cken- or
oyster-soup,--more as a relief to the unpleasantness of a milk diet than
for any other reason.

When the weight has been sufficiently lowered, we add to the diet beef,
mutton, oysters, etc., and finally arrange a full diet list to include
but a moderate amount of hydro-carbons. Meanwhile, the milk remains as a
large part of the food, and the active Swedish movements are still kept
up as a habit, the patient being directed by degrees to add the usual
forms of exercise.

If we attempt to make so speedy a change in weight while the patient is
afoot, the loss is apt to be gravely felt; but with the precautions here
advised it is interesting and pleasant to see how great a reduction may
be made in a reasonable time without annoyance and with no obvious
result except a gain in health and comfort.

Cases of anaemia in women with excess of flesh have to be managed in a
somewhat similar fashion, but with the utmost care. In such persons we
have a loss of red blood-globules, perhaps lessened haemoglobin, weak
heart, rapid pulse, and general feebleness, with too much fat, but not,
or at least rarely, extreme obesity. The milder cases may profit by
iron, with rest and very vigorous massage, but in old cases of this
kind--they are, happily, rare--the best plan is to put the patient at
rest, to use massage, restrict the diet to skimmed milk, or to milk and
broths free from fat, and with them, when the weight has been
sufficiently lowered, to give iron freely, and by degrees a good general
diet, under which the globules rise in number, so that even with a new
gain in flesh there comes an equal gain in strength and comfort. The
massage must be very thoroughly done to be of service, and it is often
difficult to get operators to perform it properly, as the manipulation
of very fat people is excessively hard work. As to other details, the
management should be much the same as that which I shall presently
describe in connection with cases of another kind.

I add two cases in illustration of the use of rest, milk, and massage
in the treatment of persons who are both anaemic and overloaded with
fat.

Mrs. P., aet. 45, weight one hundred and ninety pounds, height five feet
four and a half inches, had for some years been feeble, unable to walk
without panting, or to move rapidly even a few steps. Although always
stout, her great increase of flesh had followed an attack of typhoid
fever four years before. Her appearance was strik