— TREATMENT - 165 



his obese patients. He absolutely prohibits not only all fat, but also all foods 

 made of flour, and also all sugar-containing materials. 



Cantani probably realized that the dietary formulas which he published 

 could scarcely be followed by the obese, or only endured for a brief while. 

 In some of his patients, partly on account of the unconquerable aversion con- 

 sequent upon consuming such great amounts of meat, partly on account of the 

 incapacity of the stomach to digest so much animal food, and partly because 

 of the great muscular debility which appeared after following his dietary 

 rules, Cantani himself combined his rules with Harvey-Banting formulas 

 in which a certain quantity of carbohydrates and fat were permitted. How- 

 ever, even the so-called Banting cure is by ho means harmless. The large 

 quantity of albumin required by it on the one hand, and the too great limita- 

 tion of IST-free foods (fat and carbohydrates) on the other hand, are very badly 

 tolerated by the patient, and, as professional experience has shovm, not infre- 

 quently are productive of serious harm. We know, for example, to mention 

 but one point, that no-fat cures of this kind may produce severe organic dis- 

 ease of the kidneys. The danger of such cures would be yet greater if the 

 " lean meat " did not contain a certain proportion of fat ; even lean beef con- 

 tains about 2 per cent, of fat. N"evertheless, the amount of carlDohydrates 

 allowed by these tables is still insufficient. Cheese, of course, cannot be taken 

 in a no-fat cure — it is expressly forbidden by Cantani — as there is no kind 

 of cheese that is free from fat. 



By this no-fat method of treatment, quite insupportable conditions are 

 produced which even a very strong-willed person can at most endure for only 

 a brief while. Yet these methods were those most commonly employed up to 

 the beginning of the eighth decade of the nineteenth century. Since then, 

 however, the " no-fat " method has more and more fallen into disuse. Of 

 course, it must be admitted that the treatment by the withdrawal of fat is 

 efEectual and even to a certain degree rational, i. e., by such a system of nutri- 

 tion a loss of fat may be brought about without damage to the muscle; but 

 great care must be exercised. In the most favorable eases the method can be 

 pursued only for a period of a few weeks, or at most a few months, provided 

 all goes well. Further, this method can only be risked in obese patients who 

 are still in good muscular condition; for only very strong constitutions can 

 endure such a diet for any length of time. On account of this limited applica- 

 tion, the " no-fat " cures do not fulfil the requirements which a truly rational 

 cure of obesity calls for. In such a method, for instance, it is desirable that 

 the patient should, without danger to his health and without too great priva- 

 tion, be able to continue the diet permanently after the result has been ob- 

 tained, though perhaps with slight modifications. Such modifications have, 

 however, not been proposed by any of the exponents of these methods if we 

 except the advice of Cantani that, in case his dietary regulations prove 

 impracticable, the Banting cure, i. e., the regime of Thomas K. Chambers, is 

 to be substituted. I do not believe that such modifications of antifat cures 

 are possible without violating and completely overthrowing their prmciple 

 In such a modification the amount of albumin which is to be consumed must 

 be lessened, and either fat or carbohydrates substituted in a correspondmg 



