Pfeiffer starts with a dietary supplying 3,o00 calories, which is equivalent to the normal demands, and this " maintenance diet is to be slowly 39 diminished, cacti element being reduced as the peculiarities of the case indicate.
Van Noorden's dietary consists of the following: 13reakl.Lst-3 ur. lent ineat with I oz. Mead and a cup of unsweetened collet. or tea containing ;Wont oz. indk. 2 hours later an egg is taken, and 2 111 Mrs afterwards a cup ol strong clear soup. Dinner follows in i hour, and should consist of a small cup ol clear soup, 5 oz. fish or lean meat, and 3'. oz. pot at oes, all (I the same amount of fresh fruit with some green vege tholes. 2 hours later a cup of strong coller is permitted, followed in an hour be 7 oz. fresh fruit, and 2 hours afterwards by a tumblerful of skimmed milk. Supper following 2 hours later. and consisting of oz. cold meat without tat, i ()Z. cvholeiitu it and i or 2 ()Z. 01 unsweetened cooked fruit.
The daily intake in this system represents nearly 1,400 calories, being 25o above the Bunting and 200 below the Oertel maximum, and slightly exceeding the Ebstein.
The Weir Mitchell plan of treating obesity by a simple dietary of skim milk is often satisfactory and is easily carried out. It consists in giving a tumblerful of milk with one egg every three hours whilst awake for three weeks at a time. The objection to this plan is the large amount of milk sugar ingested.
In all the treatments of obesity sugar should be discarded; where a sweetening substance is demanded saccharin may be permitted. Green and fresh vegetables are unobjectionable; they may be freely permitted no matter what plan of treatment be pursued, and they produce a feeling of satiety which is greatly to be desired when the bulk of the diet has to be seriously curtailed.
The Salisbury system consists of a diet of beefsteaks and hot water, and is now only employed in the form modified by Towers-Smith, who gives for the first 14 days for breakfast and luncheon, s lb. of lean steak; for dinner, 1 lb. of grilled cod and I lb. of lean rump steak; and at intervals during the 24 hours, one gallon of hot water; and the last thing at night, halt a wineglassful of whiskey in cold water. During the next 2l days the diet is nun e varied, and the hot water is reduced to 4 pints. Mutton chops fat, turbot, \yhiting, sole, green vegetables, and rusks are allowed. During the next 31 days the amount of hot water is further reduced to r quart, and lea is permitted with captain's biscuit, the bottom crust of a stale loaf, fish, fowl, game, joints of any kind, with a little light wine and seltzer water; , grs. of Bicarbonate of Potash are to be taken night and
morning. Alter these periods, which amount to about 9 weeks, the ordinary diet is indulged in.
Mien so employ ed there is not much distaste against the sameness of the' animal food; should this arise, beef tea or beef essence may be substi tuted. If a slice of fresh lemon be infused in each cupful of hot water, the danger of any scorbutic condition arising is prevented. A serious objec tion to the original Salisbury ticatment was the absence of fresh vege tables for long periods.
The " y " in mid Led contrast to the above system as carried out by Schroth and Dance!. The diet consists chiefly of dry rolls, two or three days old, a little thick gruel, and a small amount of light wine. It is a method to which even the most resolute patients will not long submit, and it is unsuitable for gouty subjects owing to the restrictions placed upon the eliminatory organs.
In the use of any of these dietaries the carbohydrates should be first restricted, next the fats, proteids and fluids. Once the excess of fat in the patient's body has been consumed by the demands made upon it through feeding upon a starvation dietary and the increase of metabolism by open air exercises, the loss of weight should be stopped by a cautious approach towards the ideal maintenance diet. The total and relative proportion of proteids, fats and carbohydrates necessary to keep the individual permanently at the reduced body weight and in good vigorous health can only be ascertained by frequent weighing and judicious changes in his dietary till the physician finds the minimum of each class of food necessary to meet the requirements of the case.
All of these dietaries except Ebstein's contain more proteids than arc necessary to sustain life under normal conditions, and this dietary only affords less than one-tenth part of the ideal amount of carbohydrates (15 oz.). It also should be kept in mind that it supplies over 6o per cent, of necessary fat, containing as it does more than ten times the Banting. These considerations demonstrate the serious dangers which are certain to follow a rigid adherence to any system of reduction except for com paratively short periods.
The rare form of localised deposition of fat known as Adiposis Dolorosa or Dercum's Disease, and which is often associated with neuritis, is best met by thyroid feeding and local sedative applications.