Uremia, or renal insufficiency, demands the most careful regulation of diet. The toxins that provoke it are produced in small part by the metabolism of living cells, but chiefly by fermentation in the stagnant contents of the intestines, or by common ingredients of food, such as potassium salts, which probably play a part in uremic intoxication. These are derived directly from the food and can be excluded from the body by a regulation of diet and by emptying the intestines. Catharsis must be provoked, so as to remove from the bowels all fermenting and toxic matter. For this purpose elaterium, calomel or salts can be prescribed. If a patient suffers from uremic mania, from acute uremia, or from symptoms of mild uremia that are becoming severer, all food should be forbidden for thirty-six or forty-eight hours, but water should be given as freely as possible. If unconsciousness prevents its being swallowed easily, it should be given by the rectum or sub-cutaneously, so that diuresis will be aided as much as possible. Cathartics should also be given so as to empty the bowels as rapidly and as completely as possible. No treatment is more effective than this. When the uremic symptoms have disappeared, food may be given, but the amount and character of it should be prescribed with care. To begin with, water gruel made of arrow-root or rice is sometimes recommended. It is rarely necessary to do this. It is better to give no food until the symptoms of uremia are gone, and then to begin by giving milk. At first a half glass every two hours may be given. The amount should gradually be increased to a full glass. Milk is an ideal food in these cases, for it contains a minimum of toxic matters, is not likely to ferment in the intestines, and is a valuable diuretic. Care must still be taken to make the bowels move freely. When the volume of urine voided approaches the normal average, starches and sugars may also be given. For example, rice, breads, potatoes, and many fruits may be used to supplement, not to displace, the milk. If improvement continues, vegetables may also be permitted to form a part of the diet. Albuminous food should not be used so long as the daily excretion of nitrogenous waste is much below the average for one on a milk or a modified milk diet. In an acute nephritis it should not be used so long as there is albumin in the urine; in chronic cases not while the urine contains much sediment, numerous casts, epithelial and blood-cells, or granular matter. When proteins are added to the diet, it is best to begin with fish and soft-cooked eggs; later, to add squab, breast of fowl, and, when recovery is complete, the red meats and game. Protein foods should be given at first in small portions, and their effect upon the amount of urine, urea, and albumin voided should be watched carefully. In the same way the effect of larger amounts and of different kinds of foods should be studied.

So long as large quantities of milk are taken daily it is not necessary to urge the drinking of water, but when the diet is varied and the amount of milk taken is lessened, it is best to prescribe the drinking of approximately two quarts of fluid, preferably milk and water. A little tea or coffee, and milk soups, may be permitted in many instances.

It is equally necessary to keep the intestines well emptied, the skin clean and active, and the lungs filled with pure air. This disease should be treated in large, well-ventilated rooms. The patient must be protected from drafts and from cold by suitable clothing. Hot baths and friction of the skin are imporant aids to treatment.

In all cases of uremia as complete rest as possible should be enjoined.