Dancel devised a diet in which the amount of fluid ingested was much reduced, on the assumption that excess of fluid increased corpulence. He only allowed from 6-12 oz., gave purges, ordered much exercise, and abstinence from fatty and farinaceous foods. There is no doubt that the amount of fluid should be limited, but not very rigidly. Limitation does not affect the metabolism of fat. The interdiction of fluid at meal times leads to less food being taken, because mastication takes longer and the patient is more easily satisfied. It may impair appetite unduly. Liquids with food dilute gastric juice and may affect protein digestion. From \\ to 3 pints may be allowed in twenty-four hours, and it should be reduced to the smaller amount, if possible without injury. Small quantities at meals and a glassful night and morning are satisfactory amounts. The quantity must not be unduly reduced if the weather is hot and there is much sweating, or if a large amount of protein food is taken. Strict limitation is valuable if the circulation is feeble in chlorotic and hydraemic cases, and for the sake of the mental effects at the commencement of treatment. Saline, alkaline and effervescent drinks, unsweetened : hoc weak china tea, coffee; and occasionally cocoa, are admissible drinks. Alcohol should not be given unless there are special indications, such as an enfeebled circulation and general debility. It is a fat sparer, causes deficient oxidation and favours fatty degeneration of protein tissues. Dry hock, Moselle and claret are the most suitable wines. Sweet wines and malt liquors are not permitted, and spirits in only small quantities.

Subsidiary Methods

Saline cathartics and the aperient waters of various health resorts, such as Kissingen, Homburg, Marienbad and Carlsbad, act chiefly as starvation cures. They are often useful at the beginning of treatment in plethoric patients. Many of these keep well for years on an annual course of spa-treatment. The peptones and fats are evacuated before full absorption has had time to take place. Unfortunately the effects are rarely more than temporary, for the patient feels weakened by the drain on the system, is often sent to a bracing place to recover, and builds himself up with a liberal diet. In the hydraemic cases, kept in bed, moderate purgation is useful.

Bed treatment is essential in the hydraemic patients, in many anaemic ones, and when the calorie value of the diet is suddenly much reduced, especially in the milk cure. Estimations of the number of red cells, the haemoglobin and the specific gravity of the blood serum will assist in the diagnosis of the progress of the case. Thyroid treatment is only justifiable when there is evidence of myxoedema. It may cause toxic symptoms. On account of it increasing N-excretion, it is dangerous except as a temporary measure. It should never be relied on as a substitute for diet.