This most frequently takes the form of tuberculous peritonitis, tuberculous ulceration of the bowel, or tuberculosis of the lymphatic glands (tabes mesenterica). The infection comes from the intestine or from the thoracic glands through the lymph channels. The great majority of cases occur after two years of age. The symptoms may be slight, such as a general lassitude, and some anemia; in other cases wasting is a prominent feature; and in some cases diarrhoea, with the passage of blood and mucus, may have attracted the attention of the parent. Some degree of irregular temperature with slight pyrexia is frequently present. When the condition becomes well marked, abdominal distension is the chief feature, this arising from flatulent distension, atony of the bowel, and often catarrh and ulceration of the intestine. These conditions make the dietetic treatment one of some difficulty.

The special point to be attended to in the dietary is the necessity of the utmost care with regard to the administration of any of the readily fermentable foodstuffs. Bread and milk foods and farinaceous puddings are quite unsuitable for these patients; too often these enter largely into the dietary. The bowels should as a preliminary be judiciously emptied by a dose of castor oil, given two nights in succession. If there is loss of appetite, with pain, the food should for a day or two be restricted to meat soups, chicken jelly, mutton, veal, or chicken tea, which can gradually be strengthened by the addition of Plasmon, Sanatogen, and raw-meat juice. It should be noted that diarrhoea is not a contra-indication to this diet, the looseness of the stools usually resulting from ulceration of the bowel or from fermentation of starchy foods. As soon as the patient can take it, more solid food is given in the form of pounded fish, or chicken, white of egg, and thin slices of toast or rusk. In patients whose appetite at night is deficient on account of the evening temperature, it may be advisable to give fluid food only at night, reserving the solid food for the two earlier meals. When the appetite is restored it is better to give three meals a day only, and nothing but fluids between meals. In cases with feeble digestion and appetite, the more frequent use of smaller feeds is indicated. The following is an appropriate diet for a case of abdominal tuberculosis in a child, in whom the appetite is satisfactory: -

7 a.m. - Glass of milk and a Plasmon biscuit.

8 a.m.: Breakfast - Milk; scrambled egg or steamed fish; toast and butter.

11 a.m. - 8 ounces meat soup, with juice from 1/4 lb. raw beef.

I p.m.: Dinner - Red meat, broiled or roasted, hot or cold, clear gravy; small helping of well-cooked vegetables, not potatoes; slice of dry toast. Custard, hot or cold; curds and cream; cream or blancmange, in preference to starchy or suet puddings.

4.30 p.m. - Glass of milk and a biscuit.

Supper

Milk to drink.

Fish, egg, or chicken.

Slice of toast.

Fatty foods, such as cream, yolk of eggs, and cod-liver oil and malt, are gradually added to the dietary. An examination of the state of the stools and a consideration of the symptoms will guide us in increasing or otherwise the amount of food administered.