The treatment of tuberculosis, especially of pulmonary tuberculosis, with very large diets has been so frequently advocated, and is still so widely practised, that it is necessary to refer to it.

The routine treatment of consumption with diets of a very high nutritive value is very often associated with most satisfactory clinical results, as evidenced by arrest of the tubercular process and restoration of health and strength, although this method of treatment results in a considerable strain being thrown upon the digestive system and the body metabolism. In the case of patients who have good constitutions, and especially good digestions, continued high feeding may produce no permanent and indeed little or no temporary ill-effects, except some dyspnoea due to excess of body-weight. Such a patient becomes obviously too fat, often a stone or two above his normal weight, but his digestive and excretory organs may successfully cope with the strain imposed upon them. On return to ordinary life, on completion of his course of treatment, such a patient loses a good deal of his excess weight, and the net result may be satisfactory enough. In many instances, however, and notably in the case of patients with naturally weak digestions and in those who continue the high feeding for a long time after their normal body-weight has been well exceeded, the taking of a very large diet is attended with very serious disadvantages. One of the earliest symptoms is failure of appetite, amounting to a positive loathing of food; very often also there is flatulent dyspepsia.

This impairment of the alimentary system is often associated on exertion with a degree of dyspnoea out of all proportion to the extent of the lung disease; this dyspnoea is no doubt due to the loss of the physiological balance between the cardio-respiratory functions and body-weight. An individual in such a condition looks obviously too fat, and not infrequently, in addition to some degree of anorexia and flatulent dyspepsia, he complains of a feeling of heaviness throughout the day, but especially marked after meals, and a general inaptitude for physical and mental exertion. If the administration of very large diets be continued after the condition just described has been established, vomiting and diarrhoea may follow, representing, as Sir Douglas Powell suggests, "the attempts of nature to rectify our want of foresight." The result is that the individual, for a time at least, takes a smaller diet and loses some weight, and his alimentary tract benefiting from this rest usually soon recovers its normal tone. It is to be said in favour of the system of continued very high feeding that, in spite of the discomforts and digestive disorders from which many patients suffer when thus treated, it often results in the tubercular disease becoming arrested. Excessive feeding is clearly a vastly better method of treatment than under-feeding, for it at least ensures the patient taking enough to repair his waste. The point to realize is that such over-feeding is quite an unnecessary hardship for a patient to undergo, and that it may do positive harm.