A meat diet is specially recommended in tuberculous affections. In 1889 C. Richet and Hericourt experimentally proved the value of a raw-meat diet in tuberculosis in dogs, and showed that the benefit was derived from the muscle juice and not from the muscle fibre (zomotherapy). The method of preparing meat juice is described on p. 77. A recently introduced muscle juice, Carnine Lefranc, is a valuable meat-juice preparation. It has an agreeable taste; it keeps well, and may be given in doses of from 1 to 4 ounces daily in any fluid except beef-tea. The special value of meat juice and of other proteins in the treatment of tuberculosis is fully described in Chapter XXV (Tuberculosis).

Many years ago a meat and hot-water diet, commonly known as the Salisbury treatment, was recommended by Dr Salisbury for the treatment of chronic gout, obesity, chronic gastro-intestinal derangements, and other disorders of nutrition, which were attributed by Salisbury to abnormal carbohydrate fermentation. In its strict form the treatment consists in the daily administration of 1 to 3 lbs. of meat with 3 to 5 pints of hot water, for a period of four to twelve weeks. The treatment aims at thoroughly cleansing the stomach before eating, by giving a pint of hot water an hour and a half before each meal and at bedtime. If the water is drunk slowly, the stomach will not be distended and the patient will not experience any sense of discomfort. The slightly nauseating taste of plain hot water may be overcome by the addition of ginger, lemon juice, or weak tea, and in cases associated with intense thirst the addition of a little nitrate of potash makes the water a more efficient thirst-quencher. If constipation is present, a teaspoonful of magnesium sulphate can be added to the water. A cardinal point in treatment is to observe the specific gravity of the urine and regulate the amount of water taken accordingly. If the urine gets persistently below sp. gr. 1010, the patient becomes markedly asthenic, and the amount of water should be considerably reduced. The specific gravity of the water should be kept between 1012 and 1015. The chief article of diet is finely minced steak, which allows the patient to get the maximum of nitrogenous food with the minimum of digestive work. At first the patient begins with lean meat of beef in mince or cakes. If unable to assimilate solid food, other preparations, Carnrick's liquid peptonoids, peptonised home-made beef-teas and essences, Wyeth's beef juice, Brand's beef juice, Oxo, and Carnine Lefranc may be used instead. Gradually the patient begins to take lean mutton cakes and the white meat of chicken. The white of an egg, raw, lightly boiled, or poached, is also allowed. The following directions will be found useful in the preparation of the meat cakes.

Lean Meat Cakes

The beef should be taken from well-grown animals, and steaks cut from the centre of the round are the best for this purpose. The beef-pulps can be prepared in the following manner. All the fat, fascia, and connective tissue and bone are removed, and the meat is placed on a board or in a chipping tray, and is shredded down with a blunt knife; the pulp is then scraped together with a spoon; the result is that all the tough fibrinous parts remain behind. The scraped pulp is lightly moulded by the hand into cakes from 1/2 to 1 inch thick, and slowly boiled over a clear fire free from smoke. When cooked, serve on a hot plate with a little butter, and season to taste with pepper and salt. The flavouring may be varied by using Worcestershire or Halford sauce, mustard and horse-radish, or lemon juice. A small quantity of dry celery is also permissible, from 4 to 6 ounces of meat is the maximum that can usually be taken at a meal at the outset of treatment; later 8 to 10 ounces or more may be taken by some patients. Four meals should be taken daily.

Oysters are a welcome addition to the monotony of the diet, and may be prepared as follows: -

Oysters - Panned

Take 6 deep-sea oysters, place them in a colander and pour cold water over them. Drain for ten minutes. Place the oysters in a very hot iron pan, add salt, pepper, a small piece of butter, and a teaspoonful of meat stock. Cook for a few minutes, and serve the oysters garnished with a thin slice of lemon.

Oysters - Broiled

Take 6 large oysters. Lay them on a board and dry them, season with salt and cayenne pepper. Have a gridiron thoroughly heated, place the oysters on the gridiron and brown them on both sides. Place the oysters on a very warm plate, and pour round them a little heated beef juice and a little melted butter.

Crusts of stale bread, unsweetened rusks, and protein biscuits, e.g. Kalari (p. 476), are the first foods added to this dietary.

Great care and consideration are called for both in the recommendation of this diet and the best means of giving effect to it. Some time ago the writer saw a patient who came to him complaining of intense weakness and loss of flesh, consequent on a course of treatment lasting nine weeks, carried on "by correspondence." The patient had been instructed to take a moderate amount of exercise, including golf, but was greatly surprised to find that not only was exercise impossible, but at times she had hardly strength to stand. Special care has to be taken in the case of stout subjects. The very strict.Salisbury regime is in the author's experience seldom necessary or advisable, but a modified Salisbury dietary (sec infra) is of great value in some cases of indigestion and chronic auto-intoxication associated with it. A regime like the following will be found of great value in such cases.

While the nutritive value of this diet is comparatively small, it amply suffices for the short time in which the diet is necessary. Its use effects a profound improvement in the state of the intestinal excretions, and a corresponding improvement in digestion as a whole.

Modified Salisbury Diet

7 A.M.

8.30 A.M.

1/2 pint or more hot water.

4 to 6 oz. meat rissoles.

2 Kalari biscuits (p. 476) with a little butter.

Small cup of very weak tea.

11.30 A.M.

I P.M.

1/2 pint or more of hot water, flavoured with lemon if desired.

Breakfastcupful of beef-tea with 1/4 lb. scraped meat (see beef puree, p. 77).

Thin slice of baked bread or dinner toast (p. 93).

Half a dozen oysters as above (see also p. 305); or

Consomme with custard (p. 272); or consomme with egg (p. 272), with baked bread or toast.

3 P.M.

4.30 P.M.

1/2 pint or more of hot water.

Breakfastcupful of skimmed milk, to which is added a full table-spoonful of Carnine Lefranc or other meat juice ; or

Plain egg flip (p. 48) flavoured with cinnamon in place of sugar.

Unsweetened rusk or crisp biscuits.

6 P.M.

7.30 P.M.

1/2 pint hot water.

4 to 6 oz. meat rissoles or mince, followed by an egg jelly (p. 302) in which the sugar is reduced in amount ; or a blancmange made with milk in place of cream (p. 301).

The above regime should be maintained for ten clays to a fortnight, after which additions in the form of steamed fish, chicken, malted breads, green vegetables, jellies, and fruit can be slowly made. The return to ordinary farinaceous foods must be made very gradually, preferably starting with the invalid foods (p. 183).