When obesity has caused cardiac weakness, graduated exercise should form an essential element of treatment. Oertel's plan, which may be carried out at home or at one of the "Ter-raincurorte," is particularly well adapted to the needs of these patients.

Those who are active and vigorous and only moderately overweight can be treated at home and sometimes even their usual avocation need not be interrupted, but when it is necessary to remove many pounds and especially if the heart is weak or other organs are not normal it is best that the patient give himself wholly to the cure. He is more certain to do this at a sanitarium or health resort than at home. However, resort to neither of these is necessary. Usually six or eight weeks are required to effect satisfactory results and often a longer time devoted to a modified treatment at home may be required. A permanent and persistent change in habits of eating and exercise are commonly requisite to maintain the reduction which may have been effected.

Those who are only moderately overweight frequently can be sufficiently reduced and the reduction maintained by first inquiring in detail into their habits of eating and by then cutting out one or two or a few of the carbohydrates which they habitually use.

The sample diets quoted below are interesting types: Ebstein recommends the following:

Breakfast

A cup of black tea without sugar or milk, and two ounces of buttered toast.

Dinner

A meat soup or broth, from four to six ounces of boiled or roasted fat beef with meat gravy, not thickened; one or two fresh vegetables in moderation, and salad and fresh or dried fruit. A little light wine and black tea without milk or sugar.

Supper

Tea as before, a soft-cooked egg, a little fish, ham or cold fat meat, an ounce of thin buttered bread or toast and fresh fruit.

Oertel's diet for the obese is as follows:

Morning: One cup of coffee or tea with a little milk and about three ounces of bread.

Noon: Three or four ounces of soup, seven or eight ounces of roast or boiled beef, veal, game or poultry, not too fat, salad or a little vegetable, fish, if desired, from one to three ounces of bread or farinaceous pudding, from three to six ounces of fruit. Drink nothing at this meal, or, if the weather is very hot, six to eight ounces of light wine.

Afternoon: Coffee or tea as in the morning, and not to exceed six ounces of water; rarely an ounce of bread at this time.

Evening: One or two soft-boiled eggs, an ounce of bread, perhaps a little cheese; salad or fruit; from six to eight ounces of wine with four or five ounces of water.

Schleicher recommends:

Morning: 7 a. m., a mutton or veal cutlet, or a portion of sole as big as the palm of the hand; the same quantity of bread without butter. 8 a. m., a cup of tea with sugar. 10.30 a. m., a sandwich of bread and meat.

Afternoon: 1 p. m., meat, eggs, green vegetables, cheese, an orange; two glasses of white wine. 4 p. m., tea with sugar. 7 p. m., a small quantity of bread and cheese. 9 p. m., cold meat, eggs, salad; two glasses of wine.

Another menu is:

Breakfast

9 a. m., five or six ounces of meat (except pork or veal) or fish; a little biscuit, or one ounce of dry toast, a cup of tea or coffee with milk or sugar.

Dinner

2 p. m., fish or meat (avoiding salmon, eels, herring, pork, and veal); five or six ounces of poultry or game; any vegetables except potatoes, parsnips, beets, turnips, or carrots; dry toast, one ounce; cooked fruit unsweetened, claret, sherry, or Madeira.

Tea: 6 p. m., cooked fruit, two or three ounces, a rusk or two; from two to four ounces of solids; nine ounces of tea without milk or sugar.

Supper

9 p. m., meat or fish as at dinner, three or four ounces; claret or sherry and water.

The foods of those attempting a reduction in weight or desirous of maintaining a reduction already attained must consist of meats, fish, eggs, such vegetables as artichokes, asparagus, beets, brussel sprouts, cabbage, cauliflower, carrots, celery, cucumbers, dandelion greens, eggplant, endive, lettuce, mushrooms, onions, parsnips, radish, rhubarb, spinach, squash, string-beans, tomatoes, turnips, watercress, fruits of all kinds, except dates, figs and raisins and very sweet dried or preserved fruits.

Sugar, bread, cereals and other foods rich in starch and sugar must be forbidden or limited by judicious prescription.