DIET IN BRIGHT'S DISEASE

JOHN M. BATTEN
1894 Journal of the American Medical Association  
The diet in the management of a case of Bright's disease of the kidneys is a very important feature. It would seem as nitrogenous ingesta in great part undergo metamorphosis and yielding their nitrogen to be carried off in combination with a portion of other elements under the form of urinary products, that a non-nitrogenous diet or one approximating it is the proper food in this disease. The experiments of Schmidt show that the amount of urea passed in the urine is related to the quantity of
more » ... o the quantity of food ingested, the nature of it remaining the same. He found that when a cat ingested 44.188 grammes of meat daily, that the amount of urea excreted per kilogramme, body weight, was 2.958; 46.154 grammes were ingested; 3.050 grammes of urea were excreted. 75.938 " " " 5.152 " " " " 108.755 " " " 7.663 " " " " It will be seen that when the cat was living on flesh diet that the kidneys excreted on an average 6.8 parts urea for every 100 parts of meat consumed, and that the great bulk of the nitrogen belonging to the food ingested passed out of the system in the form of urea. If all the nitrogen was excreted by this way the quantity of urea would amount to 7.88 per cent, of the weight of the meat ; the nitrogen contained in 100 parts of flesh corresponding with that contained in 7.88 parts of urea. But there were 6.8 parts of urea produced instead of 7.88 parts, which may be spoken of as representing the actual equivalent, as far as contained nitrogen was concerned, of a 100 parts of flesh. Lehman states from observations made on himself when he ate animal food wholly, that about five-sixths of the nitrogen ingested was found in his urine in the form of urea. From the foregoing observations it must be ad¬ mitted that nitrogenous matter undergoes meta¬ morphosis within the system. It must also be ad¬ mitted that nitrogenous matter must undergo changes in the system rapidly, as it has been found that the amount of urea excreted by the kidneys is quickly affected by the quality of the food ingested. Lehman also found that when he had breakfasted exclusively on animal food that his urine was so rich in urea as to throw down a copious precipitate of the nitrate on the addition of nitric acid. In Dr. Parkes' observations on two soldiers, A and B, he also found that a change in the food ingested soon affected the quantity of urea excreted. These men were kept the first, second, third and fourth days on a regulated mixed diet ; the fifth and sixth days on a non-nitrogenous diet, the seventh, eighth, ninth and tenth days on a mixed diet, the eleventh and twelfth days on a non-nitrogenous diet, and on the thirteenth, fourteenth, fifteenth and six¬ teenth days on a mixed diet. A, during the first four days on a mixed diet excreted 35 grammes of urea as the daily mean. The fifth and sixth days on a non-nitrogenous diet, .20 grammes and 13.52 grammes respectively. On the seventh, eighth, ninth and tenth days on a mixed diet he excreted 20.67, 25.68, 26.29 and 29.67 grammes of urea respectively. On the eleventh and twelfth days on a non-nitro¬ genous diet he excreted 19.12 and 15 grammes of urea respectively, and lastly, on the thirteenth, fourteenth, fifteenth and sixteenth days on a mixed diet he passed the first day 20.8, second 26.36, third 28.32 and fourth day 30.10 grammes of urea. B, who was a much smaller man, the mean for the first four days on a mixed diet was 25.92 grammes of urea passed. Dur¬ ing the fifth and sixth days on anon-nitrogenous diet the urea excreted was 17.3 and 12.65 grammes respec¬ tively. On the seventh, eighth, ninth and tenth days on a mixed diet the urea excreted 14.40, 23, 25.20 and 22.99 grammes respectively. On the eleventh and twelfth days on a non-nitrogenous diet he voided 16 and 13.20 grammes of urea respectively. Lastly, on the thirteenth, fourteenth, fifteenth and sixteenth, days on a mixed diet the urea passed was 23, 24.36, 24.57 and 21.36 grammes respectively. The above observations show that urea excreted by the kidneys was increased or diminished according as nitrogenous or non-nitrogenous food was ingested. Mahomet, age 22, and weight 165 pounds, \vho had been living on an ordinary mixed diet, conducted two experiments on himself with a view to obtaining more precise information with regard to the time required for metamorphosis of nitrogenous matter to occur and to lead to an increased elimination of urea. In order to do this, he took his dinner of mixed food as usual at 1:30 p.m., April 16, 1871. Prom this time, so as not to suffer too much from want of nitrogen¬ ous food, he restricted himself to tea, sugar, butter, arrowroot and rice, the latter being the least nitro¬ genous of the natural food products. This diet was continued throughout the 17th, and at 8 a.m. on the 18th he took four eggs so as to supply nitrogenous matter. By the following morning it would be ex¬ pected that the urea excreted would be at a low point when a meal was taken of meat diet. Under a restricted diet the urea steadily decreased from 21 to 9.05 grains per hour. After eating the eggs the urea readily increased within the next four hours to 13.82 grains, and during the remainder of the day the urea only underwent a little further increase. The following morning the urea had de¬ creased to 10.62 grains per hour, then after eating plentifully of beefsteak at breakfast the urea rose to 21.16 grains per hour, and with a repetition of meat Downloaded From: http://jama.jamanetwork.com/ by a University of Arizona Health Sciences Library User on 06/05/2015
doi:10.1001/jama.1894.02421210001001 fatcat:bvfaaqgp6zarvojk6d4ke4z7hy