To arrive at a standard diet suitable for the treatment of the average adult suffering from tuberculosis, we have worked out the average nutritive value of the diets taken by 200 of our patients who made very satisfactory recoveries. We have, in this analysis, considered the diets taken by the men and women patients separately, and from them we have calculated the standard diet for each sex respectively. The 200 patients by whom these diets were taken, as has previously been mentioned, represented many types of tubercular disease both as regards the exact nature of, the extent of, and the severity of the morbid process. The nutritive value of the average diet taken by the men patients works out at approximately 150 grammes of protein and 3,200 calories daily, the average diet taken by the women at 128 grammes of protein and 2,700 calories. These are standard working diets, and as such will be found very useful, and to give very satisfactory clinical results. They will, of course, require modification in individual cases; for example, a man of large physique will require quite 10 per cent more protein and 20 per cent more calorie value than a small man, other things being equal. As a matter of experience, however, we do not often prescribe to patients with active tuberculosis diets with a lower nutritive value than those of our standard dietary.

It is of interest to compare our standard diets with the standard diet worked out by a careful observer on this subject, Dr. H. M. King of the Loomis Sanatorium in America. In his paper, "Diets in Tuberculosis" published in the Transactions of the National Association for the Study and Prevention of Tuberculosis (Washington, 1906), Dr. King thus describes his observations :

"With a view of establishing a working diet, so to speak, for certain classes of tubercular invalids the following experiment was recently made at the annex of the Loomis Sanatorium. Twelve patients equally divided as to sex were selected with reference - first, to similarity of conditions, all but one with quiescent or arrested lesions, and that one with but a very moderately active lesion; secondly, with reference to similarity of weight, the men averaging 11 or 12 kilos more than the women; and thirdly, with reference to a close approach of each patient to his or her normal weight. In all but one case the patients were but slightly below the indicated standard; nevertheless, the appearance was that of a very well-nourished group of individuals. These patients were placed at a table by themselves, and their food, while not differing from that of the other patients, either in quality or quantity, was accurately weighed and recorded for a period of 14 days. The average diet taken by these patients throughout this period worked out at 166 grammes protein, 179 grammes fat, 322 grammes carbo-hydrate, with a calorie value of 3,667".

Commenting on this average diet, Dr. King states that "This dietary has seemed to us to meet in a fairly satisfactory manner the requirements of the class of tuberculous invalids treated in the annex division of the Loomis Sanatorium. Nevertheless, I felt that the protein constituent of the dietary has been in excess of the tissue needs, and if so, that an unnecessary and perhaps harmful tax was thus imposed upon the organs concerned in protein metabolism and elimination".

The diet taken by King's patients at the Loomis Sanatorium is somewhat larger than our standard diet for men, both in protein and calorie value, the average daily intake of protein in King's diet being 166 grammes compared with 150 grammes in our standard diet.

Grams, of Protein.

Cals.

King's standard diet ....

166

3,667

Our standard diet for men .

150

3,200

In a letter to us on the subject, King writes : " The question of establishing the minimum protein food constituent which would give a plus nitrogen balance in cases of tuberculosis is of much interest to me, and I have not by any means reached satisfactory conclusions with regard to it. For the present, the average diet which we find, for practical purposes, most useful, is almost identical with that which you quote as having been found most satisfactory with you, except that we probably average a greater consumption of carbo-hydrates, bringing the total calories to from 3,000 to 3,700".