glycosuria; (3) diabetes insipidus, so called, for which a better designation is polyuria.

Distinctions. These three affections, although they touch each other in one or more points, are in reality widely separated as regards pathology, prognosis, and treatment.

Glycosuria not Diabetes.-The more or less continuous passing of traces of sugar in the urine, or the occasional and temporary passing of sugar in the urine in considerable amount, does not constitute true diabetes; and hence we must not diet all glycosurics as if they were diabetics, else, in some cases at least, we shall do more harm than good.

Diabetes insipidus likewise is mentioned in this connection only to be separated and made distinct from both the others, as, except the passing of a large quantity of urine, it has nothing in common with either.

Definition. While there are many variations in the clinical history of cases of true diabetes, and all the symptoms need not be present in the same case at one time,