Tuberculosis, particularly pulmonary tuberculosis, is an infectious disease in which the metabolism of the body is more or less seriously disturbed. One of the first symptoms diagnostic of tuberculosis is a more or less continuous fever with progressive loss of weight. This symptom is, of course, likely to be accompanied by such local symptoms as coughing, and, with the more severe onset of the disease, even hemorrhage from the lungs. Once the tuberculous infection is established, and the disease has reached the point indicated by the above-named symptoms, the situation is a serious one and requires the most assiduous attention, with a radical revision of the hygiene, with a view to making it as nearly perfect as possible.

Experience of recent years seems to indicate that about the only remedial treatment that is effective is in the direction of perfect hygiene. The two most important phases of this hygienic treatment are, first, absolute purity of air, and second, ample nutrition. The first is accomplished most effectively and satisfactorily when the patient remains continuously out of doors. If in the house at any time in the day, he should always be in a room whose ventilation is as nearly perfect as possible. Coldness of the air is rather advantageous than otherwise, and we find tuberculous patients sleeping out of doors, on back porches, sleeping balconies, in tents, on roofs, or under specially devised window awnings.

This regime of the tuberculous patient naturally requires no small amount of heat-producing food, as the draft upon body temperature is very considerable in this out-of-door life.

Furthermore, the continuous fever experienced in the earlier active stages of the disease is associated with a more or less extensive breaking down of vital tissues, as well as the consumption of the fat reserves. If this consumption of tissue is not early checked, extreme emaciation will certainly follow with a serious embarrassment of all the forces of the system in vitality, strength, and resistance. The most that physicians and attendants can do for tuberculous patients, as a rule, is to assist their physical resources in combating the infection. If this can be successfully accomplished for a few months, the chances are favorable to a successful healing up of the local infection, and a recovery more or less complete.

Next in importance and hardly less important than securing of absolutely pure air for respiration is the insuring of a large amount of food assimilation. The object of this is to make good the waste resulting from the fever; fortunately, as a rule, tuberculous patients have fairly good digestion, and so long as this condition lasts the dietetics present comparatively simple problems.

The principal problem in the dietetics of tuberculosis is to get as much nourishment as possible assimilated. Many devices have been utilized; a few years ago a popular treatment consisted in the use of inordinate quantities of milk and raw eggs and scraped or hashed raw beef. If a patient were able to take this food with a relish for a considerable time there would be no reason to criticise it. However, the fact of the matter is that most patients will find such a diet exceedingly distasteful after a few weeks and then will begin to long for other foods. Recourse must, of course, be had to other foods, and the appetite having been spoiled for milk, eggs, and raw meat, these most valuable adjuncts of the diet will have to be cut out for weeks or even months.

A very much wiser course to pursue would be to put the patient upon a general mixed diet from the first, introducing as large a proportion of milk, eggs, and choice meats as can be done with certainty that the patient's craving for these foods will not be interfered with. While it is true that whole milk is more nourishing than skimmed milk, some patients find it less easy to digest. When this is the case skimmed milk may be resorted to. However, it is wiser to try first the addition to the whole milk of limewater or such other diluent as barley water. The predigested milk, as peptonized milk, should not be used. As a general rule, predigested foods should only be used for very acute conditions, lasting only a few days.

While raw eggs are more easily digested than cooked eggs, they are so distasteful to most people that it would be much wiser to cater to the appetite than to any theoretical consideration regarding ease of digestion. We have learned in preceding chapters that the appetite is a primary consideration in the ready digestion of food. Soft-boiled eggs, seasoned with butter and salt, may appeal very strongly to an individual who would be nauseated with a raw egg. If the gelatinous white of the soft-boiled egg is masticated perhaps with dry bread until it has been reduced to a creamy consistency and actually disappears almost unconsciously from the mouth as it is thus reduced, we cannot conceive any reason why eggs thus prepared and eaten should not serve in the body the same purpose as the raw egg. As a matter of fact, the author believes that it will serve the needs of the body incomparably better than raw egg taken under protest. There are several methods of taking raw egg, which may be introduced as variety, especially if they are pleasing to the patient. Egg beaten up and mixed with milk - one egg to a half pint, and slightly flavored, as with vanilla or nutmeg - makes a very pleasing drink and may be introduced not infrequently as a variation of the diet. Light custards of milk and egg are very pleasing to most people, and when properly made are very readily reduced to a fluid state by mastication. Scrambled eggs, omelets, may also be introduced for variety, but the same precautions must be observed in their mastication as was suggested above in the use of boiled eggs.

As to meat, this should be taken very much more freely than a person in ordinary good health would take meat. While once a day would be considered quite enough for an ordinary person in good health, it is considered wise to introduce meat at least twice in a day for tuberculous patients. Care should be taken to choose the best quality of meat, whenever the patient is in a position to afford the cost of the choicer meats. The choicer cuts of steak and of mutton,, broiled, are probably the best form in which to serve the heavier meats. Chicken may be roasted or fricasseed; fish may be boiled or baked. A few years ago it was customary to reduce meats to a pasty condition by grinding, and to cook them as little as possible. The use of meat in this condition is almost certain to have the same effect on the patient's appetite after a few weeks as would the ingestion of raw egg. The meat must be cooked in order to develop in it the flavors pleasing to the average appetite.