6 P.M.--Tea: 2-3 ounces cooked fruit; 1-2 ounces rusks; 2-4 ounces solids; 9 ounces tea, without milk or sugar. 7 P.M.--Supper: Meat or fish as at dinner; claret or sherry and water, 7 ounces. Total daily solids, 21-27 ounces. Total fluids, 35 ounces. * * * * * Oertel pointed out the great benefits which might be derived by those individuals suffering from certain types of heart disease which are accompanied by obesity. He made it distinctly understood that while the treatment in no way affected the heart lesion,--that is, in so far as altering the character of the disease,--it greatly reduced the work imposed upon the circulatory organ and permitted a more complete oxidation of the blood.[159] ~Oertel's Method.~--Oertel bases his dietetic treatment of obesity upon the heart changes and those which naturally follow in the circulation. He makes the following suggestions, taking always into consideration the condition of the patient, whether he is anemic or plethoric. "(a) Where there is an abnormally increased amount of fat in plethoric patients with unimpaired or only beginning changes in the heart action, the diet should aim at: (1) An increased supply of protein. (2) A decrease in the fat-forming substances. (3) Little or no diminution in the supply of liquids below the physiologic amount (1500 c.c.--3 pt.) (b) Where there is obesity in anemic patients, viz. serious plethora, the diet should aim at: (1) An increase in the quantity of proteins. (2) A diminution in amount of fat-forming substances and eventually (3) a decrease in the amount of fluid. (c) Where there is obesity in adults with anemic symptoms in whom not only the amount of protein but also the abnormally increased amount of fat is slowly wasting away, they require: (1) An increase in the amount of protein taken. (2) A sufficient amount of fat and carbohydrates or even an increase of same to prevent the falling off of fat. (3) A diminution in the amount of fluid taken." Oertel claims that the simplest method of reducing the fat-forming elements in a diet is to decrease the amount of fat and allow a certain amount of carbohydrates, regulating the diet according to the individual. The following table is given by him as showing the minimum and maximum amount of the different food constituents constituting the obesity diet: ==========++=========+========+==============+=========== ||_Protein_| _Fat_ |_Carbohydrate_|_Calories_ || _Gm._ | _Gm._ | _Gm._ | ----------++---------+--------+--------------+----------- Minimum || 156 | 25 | 75 | 1180 Maximum || 170 | 45 | 120 | 1608 ==========++=========+========+==============+===========