Tuberculosis is one of the wasting diseases, and the rationale of its treatment consists in improving general nutrition, repairing waste, and in increasing what we know as the resistant and recuperative powers of the human body; in this treatment dietetics form one of the most important factors at our command. It is not a simple matter to generalize when speaking on the subject of the dieting of tuberculosis. The disease may manifest itself in such varied forms; it may be very acute, for example, as a general infection, or the morbid process may be quite localized and give rise to little or no constitutional symptoms; very often, as in the case of pulmonary tuberculosis, for instance, the disease runs a protracted and chronic course with intervals of more acute exacerbations. The signs and symptoms, then, of tuberculosis differ considerably, according to the character of the infection, and the part, or parts, of the body affected; for this reason, the dietetic indications in patients suffering from this disease may vary a good deal. The diet, for example, which is in every way adequate for a patient with a limited and quiescent lesion in the lung, and whose body weight is in excess of his normal, will usually be found to be quite unsuitable for a patient with extensive and active disease in the same situation, associated with high fever and general constitutional disturbance. Tuberculosis of the larynx, associated with dysphagia, and the common complication of consumption, haemoptysis, both require special dietetic treatment; tuberculosis of the intestines and kidneys, and the various dyspepsias due to tubercular infection, also have their special dietetic indications. Speaking generally, the principles underlying the dietetic treatment of all types of tubercular disease are the same, but in the case of disease of certain organs, there are special indications to be considered. We may, then, conveniently discuss the subject of dietetics in tuberculosis in two sections (1) the dietetic treatment in tuberculosis generally, and (2) the special dietetic indications in tuberculosis of various organs.
Our researches upon the dietetics of tuberculosis have been carried out in the course of some eight years' residence in sanatoria for the treatment of this disease. The patients we have treated, although they have been for the most part patients suffering from pulmonary tuberculosis, have included a good number of those suffering from tuberculosis of other organs, more especially of the larynx and of the intestines; a fair proportion of cases of surgical tuberculosis, such as bone and joint disease, lupus, etc., have also been observed. Our conclusions, then, as to the broad lines upon which the dieting of tuberculosis should be based have been formed as the result of observations upon a large number of patients suffering from tuberculosis in various regions, and for this reason we think that they may be taken as having a general application in the treatment of the disease. Opinions as to the best principles upon which diets for the treatment of tuberculosis should be constructed have differed very much, and at the present time the practice of physicians in this respect varies very considerably. An interesting illustration of the fact is afforded us by the statistics collected by Irving Fisher of Newhaven, in America, for the annual meeting of the National Association for the Study and Prevention of Tuberculosis held at Washington in May, 1906. The results of his inquiry are published in the Transactions of this Society (1906). Fisher states that "Letters of inquiry were sent out to 95 of the leading sanatoria of the world of which 63 were in the United States, 2 in Canada, 13 in Germany, 11 in Great Britain, and the remainder in France, Austria, Norway, Switzerland, and Russia. Very few" (less than 20 apparently), he continues, "supplied any measured data, and in most cases the statement of the food consumed was given only in a general way".
In regard to the question of the quantity of food consumed, Fisher found that of 64 sanatorium physicians, 28 were distinctly in favour of the system of forced feeding, and 29 were distinctly reactionaries against it. In the table of measured data which will be found in Fisher's Appendix, it will be seen that the dietaries range all the way from 2,500 calories to 5,500 calories, and have a protein value of from 160 to 300 grammes. Commenting on these facts, Irving Fisher writes : "Naturally, not all of these standards can be correct, and if we are to believe that there is any virtue in physiological economy, we must conclude that those sanatoria which use the lowest standards consistent with weight-gaining must be more nearly on the right track".
In conclusion, Fisher sums up the present position with regard to the question of the dieting of consumptives in the following words : " There is as yet very little known with certainty as to the most efficient diet in the treatment of tuberculosis or the extent to which this diet should be individualized. In order to determine either the standard or individual diet, much study and accurate observation are needed".
The object of our researches was to determine (1) the best principles upon which to construct diets for the treatment of tuberculosis and (2) if possible, to arrive at a standard diet suitable for the treatment of the average tubercular person.
We may say that it is clearly impossible to construct a dietary which is suitable for the treatment of all types of tuberculosis and for every individual sufferer from this disease. To attempt to do so would be to attempt as impossible a task as that of constructing a dietary which would be suitable for every one enjoying normal health, irrespective of sex, age, or occupation. However, in the same way as it has been possible as the result of prolonged scientific research and observation to formulate the essential principles upon which diets for normal individuals should be constructed, so it should be possible to determine the principles upon which diets should be constructed for the use of those suffering from tuberculosis. Further, it seems reasonable to assume that by continued accurate observations upon a large number of patients, a standard diet can be determined which is suitable for the treatment of the average tubercular patient, and which, with slight modifications, either by way of increase or decrease in some of its constituents, should be suitable for any individual suffering from this disease.