It has been said, "a piece of charcoal, some atmospheric air, a little water, and some salt contain all the elements of a typical diet, and in ample quantity;" but we cannot live on a piece of charcoal, some atmospheric air, a little water, and some salt, served in kind, at least. But prepare them in palatable dress, and we take them with avidity and grow fat, showing it is not altogether the elements the food contains that make it available, but how and in what way these elements are contained is the important matter. Another thing it shows, - we must know something more than the absolute chemical composition of food-stuffs before we can foretell exactly the effect on the individual.

Now, as to the special diets for obesity, etc., call them what you may, they all mean, as a rule, semi-starvation. Withhold a proper amount of food from the animal and you cause a loss of weight.

Excessive weight is a great source of inconvenience, - a humiliation, to some. It is most frequently hereditary and a perfectly natural state for the individual. After all, the philosophy of existence, in one sense at least, is to feel good and well. Obesity may be a disease, but if so, it is usually the fault of bad habits in the individual. If one will live a sober, industrious, and in every way a temperate life, restricting, as one surely must very decidedly, the appetite for sugars, starches, and fats in particular, and for all meats and drinks somewhat, but not beyond the comforts of existence, as most of these special methods do, then one will neither be overburdened with fat nor threatened with evils of a more dangerous kind from unscientific regimen.

The Banting system undoubtedly, if followed up, causes loss of bulk, but has its dangers, and surely is most inconvenient and unpleasant to those following it. He allowed about twelve ounces of lean meat per day, about two ounces of bread, and about twelve ounces of fruit and green vegetables. He allowed thirty-five ounces of fluids in twenty-four hours, nothing like as much fluid as a man should part with in the same length of time. As Thompson says, the fats and albuminoids are not well balanced here, and constipation of the bowels must ensue.

The Ebstein theory, as given by Thompson, is, that animal foods, as well as carbohydrates, particularly sugars and starches, are capable of being turned into fat. The carbohydrates, he says, furnish force for the body, and by their combustion spare the complete oxidation of the albuminates, which are therefore stored in the tissues in a sub-oxidized form. His theory is that fatty food does not give rise to the storage of fat in the body, and he allows it, and particularly because it causes satiety sooner and makes one eat less. He allows no sugar, potatoes, rice, or other farinaceous food except three ounces and a half of bread daily. He allows the non-starchy vegetables and a moderate amount of any kind of meat. He restricts fluids to about one-half normal. Breakfast, one cup of black tea, no sugar or milk, with two ounces of buttered toast. Dinner, at noon, six ounces of boiled or roasted fat beef, with drip gravy, one or two non-starchy vegetables in moderation, and for dessert a salad and a fruit, a little light wine, and tea, no sugar or milk. Supper, tea, no milk or sugar, one soft egg, a moderate allowance of fish, ham, or cold fat meat, one ounce thin buttered bread or toast, and fruit. On this diet one cannot work hard or take active exercise and be thoroughly comfortable, for he only gets fourteen hundred calories potential energy in nutrients.

On the preceding page is a table by Atkinson of a comparison of dietaries for obesity with ordinary dietaries, from Thompson.

From this table the patients under Banting and Ebstein get starvation diet sure, while the students from the Northern United States get too much. Atkinson's man at moderate work gets well supported; the poor sewing-girl is ill nourished, mostly on carbohydrates, as we should suppose; and the German professor, how about him? Well, he does not live high, but gets several glasses of beer, as his carbohydrates show.

The Oertel system is newer, and I am indebted to Professor Thompson's book for information in regard to it. The purpose in Oerters system is to strengthen the circulation by strengthening the heart, and then the fat, once rid of, does not return. He makes two classes of the obese, and regulates their diet accordingly. First, those in whom fat has accumulated, but in whom the circulation and respiration are not impaired, and the person can use muscular effort and walk and run. Second, those in whom, from advanced stasis and hydraemia, and with a deficiency of haemoglobin in the blood - anaemic - the amount of oxygen taken up from the lungs is much reduced, and who are short of breath on exertion. For the first class he allows 50 grams of fat, 200 grams carbohydrates, with 150 grams albumin, or more if needed. For the second class - fat people, short-winded, and with dropsical tendencies (I suppose he mostly puts in this class those yet with organs fairly sound) - he allows 30 grams of fat daily, with 100 grams carbohydrates, and considerably over 150 grams albumin, - more, you see, than the first class gets. In this second class he gives little fluid, and not overmuch to the first class. He thus, he says, reduces blood-pressure, venous stasis is lessened, and thus the vessels in the fatty tissue are drained, and nutritive changes occur here, - the fat is broken up, carried away, cremated, as it were. Oertel allows twice the amount of animal food that Ebstein does, double the amount of carbohydrates, and less than half the fat. He also allows more fat and starch than Banting. He allows twelve ounces of light wine, and as much water at dinner, a very fair allowance, with six ounces of bread daily. He allows eggs occasionally. For those who are able, he prescribes the "terrain cure," mountain-climbing, or golf - watching the heart, which gets strength as the exercise progresses. For those who cannot thus exercise, he prescribes massage, friction, and baths, here still further reducing fats and starches. The Schweninger system is about like Oerters, but he allows no drink at meals, advises waiting until two hours after meals to drink. He gives little bread and restricts fluids generally. This is probably a wise precaution.

Germain-See says much water is necessary in treating corpulency. He allows meats, lean and fat, but no sugar or starches. His drinks are hot weak tea and plenty of water. He allows little or no alcohol. Thompson suggests that this treatment with plenty of fluids is best for gouty and rheumatic cases where we desire to eliminate the waste from the system. This, at any rate, is some encouragement to the gouty stout man, who so far has received little consideration in this matter.

Dr. S. Weir Mitchell's system for obesity consists chiefly in rest, skim-milk diet, massage, and movements for passive exercise. After a fortnight he begins to allow a little light broth; he is careful to watch the condition of the heart After six weeks he allows some lean meats. This treatment requires the abandonment of all labor, and is among the best of treatments to amuse while at the same time it relieves, and is especially applicable to women society-tired and suffering from overindulgence in various forms.

There are a number of other treatments, but they differ only in degree from those already mentioned.

The principle in all is the same, - semi-starvation, and the end aimed at is the same, - viz., to cause those undergoing the treatment to oxidize and eliminate the accumulated fat and prevent its forming again. There are many quack remedies tinder various names. All are harmful and even dangerous, with just knavery enough in the recommendations accompanying them, putting those using them on a diet which avoids fat, starches, and sugars, to give them a semblance of doing effective work in reducing flesh.

There is at present prevalent among society women and among young girls quite a fad for reducing their weight. To be slim and slender and willowy appears to be the point aimed at, no matter with what idiopathic tendencies as to fleshiness God has endowed them. The no-breakfast idea just now predominates, the no-salt idea is common, and the no-fluids idea is followed by many, especially by young women. This is all wrong, unless they have intelligent medical supervision, and this intelligent medical supervision should see to it that the heart and kidneys of these patients are thoroughly observed and looked after. Renal calculi may supervene, or gall-stones may form, and great suffering ensue, all because the elimination of waste has been interfered with. Nature resents such unwarranted interference with her laws.

My own idea in these cases is, above all things, to study the individual, then arrange the diet, exercise, and the habits of life generally. Watch particularly the condition of the heart, the general circulation, and the kidneys. Age is very important to consider, and so is the sex and the environment of the patient The gouty patient needs different advice from one not so afflicted, and so does the patient with dropsical tendencies. Explain to each what his case needs. Explain the difference in the make-up of foods, as to oxygen, hydrogen, carbon, and nitrogen, and the difference between proteids and starches, sugars and the like, and fats, and the uses and tendencies of each in diet. Let all get intelligent advice by reading and otherwise as to what they shall eat and drink.