Diet In Advanced Cases

It not rarely happens that patients who have suffered much from indigestion in the earlier stages of phthisis finally reach a condition in which, although greatly emaciated and prostrated, they seem able to eat and digest a much larger variety and quantity of food than before. As these cases are utterly hopeless, it is often best to let such patients select their own diet, providing only that it is nutritious and of a quality which does not excite cough or diarrhoea. If the bowels are not too loose, fresh fruit, especially oranges, may be allowed, and proves very refreshing.

In very advanced cases, and in all cases during acute exacerbations of severity, with marked prostration, the patient must have food every two or three hours, and the intervals of feeding should never be longer than the latter. A diet consisting very largely of milk or milk and cream is best, but broths and pancreatinised meat preparations, albumoses, and egg albumin may be added.

Milk Diet

Milk is a food which is especially adapted for consumptives, many of whom do best when living upon it almost exclusively, while others should drink it freely in connection with other nourishment. It is fattening, is assimilated without overtaxing the digestive organs, and taken hot, either alone or with an equal part of Vichy, it is soothing to the throat and ameliorates the cough.

Advanced cases of tuberculosis living upon full milk diet should take between two and a half and four quarts a day, but not over eight ounces at once. It should be sipped, or really eaten, and not drunk, for it then will coagulate by slow degrees in the stomach and not form large indigestible curds. This should be insisted upon and ten minutes should be occupied in drinking half a pint. If the milk disagrees at first it may be modified in any one of the ways suggested on p. 74, but it is best not to give it in connection with beef juice.

In this country cow's milk is preferred, but elsewhere the milk of other animals serves equally well. Goat's milk, drunk largely in Switzerland, contains more salts of lime and is good for cases of tubercular diarrhœa, and sometimes ass's or mare's milk proves more digestible. The latter varieties are principally used in Russia.

Lebert's Milk Cure (From Bauer)

"Lebert directs the patient to drink slowly three hundred to five hundred grammes of milk every morning and evening between five and six o'clock, fasting. He prefers it freshly drawn from the cow, and if, in consequence of having stood for some time, a separation of the cream has already begun, recommends it to be skimmed off.

"During the continuance of the milk treatment the patient is allowed a substantial dinner, at least of soup, roast meat, young vegetables, stewed fruit, etc., and a little beer or wine. At the discretion of the physician a proper breakfast may be taken an hour after the morning's milk of a cup of tea with plenty of milk and biscuits and, perhaps, one or two light-boiled eggs, and again in the evening a good soup, as well as, when possible (i. e., in the case of non-febrile patients), some more roast meat. If milk is well borne, the regular breakfast and supper may be supplemented by further doses of one hundred to two hundred grammes of milk".

Whey or koumiss may be drunk instead of milk. For those who can digest it, cream is an excellent food. With some patients cream diluted with an equal bulk of hot water agrees even better than milk. The taste, if complained of, may be modified by a very little tea or coffee, or salt or sugar. Yeo sometimes adds a tea-spoonful of rum or brandy or aromatic spirits of ammonia. Some patients can take a quart of cream besides a quart and a half of milk per diem with profit.