The principles enunciated in the preceding volume of this series relative to the treatment of leanness apply with equal force to the treatment of obesity. In fattening cures the caloric intake should be increased so that it lies above the level of the average diet, whereas in reduction cures the caloric intake should be reduced to such a point that it lies below the ordinary maintenance diet. At the same time individual peculiarities must be carefully studied in each case and the treatment arranged accordingly. Routine treatment or the following of any scheme or schedule is more dangerous here than in the treatment of any other form of metabolic disorder, with the possible exception of diabetes. In the management of obesity the Art of dietetics becomes as important as the Science. In sanatoria and in watering places too much attention is generally bestowed upon the immediate result, too little upon the ultimate effect; the most important element of the treatment being always the education of the patient not for a few weeks, but for the rest of his life. Many of the popular so-called reduction systems that lay claim to be original are dangerous in proportion to their "orig inality" chiefly because they do not take into consideration the comfort and the daily habits and surroundings of the patient, but render it essentially impossible for the patient to carry out the rules laid down for his guidance for any considerable period of time. In this pamphlet these factors are all carefully considered and the arrangement of a régime taught that, while based upon scientific studies of a simple kind, is intensely practical and relatively easy of execution.

In the lecture on Gout and the Uric Acid Diathesis the most modern and the most important aspect discussed relates to the determination of the boundary of tolerance for uric acid forming foods. In the case of diabetes this method has long enjoyed deserved popularity. Just as in diabetes it is generally unnecessary and often dangerous to withdraw all carbohydrate food for an indefinite period of time, so in the uric acid diathesis it will be found equally superfluous and precarious or even practically impossible to completely exclude all uric acid forming food from the diet. In order to determine the boundary of tolerance in sufferers from uric acid disorders the endogenous uric acid excretion must be determined as a preliminary step; and then the degree of exogenous uric acid excretion following the intake of a definite pabulum studied separately and compared with a calculated normal. It will be found that in true uric acid cases definite and clean-cut deviations from this normal become apparent. From the diagnostic standpoint such studies are of the greatest practical importance, espe cially as the early diagnosis of so-called uric acid lesions generally remains exceedingly uncertain and vague, in as much as most patients are truly gouty before any of the numerous clinical syndromes that are attributable to uric acid perversions make their appearance. If a correct diagnosis can be made early by tolerance determinations, the patients will often be spared weakening and uncomfortable diet restrictions and the imposition of other severe measures that are detrimental rather than otherwise for true sufferers from gout and goutiness.

The therapeutic value of such tolerance determinations is as great in diabetics, for by their aid one can readily determine how much of valuable purin-containing food can be safely given without upsetting the disordered uric acid metabolism and, above all things, without chronically underfeeding the patient. For it will be found that there is generally left some power to properly assimilate purins; and this power should by all means be utilized. The details in regard to the technique of tolerance determinations and the estimation of the endogenous and exogenous uric acid excretion, the tests of purin-free and purin-containing foods, as well as the practical dietetics and the general treatment of the uric acid diathesis, all based upon these studies, are given with great exactness in this volume and make very interesting and instructive reading.

Alfred C. Croftan.

May 9, 1910.

100 State Street, Chicago.