KARELL CURE
Karell has devised the milk cure, which is used possibly more than any other diet. It not only furnishes a dietary régime, which is used in nephritis, but it is likewise advocated in organic diseases of the heart and blood vessels.
Methods of Administering the Karell Cure.—The cure is begun by giving from 3 to 6 ounces of milk three or four times a day. Karell makes a point of using small quantities to begin with and having the milk skimmed. The milk is given at regular intervals, is warmed in winter and given at room temperature in the summer. It may be given plain or diluted with limewater. After a week if the stools remain solid, the daily allowance of milk is increased to two quarts. Constipation is an indication of the agreement of this diet and the patient’s utilization of the milk. If, however, he manifests gastro-intestinal disturbances, resulting in diarrhea, the amount must be temporarily reduced. Karell advocates boiling the milk and relieving the constipation with enemas or mild laxatives. The addition of small quantities of coffee to the morning portion of milk, or of stewed prunes or a baked apple to the afternoon feeding, also tends to overcome the condition.
Thirst.—The extreme thirst may be relieved by adding plain water, limewater, or seltzer to 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 régime.
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.