Tea

Two or three ounces of fruit; one kind of pastry; one cup of tea.

Supper

Three or four ounces of lean beef or fish; one or two glasses of red wine.

At Bed-Time

Grog without sugar (whisky and water, or rum and water), and one or two glasses of sherry or Bordeaux.

"Bantingism," to be effective, must be most closely followed, when, unfortunately also, it proves extremely debilitating; it is suitable only for sturdy, hard riding gluttons of the Squire Western type. The patient rapidly loses strength as well as flesh, and speedily acquires an unconquerable repugnance to the dietary. Further, from a strictly physiological point of view, the quantity of meat is greatly in excess, while with the cessation of the regimen, the fat quickly reappears.

Next Ebstein formulated a dietary that is certainly much better tolerated than that of Harvey and Banting, and yields as good, or even better, results. He allows patients to take a definite quantity--two to two and a half ounces-of fat daily, in the form of bacon or butter which, theoretically at least, offers several advantages: It diminishes the sensations of hunger and thirst, and plays a special role with respect to the albuminoids; the latter may thus be assimilated by the economy without being resolved into fat, and thus the adipose of the organism at this period is drawn upon without subsequent renewal. The following is the outline:

Breakfast

At 6 a.m. in summer; 7:30 in winter:--Eight ounces of black tea without either milk or sugar; two ounces of white bread or toast, with a copious layer of butter.

Dinner

2 p.m.:--A modicum of beef marrow soup; four ounces of meat, preferably of fatty character; moderate quantity of vegetable, especially the legumines, but no potatoes or anything containing starch; raw fruits in season, and cooked fruits (stewed, without sugar); two or three glasses of light wine as a beverage, and after eating, a cup of black tea without sugar.

Supper

7:30 p m.:--An egg, bit of fat roast, ham, or bacon; a slice of white bread well buttered; a large cup of black tea without milk or sugar; from time to time, cheese and fresh fruits.

Germain See suggests as a modification of this regimen, the abundant use of beverage, the addition of gelatins, and at times small doses of potassium iodide in twenty cases he claims constant and relatively prompt results.

Whatever may be urged for Ebstein's system--and it has afforded most excellent results to Unna and to Lube, as well as its author--it certainly exposes the patient to the terrors of dyspepsia, when the routine must needs be interrupted or modified; hence it is not always to be depended upon. As between dyspepsia and obesity, there are few, I fancy, who would not prefer the latter.

Another "system" that has acquired no little celebrity, and which has for its aim the reduction as far as possible of alimentary hydrocarbons while permitting a certain proportion of fat, is that, of Denneth, which necessarily follows somewhat closely the lines laid down by Ebstein.

Oertels' treatment, somewhat widely known, and not without due measure of fame, is based upon a series of measures having as object the withdrawal from both circulation and the economy at large, as much of the fluids as possible. It is especially adapted for the relief of those obese who are suffering fatty degeneration of the heart. The menu is as follows:

Breakfast

Pour to five ounces of tea or coffee with a little milk; two to two and a half ounces bread.

Dinner

Three or four ounces of roast or boiled meat, or moderately fat food; fish, slightly fat; salad and vegetables at pleasure; one and a half ounces of bread (in certain cases as much as three ounces of farinaceous food may be permitted); three to six ounces of fruit; at times a little pastry for dessert.--In summer, if fruit is not obtainable, six to eight ounces of light wine may be allowed.

Tea,--A cupful (four to five ounces) of tea or coffee, with a trifle of milk, as at breakfast; one and three-fourths ounces of bread; and exceptionally (and at most) six ounces of water.

Supper

One to two soft boiled eggs; four or five ounces of meat; one and three fourths ounces of bread; a trifle of cheese, salad, or fruit; six to eight ounces of light wine diluted with an eighth volume of water. The quantity of beverage may be slightly augmented at each meal if necessary, especially if there is no morbid heart trouble.

Schwenninger (Bismarck's physician), who opened a large sanitarium near Berlin a few years since for the treatment of the obese, employs Oertel's treatment, modified in that an abundance of beverage is permitted, provided it is not indulged in at meals; it is forbidden until two hours after eating.

Both Oertel's and Schwenninger's methods have procured grave dyspepsias, and fatal albuminurias as well, according to Meyer and Rosenfield. It has been charged the allowance of beverage upon which Schwenninger lays so much stress in the treatment at his sanitarium has a pecuniary basis, in other words a commission upon the sale of wines.2

Thus, it will be observed that while some forbid beverage, others rather insist upon its employment in greater or less quantities. Under such circumstances, it would seem but rational, before undertaking to relieve obesity, to establish its exact nature, and also the role taken by fluids in the phenomena of nutrition.

Physiologists generally admit water facilitates nutritive exchanges, which is explained by the elimination of a large quantity of urine; the experiments of Genth and Robin in this direction appear conclusive.

Bischoff, Voit, and Hermann have shown that water increases, not alone the elimination of urine, but also of sodium chloride, phosphoric acid, etc. Grigoriantz observed augmentation of disintegration when the quantity of beverage exceeded forty-six to eighty ounces ("1,400 to 2,400 cubic centimeters") per diem. Oppenheim, Fraenkel, and Debove, while believing water has but little influence upon the exchanges, admit it certainly need not diminish the latter; and Debove and Flament, after administering water in quantities varying from two to eight pints per diem, concluded that urine was diminished below the former figure, while above the latter it increased somewhat, being dependent upon the amount ingested. It was on the strength of the foregoing that Lallemand declared water to have no influence upon the exchanges.