THE TECHNIC OF OVER-NUTRITION AND UNDER-NUTRITION 73 



A diminution of food to about two-fifths of the usual requirement is 

 looked upon as the utmost that may be wisely attempted in the obese patient. 

 The amount and rapidity of the loss of weight depend in the main on 

 the accompanying conditions. If the patient is inactive, the loss in weight 

 amounts to from 6^ to 13 pounds in a month. The greater reductions are 

 noted in the medium, the slighter decreases in the most marked grades of 

 obesity. If auxiliary measures, such as systematic muscular exercise, hydro- 

 therapeutic agents, mineral spring cures,, etc., are utilized, the loss in weight 

 may readily be increased to 22 to 33 pounds in a month. 



The following table showing the success which Dapper attained in his 

 sanatorium at Kissingen, in which the diet scheme was based upon that pro- 

 posed by me, is instructive : 



In what proportions the main constituents of the food, albumin, fat, and 

 carbohydrates, are to be arranged in the antifat diet of milder and medium 

 grades is of minor importance. The restriction of food is not so complete 

 that danger from uniformity of the diet is to be feared. On the other hand, 

 the question as to how we are to act in antifat cures of the third degree has 

 been much discussed. It cannot be considered of vital importance, for prac- 

 tical experience has sufficiently demonstrated that with a high intake of albu- 

 min (Banting, Oertel, Kisch, v. Noorden) as well as with a low intake of 

 albumin (Ebstein, Hirschfeld) satisfactory results have been attained. The 

 investigations in metabolism of the last few years are in accord with this. 

 I regard the question as one of technic rather than of theory or principle. 



