170 OBESITY 



is no cheaper, and at the same time more palatable, albumin for these pur- 

 poses. Bread produced from fresh casein (casein bread) may of course be 

 also utilized in the nutrition of gouty patients, for casein does not produce an 

 increase in uric acid excretion. The bread made with this casein can be 

 readily baked by any baker. I have often used it with advantage in the 

 nutrition of the obese, of gouty patients, and particularly also in diabetes 

 mellitus. 



It is obvious that within certain limits leguminous vegetables may also 

 be utilized in the nutrition of the obese. Besides a plentiful amount of albu- 

 min these vegetables contain much carbohydrate, but with a corresponding 

 limitation of the other carbohydrates of the diet, they may be used with advan- 

 tage. The discreet use of fruit not too sweet, and of stewed fruit without 

 the addition of sugar, is permitted. Sugar, puddings, and starchy foods of 

 other kinds, as well as potatoes and all dishes made from them, are absolutely 

 prohibited for the obese. A small quantity of wine deficient in sugar and 

 containing small amounts of alcohol may be given, provided the patient can- 

 not get along without it. Beer I prohibit. This is generally one of the most 

 severe trials which the obese patient is called upon to undergo. Brillat-Savarin 

 is, however, quite correct when he says to the obese : " Avoid beer as you 

 would the pest." But with regard to tobacco, provided there is no contra- 

 indication on account of the heart, I permit a moderate indulgence — two or 

 three mild cigars a day. 



Finally, regarding the proper quantity of albumin for corpulent individ- 

 uals, of course all superfluous proteid must be reduced according to the indi- 

 vidual requirements, as in the antifat methods of treatment. Certainly custom 

 permits entirely too much latitude in this direction, and often the patients 

 take far too much albumin. We have seen that by including vegetable albu- 

 min in the diet, a considerable amount of the albumin needed by the body 

 is provided. On the other hand, I must emphasize that, in such a diet, the 

 patients have all the variety necessary for those who live under normal condi- 

 tions, and who do not perform excessive bodily labor. With this diet, wherein 

 the fatty foods fill their proper place, we find that hunger is more easily satis- 

 fied than with an antifat diet, and that the thirst which occurs in all antifat 

 cures is also avoided. If thirst were not a constant feature in " antifat cures " 

 it would be unnecessary to make such statements as that the patients " must 

 learn to endure thirst." The effect of fat in' diminishing thirst has been 

 observed and dwelt upon by so many competent authorities that it is unneces- 

 sary for me to enter more minutely into this subject. If the method of treat- 

 ment proposed by me, or, let us say, the " proper manner of life for the obese," 

 IS mamtamed (controlled, of course, by an expert), eventually the superfluous 

 fat, and only this, will gradually disappear. A too rapid loss of weight is 

 mjurious. Loss of fat should always occur slowly, and must be brought about 

 with great care. The method must never be allowed to fall into a rigid 

 routine, but must be arranged according to the individual conditions of each 

 case; and it must also be so arranged that the patient may pursue his ordinary 

 occupation without detriment. 



A few examples will serve to illustrate briefly the manner of life advised 



