TREATMENT 171 



by me. No hard and fast rules can be given because, as I have several times 

 stated, the method should never become a routine affair. For example, in 

 the first case (see below) if instead of the ordinary rye and wheat bread, a 

 bread richer in albumin is chosen, the ration of bread must naturally be in- 

 creased and the daily quantity of meat correspondingly diminished, etc. Three 

 meals a day I helieve to be the best rule. Yet even here some modification 

 might become necessary. In spite of many slight, but important, variations 

 the general principles remain the same. 



Observation I.— A man, forty-four years of age, moderately muscular, suffered from 

 increasing corpulence though he was otherwi.se healthy and had formerly been thin. 

 He led an active life, but limited his exercise to that in the house. He was of very 

 temperate habits, especially in the u.se of alcohol. The obesity had evidently developed 

 as the result of a very profuse ingestion of albuminous food, with the careful avoidance 

 of fat, but with a fondness for carbohydrates, particularly for sweets. The diet which 

 I had the patient follow was about as follows: 



1. Breakfast {in summer at six or half-past six o'clock) : A large cup — about 250 c.o. 

 — of strong tea without milk or sugar; 50 grams of bread (wheat or rye bread) , toasted, 

 with 20 or 30 grams of butter. 



2. Midday meal (between two and half-past two o'clock) : Meat broth, frequently 

 with bone iftatrow in a solid form (the bone should be cooked for an hour to an hour 

 and a half so that the marrow does not melt) or with an egg, or other suitable addition; 

 120 to 180 grams of boiled or broiled meat, preferably fat meat if it agrees with him; 

 vegetables as mentioned above, preferably peas, lentils or beans. For dessert, some 

 fresh fruit if obtainable, particularly strawberries, cherries, and, best of all, apples. 

 A salad, according to the season; also apple-sauce freshly cooked or, if unobtainable, 

 stewed dried or preserved fruit, always, however, without sugar. 



As fluid :-Two to three glasses of a light Rhine wine. 



Soon after this meal a large cup (about 250 c.c.) of strong tea without sugar. 



3. Supper (between seven and a half and eight o'clock) : In winter almost invariably, 

 in summer occasionally, a cup of tea as in the morning and after the midday meal ; 

 an egg or roast meat, preferably fat, or some ham with fat, or Cervelat sausage, or fish, 

 smoked or fresh ; a total of 75 to 80 grams of meat, about 30 grams of wheat bread, 

 and 15 to 20 grams of fat, this depending on the amount of fat in the meat, with more 

 or less butter. Occasionally a small quantity of cheese and some fresh fruit or stewed 

 dried fruit. 



This diet was combined with moderate exercise in the open air ; on Sundaj'S he took 

 walks usually lasting several hours, and these were continued during the summer holi- 

 days when a residence of several weeks at the seashore or in the Alps interrupted his 

 ordinary work. The effect on the patient's bodily health and mental activity was very 

 good. The diet agreed excellently. A second breakfast was never taken, but he was 

 always hungry for the midday meal. There was a remarkable decrease in tlie previously 

 extreme thirst. In the evening the craving for food was not very great, and was easily 

 satisfied. In the course of six months he lost 22 pounds, gradually but steadily, as is 

 desirable in all such cases, and in about nine months his waist measurement decreased 

 16 cm. This diet, in the main, has been continued. As time passed the ingestion of 

 fluid was still further decreased. Instead of a large cup of tea three times daily, 

 he now took a small cup only in the morning, and in the evening coffee, which formerly 

 had not been well borne ; the daily use of wine had been stopped for years. Only at the 

 beginning of the regulation of the diet was it necessary to weigh the allowance of 

 the individual foods. He soon learned to estimate them very readily. After the use 

 of aleuronat became known, it was employed by this patient very largely. 



Obsekvation II.— While in the first observation we were dealing with a case of 

 uncomplicated obesity, this one concerns a lady who suffered from obesity complicated 

 by gout. The patient is thirty-seven years of age, the wife of an officer from K. ihe 

 patient had no special family predisposition to obesity or gout. In her youth she was 



