The diets prescribed to people suffering from tuberculosis should be as far as possible similar to those taken by the same individuals when in ordinary health; the nutritive value, however, must be somewhat larger - on an average, some 150 grammes protein and 3,200 calories daily. An examination of the diets usually taken by the leisured classes shows us that their average intake of 120 grammes of protein daily is taken approximately in the following way : in meat and fish, 60 per cent, in dairy produce, such as milk and eggs, 16 per cent, the remaining 24 per cent. being taken as vegetable protein, for instance, in bread, potatoes, etc. Energy is mostly taken in the form of bread, cakes, pastry, etc., butter, puddings of various sorts {which contain milk, suet, eggs and butter in their composition), bacon, and, to a less extent, in fruit, vegetables, jams, marmalade, sugar, etc. Approximately speaking, the proportion of fat to carbo-hydrate in the ordinary diet of the leisured classes is 3 parts of fat to 5 parts of carbo-hydrate. It will be remembered that fat is a more expensive, but a more palatable and less bulky form of energy-giving food than carbo-hydrate ; this fact explains the preference of the leisured classes for fat as a source of energy.

When constructing dietaries for use by tubercular patients of the leisured classes, the increase of 30 per cent of protein and calorie value is best made by adding to an average normal dietary the requisite amount of food-stuffs of a similar nature to those which are already included in the dietary. Supposing that on inquiry we find that any particular patient's diet when in normal health has been adequate from a nutritive standpoint, an addition of 3 pints of milk daily will often be sufficient to bring this dietary up to the necessary nutritive standard for the efficient treatment of tuberculosis. Three pints of milk means an addition to the dietary of:

Protein. 50

Fat. 60

Carbo-hydrates. 75

Calories. 1,070

In short, of one-third of the diet necessary.

It must not be forgotten, however, in this respect, that the diets of patients when they are first found to be tubercular are often inadequate, the patient having unconsciously materially reduced his dietary in consequence of gradually increasing anorexia. The diet, then, of any patient when he first comes under observation very often does not represent the individual's ordinary diet when in normal health. This construction of a diet for the tubercular by the addition of 3 pints of milk to an individual's ordinary diet when in health is a very simple method and is often satisfactory; in actual practice, however, many people find some difficulty in taking an extra 3 pints of milk in addition to the milk they are already taking in tea, coffee, puddings, etc. The extra milk may be taken, a pint at each meal, or half a pint may be taken at each meal, the other three half-pints being taken at other times - preferably, perhaps, on waking, in the middle of the morning, and in the middle of the afternoon, or the last thing at night. The majority of people prefer the latter method, viz., taking the milk in half-pints distributed over the day, but, in our experience, the one method is quite as satisfactory as the other from a clinical standpoint. A certain number of people are unable to take milk in its natural form on account of dyspepsia and other alimentary disturbances which it gives rise to; in some of these cases, the symptoms appear to be due to a real dyspepsia; in others, and more often in people of a nervous temperament, the difficulty appears to be simply an idiosyncrasy. It is very rarely, however, that milk cannot be satisfactorily taken by these patients if its taste be disguised somewhat. The best methods of altering the milk are as follows : (1) by the addition to it of a small quantity of very strong tea or coffee; (2) by making it into a rather fluid Benger's food preparation; (3) by having it completely or partially pancreatized; (4) by flavouring the milk with bovril, in the proportion of a teaspoonful of bovril to a half a pint of milk; this last method results in a richly flavoured and very nutritive beef-tea, from which the taste of milk is absent. A certain amount of milk can be given in the shape of junket, custard, egg-flip, etc., but these preparations are only subsidiary, and must not be relied upon as the chief means of prescribing milk.

The value of milk, as a constituent of diets for the tubercular has long been recognized, and many people think that a dietary for a consumptive cannot be adequate and efficient if milk is not included in it. This, as already explained, is a fallacy. Milk, in short, has no specific value from a clinical standpoint.

Detailed Description Of Diets For The Leisured Classes

The following dietary has the nutritive value of our standard diet for the treatment of the average tubercular man, viz., protein 155, calorie value, 3,250.

Protein.

Fat.

Carbohydrate.

Grms.

Grms.

Grms.

Milk, 3 pints....

57

70

87

Bread, 6 oz...

16

2

88

Butter, 1 1/2 oz..

-

32

-

Cream, 1 oz.

1

6

-

Fish, 4 oz...

20

10

-

Meat, 6 oz...

44

22

-

Milk pudding, 4 oz...

9

16

50

Suet or sponge pudding 3 oz...

Potatoes 5 oz...

1

-

30

Egg, 1...........

6

. 4

-

Stewed fruit, green vegetables, soups, etc., from time to time, q.s...

1

1

7

Cake, 1 oz...

1

2

12

Totals........

155

" 160

275

Total calorie value 3,250.

In the above table the nutritive values of the majority of the food-stuffs have been calculated from the tables of the percentage composition of food-stuffs of Attwater, and in the case of the food-stuffs from original analyses.

In practice this dietary may conveniently be given in the following way: -

Man.

.

Woman.

Breakfast.

Two breakfast cups.

Milk (usually flavoured with coffee).

Two breakfast cups.

Four ordinary-sized "triangles".

Toast (or bread).

Three ordinary-sized "triangles".

A piece the size of a walnut.

Butter.

A piece the size of a walnut.

One egg.

An ordinary sized helping.

Egg. Bacon, cold ham, tongue, a herring, or a fillet of fish, etc., etc.

One egg.

An ordinary sized helping.

Four tablespoonfuls.

Porridge (in place of half the bread) and milk or cream.

Three tablespoonfuls.

11 A.M.

A tumblerful.

Milk.

A tumblerful.

Man.

Woman.

Lunch.

A tumblerful.

Milk.

A tumblerful.

An ordinary sized helping.

Fish or entree.

An ordinary sized helping.

2 1/2 oz. (a large helping).

Meat.

2 oz. (a large helping).

Two, the size of a hen's egg.

Potatoes.

Two, the size of a hen's egg.

According to taste.

Green vegetables.

According to taste.

Half a round (thick).

Bread.

Half a round (thick).

A piece the size of a walnut.

Butter.

A piece the size of a walnut.

A large helping (4 or 5 oz.).

Milk or other pudding, stewed fruit and custard or creams, etc.

A large helping (3 or 4 oz.).

Tea, a slice of thin bread and butter and a piece of cake, pastry, etc.

Tea.

Tea, a slice of thin bread and butter and a piece of cake, pastry, etc.

DlNNER.

A tumblerful.

Milk.

A tumblerful.

If desired.

Soup.

If desired.

An ordinary helping.

Fish or entree.

An ordinary helping.

As at lunch.

Meat. - Potatoes and vegetables. Pudding, etc.

As at lunch.

Half a round.

Bread or toast.

Half a round.

A piece the size of a walnut

Butter.

A piece the size of a walnut

If desired.

Savoury or cheese, etc. Dessert.

If desired.

At Bedtime.

A tumblerful.

Milk.

A tumblerful.

N.B. - The essential food-stuffs in the above dietary are printed in Roman letters; those which may be left to the discretion of the patient in italics.

Approximate value of the above diets : - Men . . . .155 protein 160 fat 275 carbo-hydrate- Women . . .135 protein 140 fat 230 carbo-hydrate.

If the above diets are compared with those taken by people in ordinary health, it is seen that there is no great difference between them, the additional milk, perhaps, being the principal feature. It is essential, of course, that these diets be varied and well cooked.