Karell Method

KARELL METHOD, the treatment of a number of diseases exclusively by a milk diet. This method was proposed by Karell (a St. Petersburg physician) in 1865 and at that time found many followers. According to Karell, the patient must consume skimmed milk, starting with 1/2 to 1 coffee cup 3-4 times a day, so as to reach 2 bottles by the 2nd week, and subsequently up to 10-12 glasses per day. Throughout the time, the patient must consume milk at strictly established intervals, namely: at 8 a.m., 12 p.m., 4 p.m., and 8 p.m. If, upon consuming a larger quantity of milk, the patient experienced a deterioration, Karell advised starting again with smaller quantities. Upon the onset of thirst, Karell allowed patients to take a little water, and after 2-3 weeks, if there was a strong desire for solid food, he allowed them to be given a piece of white bread at 8 a.m. and a stale roll with salt at 4 p.m. Treatment conducted in this way usually lasted 5-6 weeks, and during this time all medicines were excluded. As for the indications for the use of this method of treatment, in the opinion of Karell, particularly good results were obtained in general dropsy, in "heart diseases (hypertrophic), which at their core often had disturbances of abdominal circulation, i.e., in plethoric individuals," in "severe disturbances of innervation in the form of hysterical and hypochondriacal phenomena," "persistent dyspepsias," chronic liver diseases, ascites, etc. At the present time, the indications for this method of treatment are limited mainly to heart diseases with edema and obesity. Positive results are obtained mainly in fresh cases of decompensation (Glinchikov), especially with right-sided heart failure associated with emphysema and chronic bronchitis. The main factors of the Karell method are: 1) starvation, 2) significant restriction of introduced fluid, and 3) limited introduction of chlorides. Less importance, perhaps, should be attributed to the diuretic effect of milk sugar and potassium salts. The limited introduction of chlorides acts in a dehydrating manner on the organism; this same task is also facilitated by the significant restriction of introduced fluid. By the malnutrition that occurs when using the Karell method, distension of the stomach, elevation of the diaphragm, and increased work of the digestive organs are avoided—all these are factors that facilitate the work of the heart (Hirschfeld, Yanovsky). But it should not be forgotten that the Karell method leads to very sharp malnutrition, which causes inevitable protein breakdown and a strong decline in nutrition, which may prove harmful to the work of a diseased heart. Therefore, a contraindication to the use of the Karell method is a decline in nutrition and general weakness of the patient. For this same reason, at the present time, the Karell method, if it is used at all, is used in a modified form, namely: from the first day, 3 glasses of milk are given, increasing daily by 1/2 a glass and usually bringing the daily amount to 8-9 glasses. After 12 days from the start of treatment, the patient is transferred to a mixed diet (Botkin, Sirotinin). Hoffmann and Richter recommend limiting oneself to frequent inclusions in the normal diet of only a few Karell days and then quickly returning to sufficient nutrition again, since the prolonged use of milk is often very difficult for patients to tolerate and is often accompanied by dyspeptic phenomena, severe constipation, and sometimes diarrhea. Sometimes patients exhibit nervous restlessness, vomiting, and cold sweat ("milk crises" Oehme). If the Karell method in its pure form is to a significant extent of only historical interest, then the application of this method for a short period sometimes yields good results in some decompensated cardiac patients.