Different methods lead to success; the so-called lianting-cure reduces the fat in the food to a minimum, and also considerably the amount of carbohydrates, only meat is given in abundance; Ebstein permits much fat but only a minimum of carbohydrates; Oertel gives a little more carbohydrates but less fat; Rosenfeld reduces the appetite by giving large amounts of water and potatoes and his method was proved successful with children in the hands of Orgler and of Philippson. It is best not to adhere fanatically to any one met hod, but We personally have found the Carrell C111' mo(lified for children the best ; WI' first give equal parts of skint milk and whole milk or (t0 avoid large quantities) ?hole milk with cream, and figure out the number of calories needed according to the child's weight according to Table 3, p. 43-1; this will give its the amount needed in absolute rest and without any addition for the loss through the feces, etc., WO then give for one week this number of calories either as a mixture of whole milk and skim milk, or as whole milk, in sonic cases even with the addition of some cream, and this tint(' We keep the child quietly in bed. During the first few days the loss \vill be considerable hut by the end of the first week the patient's weight will be stationary and the nitrogen-balance stable. We now reduce the amount of milk and slowly go over to a solid diet consisting of: break fast: tea with skim milk, a roll and fresh fruit: dinner: lean meat, preferably boiled, with green vegetables and much green salad; supper: farina, rice or co'rnstarch cooked in skim milk with stewed fruit. Sugar should not be allowed and all sweetening done with saccharine. Cran berries cooked with saccharine may be allowed in unlimited amounts to overcome the feeling of hunger of which s-ome children complain in the beginning and they also prevent the frequent constipation. The child is now allowed to rise for a few hours at first, then for the whole day and its exercise is carefully prescribed. We thus succeeded inside of three weeks in changing entirely a child who felt very uncomfortable, was afraid to move, was easily tired and very sensitive about its condition, and got it so accustomed to this diet that it was enjoyed and con tinued for some years.
As an example we will quote the following case of a spoiled girl of eleven and a half years of age: Clara W. had been growing very stout for the last eighteen months. During the last three months the child had been getting cross, was falling behind in school, and became short of breath. Physical examination showed that the heart dulness was moderately enlarged towards the right. The pulse was of medium ful ness, regular and of average celerity (luring rest, but when she did any exercising it became quite rapid, small, and recovered its former equilib rium only very slowly. Weight 57 kg. 350 Gm. She was put to bed and
for the first five days was given 2 litres of skim milk and whole milk, equal parts, daily and her weight dropped down to 55 kg. 350 Gin. She was now placed on a limited diet, which was kept up for some her weight remained stationary, but she felt fine and was full of energy. She was no longer short of breath and liked to exercise. She no longer complained of feeling hungry. Her diet was as follows: First breakfast: 25(1 c.c. of whole milk or skim milk with a little coffee or tea (but without sugar), 3 slices of zwiebach.
Second breakfast: 50 Gm. of rye bread or graham bread (without butter), raw fruit: either grapes, 150 Gm. or one large apple, or eight plums, or two medium sized pears, or two peaches, or three apricots.
Dinner: No soup. Meat, usually boiled, beef, mutton, white meat of chicken or a squab without skin or fat, 150 Gin., On some days roasted meat, veal, roast beef, pot roast, mutton, chicken, SO to 00 Gm.; the meat for the child was either roasted separately with very little butter or she was given a piece from the middle of the roast. With this she got as much salad, either lettuce or endives, tomatoes or radishes, as she wanted, but dressed with lemon juice instead of vinegar and oil, and fresh vegetables 75 to 100 Gm., turnips, string beans, spinach, lettuce, cauli flower, brussels sprouts, kale, sour-krout, purple cabbage, all boiled in water; and stewed fruit sweetened with saccharine 75 Gm., especially cranberries, but sometimes huckleberries, plums, apricots, or peaches.
Four o'clock tea: 250 c.c. of milk or skim milk with tea or coffee, two zwiebach.
Supper: Rye bread, 50 Gm., or wheat bread, 40 Gm., without butter; lean Westphalian ham or lean cold roast, 50 Gm.; cranberries or huckle berries, 75 Gin.; radishes.
This diet should be regulated by weighing the patient once a week. The daily quantity contains about the following calories and proteids: This is 30 calories per kg. or 21 Gin. of proteid. We give in these cases purposely large amounts of proteid because we want to make sure that we save the proteid of the body and that we burn the fat and car bohydrates. The benefit is a lasting one, and this girl continued to develop normally and satisfactorily.
7. Antidiabetic will be found in the chapter treating of diabetes mellitus.
S. Antiscorbutic Diet.--In this fresh vegetables and fruit must predominate, little meat, milk whenever possible raw, otherwise pas teurized. All canned and preserved foods should be avoided. Bleeding is often controlled by a diet rich in gelatine and in recipes Nos. 35 to 39, pages 471 and 472, we have shown how large amounts of this may be given to the patient without his noticing it.