from common experience that starch alone cannot meet the requirements of the system in reference to this class of food. The dietary just recommended supplies nearly 3 oz. of butter in the milk, and this added to the butter eaten with the bread, would amount to 5 oz. daily. The meat, when well fed, offers upon the whole beast from 25 to 50 per cent. of fat, so that with 6 oz. of fresh meat we shall supply about 2 oz. of fat, giving a total daily supply of fat of 7 oz.

The essential consideration in the dietary for patients in early phthisis is abundance of nitrogenous and fatty foods, with such an addition of starchy foods as may be necessary for admixture with the fat, and this we would in the most serious manner urge upon the attention of all having the charge of such cases. There are, doubtless, many other articles of food which enter into ordinary dietaries, and which might be properly introduced into this one, besides these now indicated; and amongst these we may mention gelatin, isinglass, Irish moss, and various modern preparations of grain, as corn-flour and semolina.

There is a prevalent belief amongst scientific men that gelatin does not aid in the work of nutrition. This has been derived from the results of the inquiries of the "Gelatin Commission" in France, which showed that animals could not live on bones, however well prepared; and also from the observations of many physiologists, that as the excretion of urea is greatly increased after the ingestion of gelatin, it implies that

the gelatin did not enter into the composition of the tissues, but was transformed in the blood, and emitted as urea. We think that it would not be difficult to adduce arguments against these views, and particularly the facts that in our experiments gelatin caused as large an emission of carbonic acid as followed the employment of flesh meat, and also that nitrogenous matters have two actions which are useful in the economy, namely, that of forming nitrogenous tissue, and of exciting vital action. The last action cannot be denied to gelatin, however much we may question the former; and hence, whilst we do not attach such value to the use of gelatin as would warrant us in including that food in our scheme of dietary, we believe it to be a useful adjunct. Iceland and Irish moss act by their mucilaginous property, and are therefore rather medicinal than dietetic substances. We believe that the use of the new farinaceous preparations is of much value.

We do not attach importance to the employment of alcohols as articles of food under ordinary conditions, but we cannot doubt that there are circumstances in which these are called for. If we consider that alcohol is the chief component of these fluids, we cannot employ them under the heading of these observations, viz., the increase in the supply of food, for it is impossible to affirm that it is a food in the ordinary acceptation of that term. There are doubtless some elements in ales which supply a small amount of nutritive material, but with the conviction which we have endeavoured to establish that alcohol is not transformed in the

system, we cannot extend the same remarks to spirits, and only in a very small degree will it be applicable to wines. But we have shown* that indirectly this class of substances exerts a large influence over nutrition, and we purpose to describe this action when considering the mode of increasing vital action.

It will be remarked that we have not admitted tea as an article of dietary for consumptives, whilst we have recommended the use of coffee and chocolate. The reason for this omission is the power which tea possesses of increasing the action of the skin, and whilst there may be some cases in which this action would not be injurious, we believe that in the majority the tendency of it would be hurtful. Coffee and chocolate have an analogous action over the respiratory function, and over nutrition, whilst they lessen rather than increase the action of the skin.

It is not unusual to recommend fish as an article of dietary in this class of cases, but we submit that in the cases in which the appetite fails somewhat, and it is desired to increase nutrition, it is much more useful to give animal flesh, with its rich juices, which offers a larger amount of nutriment in a smaller volume, and to add to it the combination of nitrogenous and hydrocarbonaceous compounds found in milk as the diluent. Without offering any very strong objection to the use of fish, we think it better to avoid it, and to supply a stronger food. There are but very few cases in which the appetite refuses a moderate quantity of flesh meat,

* Lancet, 1861; British Med. Journal, Nov. 16, 1861.

and in which the free use of milk will not form a better substitute than fish.

The two general rules to be obeyed in supplying food are, to offer the largest amount of nutriment both nitrogenous and hydro-carbonaceous in the smallest bulk, and to supply it in small quantities at short intervals.

CHAPTER XXVIII.

INCREASE THE VITAL ACTIONS.

GENERAL OBSERVATIONS.

We have in a former part of this work shown that in many cases of early phthisis there is a small increase in the rate of pulsation and respiration, and when this is considered in connection with the emaciation which in some degree occurs, it may appear to contra-indicate an increase in the vital actions, as a remedy in that disease. But we venture to affirm that this wasting of the body is no evidence of increased vital action, but rather on the contrary indicates a diminution of that vital force by which tissue is formed and the due bulk of the body is maintained, and it has long been admitted that increase in the rate of the action of the heart is per se evidence of feeble vital force. Hence, as the condition met with in early phthisis is truly one of lessened vital power, the increase in these actions which indicate vital power and which also maintain it, must be called for.

There are two effects of vital action which embrace all that we would affirm under this head, viz., the increase in the heat of the body, and the deposition of tissue material.