The diet prescribed to patients suffering from tuberculosis should contain the food-stuffs generally used by people in ordinary life. To construct any dietary of a certain definite nutritive value it is necessary to have a knowledge of the percentage composition of the various food-stuffs contained in it.
The following table gives the approximate nutritive values of the food-stuffs commonly used and will be found of considerable practical value. The analyses of the uncooked foods are taken from Attwater's tables. The nutritive value of the cooked foods mentioned in the table we have ourselves determined by a series of analyses.
Approximate Nutritive Value per Ounce of Food-stuffs.
Beef, roasted as served...
Mutton, game, chicken, etc....
Raw meat, scraped...
Milk puddings, blancmange, custard, etc. .
Boiled suet puddings...... .
Bread and cake...
Butter, dripping, margarine, etc.
Milk (per oz.).......
Benger's food (made entirely with milk) .
Milk is a very valuable food-stuff, since by its use a considerable amount of nourishment can be prescribed in a very easily-taken form. The inclusion of 3 pints of milk in a patient's dietary means that a third of the necessary protein and calorie value is thus given. Milk, however, is not an essential constituent of the diet, especially in the treatment of patients who have normal digestions and can take solid foods. When, on grounds of economy, milk is not advantageously included in the diet, the patient does perfectly well, so long, of course, as the nutritive value of his diet is kept up to the requisite standard.
When whole milk cannot be afforded, use should very often be made of skimmed, or separated, milk.
It must be admitted that whole milk is much more palatable than separated (or skimmed) milk, but, at the same time, separated milk, as a drink, is by no means so unpalatable as to contra-indicate its use. The main use, however, for which we recommend separated milk is in cooking.
In puddings it is almost impossible to distinguish those made with whole milk from those made with separated milk.
Again, separated milk can be used advantageously in making cocoa, oatmeal porridge, and, in general, most articles which require milk.
It may be said that the use of separated milk, which is confessedly of lower nutritive value, bulk for bulk, than whole milk, lowers the nutritive value of the diet. This is, of course, quite true, but it is of little or no importance to the healthy man, who can make up the deficiency easily enough in other ways. In the case of persons with poor appetites, the fat lost by separation can readily enough be restored by the use of an equivalent amount of margarine, which, for cooking purposes, is quite as satisfactory as butter and less expensive. A gallon of whole milk loses 168 grammes of fat by the process of separation, and this 168 grammes of fat costs 8d. One hundred and sixty-eight grammes of fat, in the form of the best margarine, costs about 3d. In other words, we save 5d. per gallon if we use separated milk and margarine in place of whole milk without affecting either the nutritive value in the slightest degree or the palatability, provided the materials are used for cooking only.
These economic properties of milk, though not generally made use of, appear to us to be worthy of the consideration of those responsible for the construction of dietaries for the poor.
Meat should always be included in the dietary as one of the chief sources of protein. Meat, also is not an essential, when treating patients with normal appetites and digestions; we have obtained excellent clinical results when treating tubercular patients upon entirely meat-free diets, in which the protein was given in milk and vegetable foods. These meat-free diets, though very cheap, are difficult to make really palatable and, in the long run, it is better economy to include a certain amount of meat.
The amount of meat included in the average standard dietary-should be quite reasonable, viz., from 9-12 oz. of meat, as purchased daily. An ill-balanced diet containing a large excess of meat, is as prejudicial to the tubercular as to the normal individual. In some cases with marked dyspepsia or high fever, and also in tuberculous enteritis, we have found raw meat to be very beneficial; this may be, in part, accounted for by raw meat being very easily, and completely, absorbed by the alimentary canal.
When prescribing raw meat, there is some risk, however, of introducing parasites.
Cod-liver oil, malt and oil, etc., are to be considered more in the light of food-stuffs than of drugs. They have a very distinct value, especially in private practice, as the amount of fat given daily can be readily increased by prescribing them as a medicine to be taken with meals. It is quite possible that these oils have a beneficial effect, quite apart from their food value, but this point is uncertain.
In sanatorium practice they are but rarely used, as fat can be given in adequate amounts in more palatable ways, for instance, in butter and milk. Oils are very valuable indeed in the dieting of tuberculous children, as they are readily taken by them. In the case of out-patients, also, they are a very useful means of increasing the value of the diet.
There is a considerable difference of opinion as to the value of alcohol in the dietetic treatment of tuberculosis.
We do not advise the inclusion of alcohol in a routine diet for a sanatorium for tubercular patients or as a regular constituent of a tubercular dietary. Alcohol, however, is often of use; in patients with considerable debility, a glass of Burgundy, or some good wine with luncheon and dinner, often improves the appetite and digestion of such patients; in the case, too, of people who have always been used to a certain amount of alcohol, it is sometimes advisable to allow small amounts to be taken at the usual times. A glass of beer at meals in place of milk can often be given to convalescent patients with advantage. Alcohol is often of great service in treating patients who are acutely ill, or considerably exhausted; brandy, in doses of 1-3 oz. daily, in our experience is the most satisfactory form in which to prescribe it. In the treatment of night sweats, also, 1/2-l 1/2 oz. of brandy, given in hot milk, often gives great relief, and not infrequently, the taking of such a draught in the early hours of the morning will altogether prevent the occurrence of this depressing symptom.