Fats And Oils

Fats and oils are indicated in tubercular disease, and especially in pulmonary phthisis, in as large amounts as the patient may be able to digest. Crisp fat bacon, butter, cream, whole milk, egg yolk, cod-liver oil, and olive oil all furnish desirable forms of fat when the intestine absorbs them. Russell's emulsion of mixed fats is a very digestible preparation by which to administer this class of food.

While fat is being taken it is well to occasionally observe the stools to see that none passes away undigested, and if any one fat disagrees and causes dyspepsia its use must be restricted, or temporarily withheld while another is tried. As a rule, cream butter and cod-liver oil will prove the best. If a patient can take one quarter pound of butter a day it furnishes about one half of the necessary heat units. Fats, well digested, seem in some instances to have an almost curative power, so greatly do nutrition and body weight improve during their use.

Cod-Liver Oil

The use of cod-liver oil in phthisis should be determined by the condition of the digestive organs and the general nutrition of the patient. Wherever the digestion is fairly good, in the absence of gastric catarrh, the oil is of great nutritive value, and it is usually well borne when properly administered. If there is much gastric catarrh, or if the stomach is irritable and nausea is easily excited, persistence in the use of the oil will only make matters worse. It should be at least temporarily discontinued, though in the chronic forms of tuberculosis unaccompanied by fever, in which debility and emaciation predominate, cod-liver oil is often well tolerated. It is on the whole more satisfactory for children than adults, particularly in cases of tuberculosis in which the bones or glands are enlarged.

The presence of diarrhoea is to be regarded as a contraindication for the administration of cod-liver oil, but unless it is given in large quantities it has very little if any laxative effect upon adults, and it may usually be continued in doses of a drachm two or three times a day, with no ill effect, and, in fact, by improving the nutrition it may sometimes benefit diarrhoea. Ringer suggests that for this class of patients a teaspoonful or more of the oil given at night before sleep may be better borne than at any other time in the day.

Commonly it is best to give the oil pure and uncombined if it can be tolerated. It may be given in capsules, although they are not always dissolved at the proper time in the stomach. Patients who require alcohol may take the oil in whisky. For the many different methods of administering it and of disguising its taste the reader is referred to the section on Cod-liver Oil (p. 204). The isolated active principle of the oil, called gaduin, has been employed with some degree of success (p. 203).

Alcohol

Alcohol is not believed to possess any specific action in phthisis, and in many cases it is positively harmful. As a rule, if patients have a fair appetite and are improving in strength its use is contraindicated. When alcohol is required as a food and tonic rather than as a stimulant, the best form in which to give it is that of malt liquor or light wine. One or two pints daily may be prescribed of beer, stout, or porter, or half a pint of claret or sound Burgundy is useful if anaemia is marked. The light Hungarian, Italian, or Greek wines may be used by those whose purse places them within reach. One of the Tokay wines, with cocoa, may be prescribed. Sweet wines, sherry, port, Madeira, and champagne are not as useful. They are liable to disagree and cause dyspepsia and headache.

The promiscuous habit of daily drinking rum, whisky, or other strong liquors in tuberculosis is to be condemned.

No class of patients exhibits more painfully and rapidly the inroads of the disease than those who for a long time have been hardening their own tissues, like pathological specimens, with daily draughts of strong alcohol. The cirrhotic changes which occur in various organs are the best possible preparation for the advancement of tubercular processes. If the exhibition of alcohol increases the temperature and the pulse rate, and is followed immediately by greater weakness, it is doing harm. Advanced cases of tuberculosis show great toleration for alcohol, but it does not follow that it is proportionately benefiting them. When in the course of an ordinary case the hectic fever becomes high and exhausting, the pulse feeble and rapid, and the digestion fails, it may be best to lessen the quantity of food and give more stimulation. Usually three or four, but seldom more than six, ounces of whisky, brandy, or rum may be required daily for this purpose. Special pains should be taken to use only such liquors as are strictly pure and of the best quality.

Diet In Mild Cases

The following liberal menu will furnish abundant variety from which to select the dietary for tubercular patients in whom the progress of active lesions is in abeyance or completely arrested, and in whom there is little or no gastric catarrh. Patients should eat all they can digest, especially of milk, eggs, and butter, and should allow five hours' interval between meals.