Ketone Bodies

Mr. J. B., 49 years old, merchant, had the English disease (rhachitis) as a child and therefore learned to walk only when he was 5 years old In the 20s hemorrhoids set in.     Towards the end of the 20s ; years he suffered from paralysis of the legs, which is why he was in 2 Somn.ern

I am unable to form a clear picture of the more detailed causes of this paralysis from the patient's statements; he was never syphilitic.  The signs of paralysis were "sporlo" toriiber.  The hemorrhoids developed more strongly over the years, there was prolapse of the rectum with frequent bleeding and the naehtheilige influence on the general condition, which - this suffering KU tends to accompany.  "In a very run-down condition I saw patient yoi; 7 years first.  He could not walk a short distance without the rectum protruding and bleeding.  I therefore did the cuffed operation at that time, which consisted of removing the most protruding nodes forming the prolapse with the ecrasenr. Despite slow progress with the instrument, there was a not insignificant secondary hemorrhage, which was not easy to stop, but finally succeeded.  The patient recovered rapidly and enjoyed good health for about 5 years.  Gradually, however, the disease reappeared, and only recently he was freed from it, and I preferred to use a non-bloody method of treatment, because the patient is very prone to bleeding.  The cure, which in a few weeks brought him to the point that the rectum no longer prolapsed and that he was again able to take gprössero walks, consisted of his inserting stool suppositories of stearin, which were provided with longitudinal fnrchen and coated with subsequent ointment.

Argenti nitr.  ^j.

Acid. tannic. 5jj.

Extr. belladonn.  ^jj.

Extr. opii 9/9.

Ax. porc.  5/S.

F. ungt. moUe.

 I owe the knowledge of this treatment of the rectal incident to a communication from Geheimrath Burow of Königsberg.     It seems to me that it deserves to become generally known.

In January 1866, a scaly, slightly oozing rash first appeared on the back of the patient's head, which he would have paid little attention to if it had not been the cause of his clothes always being covered with fallen scales.     On the hairy head and on the left ear, crusts formed between and next to the scales, which, when removed, quickly formed anew by secreting a yellowish flakiness.     The attending physician prescribed rubbing with ointment, but without success; rather, the disease spread to the head, and in the spring it also affected the chest.    The patient went to a cold-water institution, where he used rain, sitting and wave baths.     This cure had no favorable effect on the rectal prolapse, but a decidedly unfavorable effect on the skin rash.     The secretion of yellowish liquid on the head increased so that it often ran down the patient's face and neck; the head and chest were covered with scales and yellow crusts.     Since in the course of the cold water cure several small boils developed on the head and a larger one on the right hand, the patient gave it up and returned here in August.

The rash had become very extensive.  The hairy head, the ears, some parts of the face, the chest, the abdomen, the genitals, a part of the back and various parts of the legs were affected.     The affected areas of the skin were reddened.

A few weeks of aafentiialt in a mountainous area, daily walks of 6 - 8 hours (the rectal incident had already been eliminated), had a favorable effect on the rejection. It decreased.  Oertlich applied patient compresses covered with wax and fat rubs of sweet almond oil or cold cream, 2 times a week he took a lukewarm bath, in which he stayed for 1 hour.  When he returned from this two-week stay in the mountains and resumed his professional work, the rash soon worsened again.  All too soon it had spread again over a large part of the body, to the patient's great annoyance.  The hairy head, neck, ears, external auditory canal, part of the face, chest, abdomen, genitals, neck were mostly covered with it, as well as the armpits and part of the thighs.

In this condition I prescribed the flesh cure to the patient.  However, it was not used strictly and when after 8 days no substantial improvement had occurred, it was abandoned again and more vegetable food was consumed.  The adverse effect of the latter was so striking that the patient decided to try the meat cure again.  He now avoided bread completely, as well as flour foods, and subsisted almost exclusively on meat, meat broths, eggs and milk, allowing only some green vegetables and cooked fruit. After only 4 days on this diet, the appearance of the rash had changed considerably, the red areas of skin had become more massive, the watery secretion had become almost zero, as well as the formation of scales and crusts.  After 6 weeks the disease was almost completely gone.

A repeated attempt to eat bread again resulted in an aggravation as before; therefore, the patient soon returned to his meat diet, to which he owes his complete recovery.

The history given here might easily give the impression that this is not so much a psoriasis as an eczema.  For this reason I have called it Eczema squamosum, without attaching any importance to this name, but I have chosen it precisely because against the form of the disease described here, call it by whatever name you like, the animal diet was of definite benefit, while the relapse to vegetable food always showed itself by Becidive in the disease.

The response of 73 psychiatric outpatients to manipulation of their dietary intake of carbohydrate was studied with respect to symptoms of anxiety, depression, and dys-perception. In particular these symptoms were evaluated in three conditions: in ketosis, at the transition point from ketosis to non-ketosis, which I regard as an "Optimum Carbohydrate Level" (OCL), and at a higher carbohydrate intake, above 120 g per day. Ketosis was associated with improvement in 28 percent; the OCL was associated with improvement in 68 percent; and carbohydrate intake over 120 g per day was associated with improvement in 12 percent. Over all, 82 percent of the patients reported improvement when combined results of both ketosis and OCL are considered. On the other hand, 60 percent reported some adverse effects, such as fatigue, nausea, weakness, headache, and a few episodes of palpitations. These were all transient, and most were improved after administration of potassium salts. 

 The history and biochemistry of the ketogenic diet and its use in medicine, particularly in the treatment of epilepsy and also obesity, is discussed. The ketosis method of determining optimal carbohydrate intake appears to be a valuable addition to the practice of Orthomolecular psychiatry.