Nutrition in far advanced tuberculosis; a preliminary study.

This study was initiated to attack the problem of establishing nutritional balance in far advanced pulmonary tuberculous pa tients and to observe, If possible, whether a proper nutritional balance, in itself, could favorably deflect the downward course of these patients. It was evident that the invariably poor appetites of these patients should be the first point of investigation. The study of appetite has developed considerable experimental work. There is evidence that the sensation of hunger is directly correlatedwith increased gastrictone and secretions;this was evident in the fasting experiments of Hoelzel' and the x-ray observationof Barclay.2Glaessner,3in 1943,offeredexperimental evidence that gastrictone and secretoryactivityvariedinversely with blood sugar volumes. Biotner,4in 1945,found that of 70 nondiabetic adults with illnessescausing prolonged physical in activity, 63 had blood sugar findings indicative of decreased glucose tolerance.There has been evidencethat tuberculouspatientshave a tendency toward decreasedglucosetolerancealthough Kramer's study of 98 tuberculouspatients5showed only 17 per cent with such a tendency. In recentyearsa greatdeal of importance has been placed upon protein in the diet.This is especiallytrue of the influenceof protein on resistanceto infectionand repair of injured tissues. Cannon6 in 1943, postulated that a large protein reserve was neces sary to maintain proper antibody response and the phagocytic activity of mesenchymal cells. He showed that hypoproteinemic rabbits had markedly lessened ability to produce agglutinins. Madden and Whipple7 observed in 1940 that blood protein levels directly reflected tissue protein stores. Krebs8 in 1946; carefully studied the antibody response in a girl with a low total blood protein level and an extremely low gamma globulin fraction. After a full course of immunization with typhoid vaccine, she failed to develop any antibody. The maintenance of high protein levels has