Consumption The milk diet has, in my experience, been used more by consumptives than by any other class of invalids. This is partly due to the greater prevalence of tuberculosis and partly to the fact that the immediate gain in weight appeals to them. All consumptives know that a decrease of weight nearly always means an increase in the disease; conversely, they believe increasing weight indicates a gain in health. Of far greater value than the mere increase in weight is the improvement in the blood, both in quantity and quality, and the changes in the lungs it brings about. In addition to the increased capacity of the lungs previously spoken of, there are some characteristic reactions which always occur in pulmonary tuberculosis. Many people contract consumption and are completely cured simply because their vitality is strong enough to overcome the germs. Just as soon as a consumptive has sufficient blood to prevent the wasting of the tissues, the loss of weight stops, and on a further increase of the nutritive fluids, the healthy cells are so strengthened as to prevent any extension of the disease. Next follows in natural order the recovery of the affected cells, or the development of new ones, and the elimination or absorption of the germs. Almost every case of tuberculosis with consolidation of lung tissue, starting in on the milk diet, has a coughing crisis, generally about the end of the first week. The cough and expectoration greatly increase as the consolidated portions of the lung loosen up and air enters the cells which have been filled up with the products of the disease. The cough is easy and the sputum comes up from the lungs readily, while previously the cough may have been hard and ineffective. Most of the authorities on tuberculosis include amount the first signs of improvement a decrease of the cough and expectoration. This may be the case in a dry climate on an ordinary diet, because the inflammatory products would be gradually absorbed and largely eliminated through other channels or perhaps even made over and used in the system. Probably this process also occurs to some extent in this treatment but I have seen almost a quart of sputum come from a patient in twenty-four hours at this time. Later on, of course, the coughing and sputum decrease. On physical examination at this stage the air is heard entering the previously solid portions of the lungs and as the air cells become cleared out, the breathing sounds become normal. In cases where cavities have formed from the breaking down of the consolidated area, sounds are heard later on, indicating the hardening of the walls of the cavity and cessation of the extension of the disease. After another period of time the cavity may decrease in size. I have observed cavities as large as a sugar bowl become cleared out and firm walls formed around them and years after have noticed a sinking in of the chest walls and almost complete obliteration of the cavities with normal lung tissue around them. Air is more important to a consumptive than to any other invalid. In my opinion it does not matter what kind of air so long as it is pure. If the condition is serious you must stay in the open air day and night. Keep out of rooms, churches, theatres, cars, or any crowded place. Under ordinary hygienic treatment many cases have been cured at high altitudes, others in the Salton sink below sea level, others on long sea voyages or on sea islands, others in the dry air of Arizona and others in the moist air of Cuba and Florida. On a milk diet or not, a third stage consumptive who has regained his health in a certain climate should stay there. The lung tissue built up on a Colorado mountain will not long stand the air of New York City. Many, many cases that come to Arizona and get “cured,” return to other States to live, and after again losing health, come back to Arizona. But the “cure” seldom works the second time, never the third. I say to you, pick out a place where you are satisfied to live and when you regain your health you can remain there and retain it. One thing I wish to caution third stage consumptives about. There is only one possible danger to anyone taking the milk cure and that is the rupture of an artery or aneurism from the increased blood pressure. I heard of a patient who had an aneurism or blood tumor caused by a wound of the large artery of the thigh and on beginning a milk diet the pressure of the blood ruptured the aneurism causing a fatal hemorrhage before medical aid could be summoned. The same danger would be present after a major surgical operation, and is well understood in hospitals, where such patients are given very little fluid for some days after the operation. I do not believe this danger would be present with an aneurism caused by disease of the artery, because the new blood would rapidly strengthen and restore the weakened walls. I would not hesitate to apply the milk diet to such a case, beginning it rather gradually and should confidently expect a complete cure, but such patients must have complete rest for several weeks. I can imagine a patient with a cavity in the lung crossed by an artery, whose walls are eroded and weak, which might break and cause considerable loss of blood. Out of several hundred lung cases I have never heard of any serious hemorrhages; but where cavities are suspected to exist, the beginning of the diet should be gradual, commencing with, say, three quarts and increasing one glass daily until the regular amount is reached about the third week. There may be small hemorrhages from capillary vessels which are extending into the diseased tissues, where the circulation had previously been absent, but they amount to nothing. They soon close and the loss of blood is not noticed where it is being made so rapidly. Bleeding from the mucous membrane of the nose and throat may also occur where there has been a catarrhal condition, but it is always slight and never harmful. Those living in high altitudes and subject to hemorrhage should always begin milk gradually.