Before we learned of the contagious character of this affection, and its dependence on the tubercle bacillus, it was the custom to regard tuberculosis as a disease of nutrition, curable only by abundant feeding - all that a patient could tolerate - and especially feeding with fats and mineral matter. Even in modern times the custom of overfeeding is largely resorted to, and when the patient has but little appetite, the stomach sound is often used to give large quantities of concentrated liquid food, perhaps predigested. Many physicians strongly disapprove of this practice, claiming that it is utterly irrational and throws an enormous amount of extra work on the organs of digestion, assimilation and elimination.

1W. Gilman Thompson, M.D.. "Practical Dietetics." New York. D. Appleton & Co.

It is as true, as ever, that a full diet antagonizes the disease. A tuberculous subject or one likely to become so, is not capable of much physical exertion, and save in the hectic fever stage, has not much temperature. The poison of the disease deprives him of a natural appetite, and unless he is able to assimilate a normal amount of food, he loses flesh progressively, as in any other affection with loss of appetite or indigestion. Hence his diet does not differ much from that of the convalescent in the composition of food; but on account of the enfeebled appetite and digestion the individual articles best borne are those used in severe indigestion from any cause. That is, they are to be concentrated, bland, and as varied as possible. As in dyspepsia, the patient does best on small and frequent meals.

Considerable use can be made of milk, cream, buttermilk, kumyss, etc. The remarkable and inexplicable curative effects of a certain amount of fat in the diet should never be forgotten. The frequent repugnance to fat has in fact been connected with the development of disease. This distaste does not usually extend to cream, butter and salad oil, and many forms of emulsions of fat with or without hypophos-phites have a deserved reputation. So important is a certain amount of fat that many physicians have it rubbed into the skin and even injected subcutaneously. The patient is not limited to a fixed daily quantity, but is given as much as he can tolerate. A certain amount of alcohol in some form is so well borne in tuberculosis as to make it a dietetic article of value. It is probable that both fat and alcohol act by protecting the protein. Both have a high caloric value, so that the amount of other nutriment can be restricted, and should consist largely of eggs, milk and an occasional piece of tender meat.

Tor an average consumptive, without fever, but with no desire for food, six small meals may be given daily.

1. 8 a. m. Milk, taken slowly, two glasses, with a roll or toast and butter and a little marmalade.

2. 10 A. m. Milk punch, taken slowly.

3. 1 p. m. A course dinner may be given for the sake of variety: cup of broth, a few bites each of fish, beef, potato and anything else craved as an entree (as a bit of smoked tongue). Also a mouthful or two of some kind of dessert. The patient may aid the appetite by taking wine, or some form of malt liquor.

4. 4 P. m. Two glasses milk slowly sipped.

5. 7 P. M. Like dinner, but much smaller. A plate of soup, a chop and a little preserve with a glass of wine.

6. Bed time. Two glasses of milk slowly sipped.

In this way up to 2500 calories may be taken without overfeeding. If a patient technically tuberculous, but with good appetite and digestion can take 3000 to 3500 calories daily without discomfort, he may do so, even though his quiet life would not otherwise make such a quantity desirable. The fat and alcohol which help so materially to swell the number of calories tend to fortify the body against the progress of the disease.

On the other hand, patients in advanced or confirmed phthisis can hardly be saved by any plan of feeding. They often suffer from severe complications like incessant diarrhoea or laryngeal phthisis which make any plan of feeding difficult. Each case, therefore, must be a law to itself. The modern custom is to feed them all they can tolerate, especially of solid food, to supply energy, for the paroxysms of coughing and the exertion necessary to dress and get about in the outdoor air.

Diet: Soups

Turtle or oyster soup, mutton, clam or chicken broth, purge of barley, rice, peas, beans, cream of celery or tomatoes, whole beef tea, peptonised milk gruel.

Fish

All kinds of fresh fish, boiled or broiled, oysters or clams, raw, roasted or broiled.

Meats

Rare roast beef or mutton, lamb chops, ham, fat bacon, sweetbreads, poultry, game, tender steaks, hamburger steak rare.

Eggs

Every way except fried.

Farinaceous

Oatmeal, wheaten grits, mush, hominy, rice, whole wheat bread, corn bread, milk toast, biscuits, muffins, gems.

Fats

Cream, butter, olive oil.

Vegetables

Potatoes, baked, boiled or creamed, string beans, spinach, onions, asparagus, tomatoes, green peas, all well cooked, cresses, lettuce (alone or with oil dressing), celery.

Desserts

Farina, sago, tapioca, apple or milk pudding, floating island, custards, baked or stewed apples with fresh cream, cooked fruits, rice with fresh cream.

Liquids

Fresh milk, cool, warm, or peptonised, cocoa, chocolate, buttermilk, pure water, tea, coffee, Liquid Peptonoids.

Avoid

Fried foods, salt fish, hashes, gravies, veal, pork, carrots, parsnips, cabbage, beets, turnips, cucumbers, macaroni, spaghetti, sweets, pies, pastry, sweet wines.