The ingestion of large quantities of meat has been recommended for tuberculous affections because of the infrequency with which they are associated with gouty states. That is to say, it is assumed that the gouty or uric acid diathesis is antagonistic to the tuberculous one, and that it can be induced by a liberal meat diet. A meat diet is also recommended for obesity, setting up a species of starvation; for dyspeptic affections, because of its simplicity and freedom from carbo-hydrate fermentation; and for chronic articular gout, diabetes and psoriasis.

The Salisbury diet is the typical meat diet and consists of 2-4 pounds of meat, beef for preference, and 3-5 pints of hot water daily for 4-12 weeks. The meat is chopped up quite fine with an American chopper, and all gristle, bone, fat and visible connective tissue are removed. It is made into patties, sufficiently firm to hold together, three to four inches in diameter, and half to one inch thick. These are placed in a frying-pan, without fat or water, and rapidly heated, first on one side and then on the other. On removal from the fire they are allowed to stand near it until of a drab colour. Salisbury recommends that they should be broiled slowly and moderately well. Butter, pepper, salt, Worcester sauce, mustard, horseradish, celery salt and lemon juice may be added as condiments. Advocates of this diet have recommended three pounds of rump steak and one of cod-fish, with six pints of hot water daily, for two weeks. For the next three weeks the hot water is reduced to four pints and other kinds of meat are allowed, with a little green vegetable and unsweetened rusks. During the next four weeks the hot water is further reduced to two pints; hock and claret with seltzer are permitted, and grilled meat, poultry or game, crusts of stale bread and captain's biscuits. The meat must not be raw and must be quite fresh.

The hot water should be given in doses of 1/2 to 1 pint, four or more times a day, say at 6 and 11 a.m., and 4 and 9 p.m., one or two hours before meals and half an hour before retiring. It should be of a temperature of 110° F. to 150° F. and should be sipped slowly in 1/4 to 1/2 hour. If it nauseates, a little tea, coffee, lemon juice, salt or sal volatile (m xxx ad oz. xx) may be added.

Five grains of bicarbonate of potash are sometimes given night and morning.

There are obvious objections to this diet. It is absolutely unphysiological, a starvation diet in respect of fat and carbohydrates. The quantity is much too large for most people. It throws a great strain on the organs which have to do with the metabolism of protein. It is essential to be sure that the kidneys are sound before adopting this treatment.

Zomotherapy is the name given to the treatment of disease by a diet of muscle juice or raw meat. A diet of raw meat and alcohol was recommended for phthisis and pyogenic infections by Fuster of Montpellier in 1865. C. Richet and J. Hericourt in 1889 experimentally determined the value of a raw meat diet for tuberculosis in dogs, and subsequently showed that the benefit was derived from the muscle juice and not from the muscle fibre, deprived of its juice by expression. They found that it was not a matter of hyper-alimentation, for only 50-100 c.c. of the juice, as a daily dose, were sufficient to cure the dogs, whereas hyper-alimentation with the washed muscle fibres had no beneficial effects. The juice contains 2.5 per cent of albuminoid material.

The technique of the feeding is so complex as to render it quite impracticable. The best rump steak of cattle must be obtained, for it is richest in juice. Mutton yields less juice and often has a disagreeable odour and unduly high taste. Horse flesh is cheaper, less efficacious, more toxic and liable to set up enteritis.

The juice must be prepared from perfectly fresh meat If the muscle has undergone rigor mortis it has lost its glycogen, and contains lactic acid and more or less toxic products of decomposition. Hence, the juice should be prepared within two or three hours of the animal's death. If it is prepared from commercial meat it is less beneficial, more toxic and perhaps infective. The animal should be neither overworked nor underfed before death. The meat must be finely minced, wrapped in stout linen, put in a sieve and subjected to slow pressure. Small household presses will yield about 20 and larger presses 30-60 per cent of juice. If one-fourth the weight of sterilized water is added and the meat allowed to stand for an hour or two before compression, more fluid is obtained, but the bulk and the increased decomposition are disadvantages. Presses, mincer and linen should be well boiled or washed in boiling water before use. In hot weather the juice should be collected in a vessel surrounded by ice. Even in winter the juice should be taken at once, because of its liability to decomposition. It is repulsive to the patient and should be given in a coloured glass or with warm beef-tea. It is liable to set up alimentary, hepatic or renal troubles. Intestinal disorders are due to neglect of some detail in the technique, generally to the impossibility of getting the meat sufficiently fresh.

The dose should be 9-15 ounces daily, with or between meals, in water, aerated water, tepid beef-tea, with or without salt or sugar. Three to six ounces is sufficient for early cases. If raw meat is given as much as a pound a day can be ordered, but few patients can take more than one-fourth to one-half pound. Raw meat and muscle juice can be combined in the dietary. No cooked meat should be allowed.

Possibly the muscle juice contains a substance which is antagonistic to the tubercle bacillus and its toxin, for muscle fibres are not invaded by the organism, and during the course of the disease they waste, perhaps being sacrificed in the defence of the body. More probably the good effects depend on the nutritive value of the fluid as a stimulant of the nervous system or of thyroid activity.

There is evidence that defective thyroid activity predisposes to tuberculous affections. These are apt to follow rapid growth at puberty, infectious diseases, prolonged lactation, sexual excess and alcoholism, in all of which the thyroid secretion is liable to be used up and the gland to atrophy from over-stimulation. Raw meat and milk stimulate thyroid activity and, according to Galeotti and Lindermann (1897), the decomposition products of raw meat increase the colloid material of the thyroid. In fowls fed on raw meat the thyroid and parathyroids become enlarged (Chalmers Watson, 1904). No such change was found by D. Forsyth in similar experiments (1907). Milk probably contains some of the internal secretion of the thyroid, for iodine can reach the infant through the breast-milk. Infantile myxoedema rarely develops until after weaning and, moreover, the infant thyroid contains little colloid.

Zomotherapy is indicated in latent, pre-tuberculous and early stages of tuberculosis. If we accept the view that the disease is due to infection in early life, through tuberculous cows' milk, it follows that undercooked meat should enter largely into the diet of young children. Meat juice and raw meat are valuable in anaemia, dyspepsia, neurasthenia, debility, convalescence, typhoid fever and after haemorrhage. Raw meat is contra-indicated, on account of its stimulating properties and its composition, in excitability of the nervous system, haemoptysis, arthritis, liver and kidney disease, and pyogenic intoxication. In some of these, muscle juice may be given if the effects are carefully watched.

Improvement is indicated in tuberculosis by increased muscular power, rise of blood pressure, increased haemoglobin, better digestion, and decrease in physical signs. In the very young the prognosis varies directly as the gain in weight, especially in the first month. Treatment should be continued for a period varying with the extent of the disease and the improvement, and may be resumed at intervals if the health again fails.

On account of the difficulty in obtaining fresh muscle juice a preparation, Carnine Lefranc, has been introduced to take its place. It claims to be made from freshly killed healthy animals by a cold process, without the aid of heat of any kind, without any added drug or chemical, and to accurately represent fresh muscle juice. One kilo of beef yields 250 grammes of the juice. It is a sweet syrup, agreeable to the taste, and keeps well. Dose : one to six tablespoonfuls daily, alone or in any fluid, except beef-tea, cold or tepid.