The bacilli-laden sputum, if swallowed, is apt to produce disorders of the stomach. This still further complicates the question of digestion.
Malnutrition, because of these derangements, increases the unfavorable outlook for the patient in this disease. Hence the diet, especially in chronic cases, is of great importance.
When means are ample, the question is much simplified, because by travel, change of scene, and pleasant surroundings the appetite is stimulated and greater variety in the diet can be gained. For those in moderate circumstances, save when free sanatoriums exist for the care of the tuberculous, it is most difficult to keep the diet from becoming monotonous and wearisome.
The appetite, especially in young people, is apt to be capricious, and it is important that the food be served daintily to tempt the patient to eat.
Growing children crave sweets and as these furnish energy they may be allowed to tuberculous children, in moderation, if they seem to be well assimilated. Any interference with digestion, however, must be guarded against.
It is better to give food in smaller quantities and oftener in order to guard against disturbed digestion from overloading the stomach. For this reason also it is better to give the heartiest food during the forenoon when the temperature is lowest.
Milk, butter, cream, olive oil, bacon, and cod-liver oil furnish the fat needed by the system in the most easily digested form and should be taken freely, if there is no irritation in the stomach which will prevent their assimilation. Variation in their use will often secure greater tolerance.
In chronic cases in which there is little or no fever, the fats are generally well assimilated and are beneficial.
The disease causes great wasting, and fats are especially important in counteracting this tendency. They may be given in alternation or be omitted from the diet for a day or two to avoid turning the patient against them.
If diarrhea exists fats must be given guardedly and if fats produce diarrhea they must be lessened or omitted until the diarrhea is controlled.