We must now approach a question that is of the greatest practical interest. In numerous watering places in which diseases of the digestive apparatus, diseases of metabolism and of nutrition are treated, a routine scheme of diet-prescribing has been adopted. Instead of inquiring at once what particular diet is the most appropriate one for each individual case, or each particular disease, the water of the watering place is considered primarily, and the first question that the patient asks the physician is, What can I eat while I am drinking this particular water, and what can't I eat? The reason why all the patients who frequent these watering places invariably ask this question is that the physicians who practice in such places have educated the lay public for decades to look upon the matter in this light. I refer in particular to Carlsbad, Homburg, and Kissingen. Whereas undoubtedly a limited number of intelligent and careful physicians have always been practicing in these places, physicians who have learned to emancipate themselves from the rigid dogma of a definite dietetic scheme said to be suited to the particular water cure that was instituted, such practitioners, I am sorry to say, have always been the exception, and the practitioners in general have always been in the habit of prescribing a diet according to a fixed scheme. Not very long ago (Therapeut. Monatsh., 1887, No. 1) such a scheme was published by an eminent authority, in which the "dietetic régime to be adopted when employing a Carlsbad cure" was described, without any regard whatsoever to the disease or to the individual undergoing the treatment. In this paper the different articles of food and drink were arranged in a very one-sided way, according to the following categories, namely: Articles to be completely avoided; articles to be used in moderation; articles to be permitted. In nearly all of the pamphlets that are published in such watering places as Kissingen, Homburg, etc., and that are intended to advertise these particular waters, such dietetic schemes are given, and invariably the saline water is considered in the first place, and the disease and the patient in the second. In addition, there is a popular prejudice among many physicians, hotel-keepers, and the general public, to the effect that each particular saline water calls for the exclusion of certain definite articles of food from the diet, regardless of the disease. In other words, that each water calls for a definite diet. This prejudice is so deeply rooted that any physician who departs from this routine scheme is severely criticised and is accused of experimenting in a dangerous way with the well-being of his patients; in fact, the prescription of a dietary that deviates from the routine régime is discussed as a sensational event of the day.

Fats, in particular, seem to figure prominently among the articles to be avoided. Thus the Carlsbad scheme of diet that has been mentioned above, includes the fats above all among the "forbidden" articles of food. In some of the watering places the directors of the cure have placarded the trees in the park with notices forbidding the use of fats, and still others print this prohibition on the labels of the bottles that they send away. And all this, I am sure, can only occur with the consent of the physicians practicing in the different watering places. How did this peculiar prohibition originate? We hardly think it worth while to incur the trouble of searching the literature for the original articles in which the use of fat is condemned.

There can be no doubt that many patients who go to these watering places should not eat fat, or who at least should reduce the quantity of fat ingested. This may very well be due to the character of the disease from which they are suffering. We refer, for instance, to cases of obesify, and to many patients suffering from certain gastric and intestinal diseases (not all, by any means), and from jaundice. Many of the patients, however, who go to Carlsbad, Kissingen, Homburg, etc., and who are not suffering from any of the above conditions, should by no means be deprived of the valuable fats of the normal diet, for if they are, it is impossible to maintain their general nutrition and strength, and certainly impossible to improve their gen eral condition. Nevertheless many physicians forbid fat to these people for the sake of a fairy tale that is devoutly believed at these watering places. We believe that a conscientious and honest physician would have to send many sufferers from gastric and intestinal trouble, many patients with diabetes and gout, many neurasthenics and convalescents from various diseases, away from these watering places if the legend that there is an antagonism between the water and fat were true.

But possibly this is no legend at all, but the truth. In order to determine this point, two methods could be pursued, namely, in the first place, simple observation of the patients; in the second, experimental investigation. As far as the former method is concerned, we must content ourselves with the statement that we personally have deviated from the old-established rule prevalent in these watering places in numerous patients, and that we have never witnessed any unfavorable effects from the simultaneous administration of large quantities of fat, and of Kissingen or Homburg water. To hundreds of patients who visited these watering places, Dapper, in Kissingen, and von Noorden, in Homburg, have given large quantities of fat together with the water, and have succeeded in increasing the weight of these patients and in producing a cure of the primary disease that they were suffering from. The results obtained from this practice were sufficiently favorable to satisfy the most exacting demands.

Nevertheless, it appeared desirable to know some thing definite in regard to gastric digestion when saline waters and a diet containing much fat were simultaneously administered. For this purpose, von Noorden some time ago performed some comparative experiments in three patients. All three were suffering from hyperacidity with mild gastric atony. Their breakfast consisted of 50 grams of roll with 50 grams of butter, and, in addition, 200 c. c. of tea, 100 c. c. of thick sterilized cream, containing 30 per cent. of fat. Each patient, therefore, at each test breakfast, received about 50 grams of fat. Each patient's stomach contents were aspirated four times: twice after the administration, one hour before the breakfast of 300 c. c. of Homburg Elizabeth water; twice without previous administration of any of the water. The stomach contents in each case were removed exactly one hour after the patient began to eat the test breakfast.