Nothing more was heard of Madame K. until the month of August in the following year. She then writes that in accordance with the advice of the medical men of Saint Dié, she, together with her family, went to take the waters of Plombières. That on her return her legs were again swollen, and that she suffered from palpitation of the heart, which gave rise to a choking sensation. She was desirous of again undergoing the anti-obesic treatment. On the 30th of September following she wrote that she had followed my instructions during the last three weeks, and had lost only four pounds in weight; but added, I have obtained a much more valuable result, and that is, the almost total release from my troublesome heart palpitation. I have not since heard from this lady, but I have no doubt that she has been once more cured of her palpitation, and that she is no longer troubled with swellings of the feet and legs. The loss of fat in this case has been attended with freedom from palpitation of the heart, from shortness of breath, and from swelling of the lower extremities. What explanation can be given as to the cause of these results? As to her ailments, did they arise from an excess of blood in the system, or was she suffering from cardiac disease? Physicians thought so and bled her, administered sedatives and alteratives, and restricted the diet of the patient. Still they did not cure her. On the other hand I recommended her food should consist of meat principally; that she should be allowed strong coffee and wine; which, together with the employment of alkaline remedies, reduced her fat and effected a cure. The following season she goes, together with her family, to the springs, and returns thence afflicted in the same way as before, and again my mode of treatment produces the same result. It is manifest that this heart affection, this shortness of breath, depended upon obstruction to the heart's action, and not upon any excess of blood in the system, since I abstracted no blood, but on the contrary, administered stimulants, together with the use of full meat diet. The swollen limbs arose no doubt from a partial portal obstruction, and ceased when the reduction of fat was effected. It may be urged that the patient was better, or even cured, of heart palpitation, before she had lost much in weight. She had lost, however, four pounds; and four pounds of fat occupy a large space. The fat in a living body is fluid and very light. A pound, therefore, is a large quantity. When a person begins to lose his corpulency, the reduction takes place first in the interior of the body, and consequently there is a great improvement during the first six or eight days in the general health of obese patients, when treated in accordance with the principles now advocated.