The prices of the various food-stuffs from which the total cost of this diet (11.74d. per day) has been calculated are those at which we have actually bought the various articles at ordinary shops and in retail amounts.

In Diet 2, which costs 10 18d. per day, economy has been effected by giving only half a pint of whole milk and replacing the other half-pint by separated milk. The ounce of butter at 1s. per pound is replaced by 1 oz. of margarine at 8d. per pound, and 6d. per pound is allowed for meat instead of 7d. This means that, for the most part, the cheaper forms of meat will have to be bought.

Table Showing The Composition Of Diets Suitable For The Treatment Of Consumption

AT a COST OF 4s. 6d., 5s. 4d., 6s., and 7s. Respectively.

1

2

3

4

Oz,

Price.

Oz.

Price.

Oz.

Price.

Oz.

Price.

Composition.

Whole milk....

20

@ 2d. per pt.

10

@ 2d. per pt.

-

-

-

_

Separated milk

__

10

@ 1d. per pt.

20

@ 1d. per pt.

5

@ 1d. per pt.

Meat, etc. (as purchased)

9

@ 7d. per lb.

9

@ 6d. per lb.

9

@ 5d. per lb.

6

Butter.....

1

@ 1*. per lb.

-

Margarine ....

__

-

1

@ 8d. per lb.

1

@ 8d. per lb.

1

@ 6d. per lb.

Suet.....

1/2

__

1/3

__

1/3

.

Cheese.........

2

(American) @ 7d.

2

(Dutch) @ 5d.

2

(Dutch) @ 5d.

3

(Dutch) @ 5d.

Bacon and brawn .

2

@ 6d. per lb.

2

@ 6d. per lb.

2

@ 6d. per lb.

2

@ 6d. per lb.

Bread..........

12

-

12

__

12

__

16

__

Potatoes ....

8

__

8

___

8

-

8

__

Pulses.....

3

-

3

__

3

__

4

-

Oatmeal ....

2

-

2

-

2

-

2

__

Sugar........

2

-

2

-

2

__

2

__

Jam..........

1

-

1

-

1

-

1

__

Bice, etc.....

1/3

-

a

-

i

-

-

__

Flour........

1

-

1

__

1

__

__,

__

Green vegetables .

Sufficient amounts

-

Sufficient amounts

__

Sufficient amounts

__

Sufficient amounts

-

Sundries . . .

-

-

-

-

Nutritive value.

Protein (grammes).

156

__

158

-

158

__

151

Fat (grammes).

__

141

__

121

__

110

94

Carbo-hydrate .

___

432

_

432

__

432

_

459

Calories.....

-

3,722

-

3,545

-

3,452

-

3,375

Economic Efficiency

No. of grammes of Protein bought per penny spent ....

-

133

-

15.5

-

173

-

195

No. of calories do. .

-

318

-

348

-

374

-

437

Ratio of costs of animal and vegetable foods.

-

72.5 : 27.5

-

68 .3 : 31.7

-

64.6 : 35.4

-

54.7 : 45.3

Cost per diem .

-

11.74d.

__

10.18d.

-

912d.

-

7.72d.

Cost per week .

-

la.

-

6*.

-

5s. 4d.

-

4a. 6d.

In Diet 3, which costs 9.12d. per day, no whole milk is included, a pint of separated milk being used instead, and only 5d. per pound is allowed for meat.

Still further economy, as shown by the fourth diet at a cost of 7.7d. per day, is obtained by reducing the amount of separated milk to 5 oz. per day, and the amount of meat to 6 oz. per day. As compensation, the daily amount of cheese is increased by 1 oz., the amount of bread by 4 oz., and the amount of pulses by 1 oz. Such a dietary as this will only be necessary when dealing with the very poor.

Calories bought per penny, 409.

No. of grammes of protein bought per penny, 18.9

Total calorie value, 3,476.

Ratio Of Cost Of Animal To Vegetable Food, 563 : 437

Amount.

Price Retail.

Nutritive Value.

Cost.

Oz.

Grms.

Protein.

Fat.

Car.-Hyd.

Pence.

Separated milk

20

570

@ 8d. per gal.

19

1

28

100

Meat, etc. .

6

170

@ 5d. per lb.

31

20

-

1.88

Margarine .

1

30

@ 6d. per lb.

---

22

-

038

Suet.....

__

__

_

-

__

-

Cheese (Dutch).

2

56

@ 5d. per lb.

18

11

__

063

Egg.....

-

-

-

-

-

-

-

Bacon ....

2

56

@ 6d. per lb.

4

24

-

075

Total animal food..........

72

78

28

464

Bread ....

16

460

@ 2 1/2d. per 2 lb

41

5

230

1.25

Potatoes

8

230

@ 8d. per st.

2

-

32

028

Pulses ....

4

112

@ 2d. per lb.

27

2

71

050

Oatmeal

2

56

@ 2d. per lb.

8

4

37

025

Sugar ....

2

56

@ 2 1/2d. per lb.

-

56

031

Jam.....

1

28

@ 3 1/2d. per lb.

1

-

16

022

Rice, etc. .

i

14

@ 2 1/2d. per lb.

-

-

10

008

Flour ....

__

-

__

__

__

-

Green vegetables .

-

-

-

5

-

10

020

Sundries

-

-

-

-

-

050

Total vegetable food.......

84

11

462

359

Total food........

156

89

490

823

The above dietary, which costs just over 8d. per day, will also be found adequate for the treatment of tuberculosis.

Diets For Use In Sanatoria For The Working Classes, Where The Patients Are Employed In Various Forms Of Manual Labour

In sanatoria where the convalescent patients are employed in actual manual work, a diet of higher calorie value must be given. After considerable experience, we have adopted the following dietary as our standard for the treatment of this class of patient.

Breakfast

Tea.

Porridge, 1/2 pt. (=oatmeal, 2 oz.).

Bacon (cooked), 1 1/2 oz.

Milk for tea and porridge, 5 oz.

Loaf sugar, 3/4 oz.

Moist sugar for porridge, 1 1/2 oz.

Bread, 3 oz.

Butter, 1/4 oz.

Dinner

Roast joint, etc., 5 oz. = 9 oz. as purchased.

Potatoes, 5 oz. = 8 oz. as purchased.

Suet pudding, 5 oz.

Green vegetables, q.s.

Tea

Tea.

Bread, 8 oz. (three rounds).

Butter, 1/2 oz.

Jam, lettuce, etc., q.s.

Supper

Pulse soup, 1/2 pt. (=3 oz. dry pulse).

Or bread, 3 oz. and cheese, 2 oz.

Or sausage, liver, fish, ham, etc.

Milk or cornflour pudding, fruit, etc., 8 oz.

Cocoa or milk, 1/2 pint.

Milk may be added if thought desirable in any individual case, but if the whole of the above diet can be taken, milk will be unnecessary.

The protein value of this diet works out at 150 grammes, and the total calorie value at about 4,000.

The use of whole milk and butter, rather than of margarine and separated milk which would make the diet appreciably cheaper, is advised; joints of meat are also given daily. An important feature in this diet is that the extra amount of nourishment required, especially the increase of protein, is given in the cheap form of vegetable protein. This vegetable protein, however, is given in comparatively small amounts and in a palatable form.

The diet, as a whole, is a palatable one, and readily taken by the working classes. From a clinical standpoint, also, we have found it most satisfactory. Its economic efficiency is well shown by the fact that it costs only 65. 8d. a week, and for every penny spent 13.2 grammes of protein and 336 calories are bought. This diet should be reduced 15 per cent in its value when prescribed to women patients.

The following is a good weekly menu which can be given when using the diet just described.

Week's Menu

Breakfast.

Dinner.

Tea.

Supper.

Sunday .

Porridge and milk, cold ham, tea, bread and butter.

Roast beef, baked potatoes, boiled peas, fruit tart.

Tea, bread, butter, cake.

Tinned salmon, sponge cake and custard, bread and cheese.

Monday.

Porridge and milk, fried bacon (rest as above).

Boiled mutton, potatoes and greens, date pudding.

Tea, etc., jam.

Bean soup, macaroni pudding.

Tuesday.

Porridge and milk, fried bacon.

Cottage pie, suet roll and jam.

Tea, etc., cake.

Fried liver, blanc-mange, stewed fruit.

Wednesday .

Porridge and milk, fried bacon.

Stewed steak and onions, potatoes, boiled ginger pudding.

Tea, etc., lettuce.

Pea soup, boiled rice and jam.

Thursday .

Porridge and milk, cold ham.

Roast mutton, boiled beans, bread pudding.

Tea, bread, butter, and jam.

Sausage or fish, bread and butter pudding.

Friday .

Porridge and milk, bacon.

Boiled beef and vegetables, potatoes, plum duff.

Tea and cake.

Lentil soup, baked lemon pudding.

Saturday

Porridge and milk, Find on haddock.

Beef steak and kidney pie, boiled peas, milk pudding.

Tea, etc., jam.

Stewed kidney and macaroni, blancmange, stewed fruit.

Directions For Poor Tubercular Patients Living At Home, For Instance, Those Attending Out Patients' Departments At Hospitals, Etc

It is by no means easy efficiently to direct the dietetic treatment of tubercular people belonging to the working classes unless they are immediately under supervision, e.g. in an institution. In our experience, the prescription of a definite diet to consumptive patients among the poorer classes is not satisfactory, as, for the most part, they have not the means at home of carrying out instructions at all accurately.

We have obtained more satisfactory results in such cases after giving general directions, as under : -

"You require to take much more food than you did before you became consumptive. Do not hurry over your meals; you will feel satisfied frequently before you have eaten enough, and you must continue to eat even when you do not want more food. Your appetite is no guide as to the amount you need. The best way to find out whether you are eating enough is to weigh yourself every week, always at the same time of day and in the same clothes. If you have not gained at least one pound during the week, you will know you have not been eating enough.