Illustrating Dr. Paquin's paper on The Nature and Treatment of the Dyspepsia in Consumptives. Fig. 1. Normal stomach. Line drawn at level of umbilicus. Illustrating Dr. Paquin's paper on The Nature and Treatment of the Dyspepsia in Consumptives. Fig. 3. Found in stomach content in case of ischochymia of a dilated stomach in a consumptive. Case A. C., 1896. Paul Paquin. A-bacillus of tuberculosis. B-starch grains. C-cocci. D-vegetable cells. E-partly digested muscle fibre. F-sarcina. G-yeast cells. H-fat globules. I-streptococci. J-crystals of fat. K-epithelial cells. he cools off systematically and gets neither clammy nor chilly and is not caught by a cold because his skin is not in a stew. This adaptation to the changes of temperature seems to me sensible and insures one, sick or well, as far as possible, against dangerous changes of the body's temperature. But if he has on thick underwear, by ten o'clock he is sweaty. He takes his overcoat off. By ten thirty he is clammy; by ten thirtyfive his nostrils are stuffed with mucus; by eleven o'clock, if already susceptible, his chest is influenced for the worse. So, I would say that light underclothing, and seasonable outer clothing, as a general measure of treatment for the disease under discussion, are recommended, as I should recommend them as a general practice for anybody under any condition in all seasons of the year. The question of diet is of paramount importance, and it is most difficult to control it properly. To begin with, let us keep in mind that it is not the quantity of food swallowed that nourishes, but its quality first, and a certain amount of it properly digested, absorbed and assimilated, and that the primary duty in eating is thorough mastication. Hence, in tuberculosis with the usual digestive disorders, the theoretical teachings occasionally promulgated, advising to feed and feed and force feed patients, is not always a safe policy, even in wasting conditions. Much of the food ingested in forced feeding injudiciously, not only goes to waste, but creates besides more or less serious disturbances of the alimentary tract. In the dyspepsias under consideration we must first of all determine if possible what the gastric juice and the other digestive elements can properly digest and render fit for assimilation. This is in a measure practicable by persistent analyses after specially adapted test meals, and by observations of the patient and inspection of intestinal excreta. After this, one is better prepared to diet the patient. It were impossible to give here more than a general outline of the most useful dietetics. For special application of each, one must understand the special conditions of the alimentary canal in each individual. As a rule, cooking plays a very important part on the digestibility of food. Certain processes of cooking too often render indigestible articles of diet other wise good and nutritious. We may lay it down as a principle that the most easily digested nutriment in the smallest bulk and leaving the least residue in the alimentary canal, should underlie the diet of dyspeptics, and that broiled, boiled or baked meats are preferable to those prepared by any process of frying or any fancy method. In the list of proper dietetics may be mentioned sweet milk, butter milk, cream, mutton, beef, poultry, certain kinds of fish, oyster broths, clam broths, mutton and beef broths, and bouillons. Few vegetables are admissible, particularly if they contain much cellulose. As a rule, potatoes baked or mashed are the safest; and peas or beans devoid of their shells may be taken sparingly. To facilitate the digestion of meats they may be deprived of their coarse fibre and broiled in the form of meat balls. Fats, except butter, grease and oily fish should be excluded, and nothing fried or greasy should be permitted, except possibly bacon, which, singularly enough, is often relished and well borne by certain tubercular dyspeptics. Meals should vary in style and appearance and nature as much as possible, in order to tempt the appetite, remembering that any food not wanted by the patient does not force the secretion of gastric juice to anything like sufficient for digestion. In aggravated cases it becomes necessary quite frequently to resort, temporarily at least, to special measures of feeding. Among these is the use of raw beef juice, freshly obtained mechanically from sound, uncooked beefsteak. The increase of strength and general improvement that follow this practice. is often remarkable, even in patients involved in extensive tubercular developments. I have such invalids under charge now consuming from four to six pounds of roundsteak per day in the form of juice extracted by a specially contrived meat press. Unfortunately the meat presses usually available are partial failures, for they are too fragile and usually extract less than 25 per cent. of the meat, making this kind of feeding expensive. So far, what is termed the "Hayes press," which is made to order after a pattern from a physician, is the only one I have found that extracts nearly all the juice of beef. Another special method of nourishment consists of egg albumin in its raw state. From one to a half dozen whites |