TREATMENT 167 



similar are the experiences in regard to carbohydrates. The question why fat 

 satiates us most rapidly may be very easily explained by the observations of 

 M. Matthes and E. Marquardsen ( Verhandl. d. Congr. fiir innere Med., 1898, 

 XVI, p. 358 u. fig.). These observers have shown that fats remain in the 

 stomach for a long time, and that large amounts of fat necessitate a very 

 large expenditure of the regulatory powers of the stomach, and produce a 

 decided encumbrance of the same. As in my diet regulations too great 

 amounts of fat are not permitted the obese, the deleterious effects arising there- 

 from are not to be feared. Further, the inclusion of fat is by no means a 

 cure ly means of nausea, as has been stated by one author. It is in fact not 

 a cure but a mode of living whereby fat simply assumes its proper function 

 as a food. 



To attain this purpose, no larger amount of fat is necessary than is per- 

 mitted to non-obese persons, even to those who are subjected to the hardest 

 labor. In the nutrition of the obese the limitation in the amount of carbo- 

 hydrates is the chief point. Of course, this does not mean that an intolerable 

 limitation of vegetable food is necessary. On the contrary, in the nutrition 

 of fat persons a plentiful use is to be made of green vegetables rich in water 

 and poor in carbohydrates, since their pre-eminent qualifications as satiating 

 foods and fat carriers make them especially suitable. Only vegetables rich 

 in starch, such as turnips, potatoes, etc., are to be avoided. By this method 

 fat is administered to the patient in gilch wise as to cause no repugnance, and 

 the carbohydrates may be limited by giving a bread richer in albumin than is 

 usually taken — a point to which I called attention a number of years ago. 

 Our ordinary bread contains only about 6 to 7 per cent, of albumin, and its 

 nutritive product is almost exclusively starch. The starch may be decidedly 

 reduced if the albumin contents of the bread are increased by the addition 

 of vegetable albumin. In this manner it is easy to prepare, even at home, 

 a very palatable bread which will contain from 20 to 30 per cent, of albumin. 

 I have repeatedly published the formulas necessary for this purpose, last in 

 the article by Schwalbe and myself on Diabetes Mellitus in the " Handbuch 

 der praktischen Medicin," Stuttgart, 1901. For the preparation of such a 

 bread we require pure vegetable albumin, which may be obtained from a num- 

 ber of plants. Vegetable albumin is easily digested, readily utilized by the 

 human organism, and is not only very much cheaper than meat but, for many 

 other reasons, is even preferable. Up to very recent times but two such pure 

 vegetable albumins were at our disposal, one of which was discovered by Dr. 

 Johannes Hundhausen of Hamm i. W., and manufactured from gluten, a 

 patent albumin which the inventor calls " aleuronat." In addition to small 

 quantities of salts (0.78 per cent.) and cellulose (0.45 per cent.) aleuronat 

 contains at least 80 per cent, of albumin, about 7 per cent, of carbohydrates, 

 and about 9 per cent, of water. The second vegetable albumin, placed at our 

 disposal later than aleuronat, is the rice albumin " ergon " which is manu- 

 factured by Dr. Hensel & Co., in the chemical laboratory at Lesum near 

 Bremen. 



This is not the place at which to enumerate the varied uses we may make 

 of vegetable albumin in the nutrition of patients with diabetes mellitus. In 



