A portion of salmon or roast ham is about equal to two and one-half eggs, but smelts and brook trout are very low in value. Raw oysters and clams are about equal, and twelve oysters contain the same number of calories as one egg. Soups, unless creamed, have a fairly low value and ten tablespoonfuls about equal one egg. Creamed soups are two to three times as valuable. Potatoes, white or sweet, green peas, mushrooms, corn, macaroni, boiled rice, oatmeal, are all valuable. Beets, cabbage, cauliflower, celery, cucumbers, parsnips and turnips have very much lower heat values. Bananas, grape fruit and grapes are high among the fresh fruits, and figs, prunes, dates and apricots, among the dried. Whole wheat bread is but little more valuable than white bread and less so than brown bread, gingerbread, frosted or layer cake. All pies have a high value, as well as bread and custard puddings. French dressing is one-half as valuable as mayonnaise or hollandaise. Nuts contain many heat units. Most drinks such as tea, coffee, cocoa, lemonade are valuable on account of their added ingredients.

We have now seen that the relative heat values of food vary between wide limits, but we must not forget that many other factors enter into diet. Protein, we have seen, is necessary for growth and repair. Inorganic salts, which are vital for life processes, occur in vegetables with slight heat value. Other compounds, some

already described, and probably others as yet undescribed, play an important role in nutrition. Lastly, in the choice of a diet, individual taste must often be the deciding factor, and foodstuffs of low heat value are often digested and assimilated by patients far better than others apparently more appropriate for their needs. Nor must it be forgotten that the diet must be well balanced, and only the patient's physician can do this skilfully.

In health the appetite is a safe guide to follow, but in disease when the body needs food most, the stomach craves it least. It is an old adage among patients with tuberculosis that they should eat once for themselves, once for the germs and once to gain weight. They meant by this that the diet should be greatly increased, and not only must three good meals but six glasses of milk and six raw eggs be swallowed every day. For many years it was thought that however well the patient might be eating at his meals, the milk and eggs must also be taken. Looked at from an economic standpoint, in many instances, this was a woeful waste. Let us see what the patient wishes to do. He has, for example, lost weight and his usual weight is about ten pounds below what a man of his height and age should weigh. His first object is to regain his lost weight, and his second to approximate or slightly exceed his normal weight. To do this he must eat, and the scales tell the

story. The tendency is to overeat and the desire to gain weight quickly is strong, but the struggle is to be a long one and no organ must be impaired. Everyone who knows anything about a motor knows that too much gasolene decreases the efficiency of the engine and clogs it with unburnt carbon. A certain quantity of gasolene enables the engine to do its greatest amount of work, more gasolene decreases the amount of work. So it is within limits in the body. When more food is eaten than can be assimilated the excess may undergo putrefactive changes in the intestines, and far from helping, hinder the body in its struggle against disease.

The rule for the man underweight should be to eat as little food as he can in order to gain weight.

Three good meals a day, two or three glasses of milk (with or between meals), one or two eggs a day, cooked or raw, are often sufficient to add enough to his weight to bring him the gain wished for. As soon as this is brought about he should consider his stomach and dispense with eggs and milk. Sooner or later he will fall ill with a cold or acute bronchitis, lose a few pounds in weight, and can then, by adding milk and eggs to his diet, quickly regain his lost weight. Such a method will reduce gastric and intestinal disturbances to a minimum. There are no more difficult problems in the treatment of pulmonary tuberculosis than

to make some patients gain weight and to help others to avoid digestive disturbances. Such subjects of course cannot be discussed here and must be taken up with the patient's physician. It might be added, however, as Hippocrates has said, that it is easier to fill up with drink than with food, which means, in other words, that when a patient has completely lost his appetite and cannot eat, he can often take, and take easily, liquid food which he can drink without chewing. Such a diet without even a cracker to chew often restores a lost appetite.

The pernicious habit of eating candy at all hours, without regard to the meals, needs only to be mentioned to be condemned. A little candy after meals or even at bedtime is, however, well borne by many patients.

III

ON ALCOHOL AND TOBACCO

"Abstinence is as easy to me as temperance would be difficult."

ON ALCOHOL

THE value of alcohol in the treatment of tuberculosis is very slight, if any, and the danger from its use very great. Its use in the treatment of pulmonary tuberculosis dates back many years. In 1680 Richard Morton advised such a patient to "forbear wine and other spirituous liquors, but especially a debauch and a surfeit proceeding from overcharging the stomach with them." Nearly one hundred years later, Reid absolutely forbade them, and this at a time when drinking was very common. Brehmer, the founder of the sanatorium idea, advised the systematic use of alcohol and his pupil, Dettweiler, also used it in limited quantities. Curiously enough, alcohol is used in the treatment of pulmonary tuberculosis in the private sanatoria in Europe today more freely than in any other part of the world. Since the death of the late Dr. Austin Flint, of New York, who advised for a time the free use of whisky in pulmonary tuberculosis, no great student of tuberculosis in America has advocated its use.