AFTER - TREATMENT AND SUBSEQUENT MODE OF LIFE - OBESITY.
After the masses of fat accumulated to excess in the body have been burned up and the normal condition between the albumin and fat has been re-established, there remains the further task of preserv ing for the future the condition which has been attained.
The means and methods, especially the mode of life through which the patient has regained his normal state, must be kept up in their general outlines, and everything must be removed which might favor renewed accumulation of fat. The rules according to which the former patient must regulate his life consist, as did the treatment, in proper nourishment, i.e., diet, muscular activity, exercise, and finally regulation of the amount of fluids of the body.
u. Diet.—This has to be regulated in general according to the form of obesity previously treated, whether the plethoric, or the anemic, or the hydriemic form, and it must agree with the former diet under which the patient recovered. In the plethoric form the amount of fat and carbohydrates must be kept within a certain limit, while albuminous food must form the bulk of the meal. The amount of fluid taken in may vary between 1,500 and 2,000 c.c. according to the condition of the circulatory apparatus. It ought, however, to contain little alcohol, sugar, or malt. Strong wines are prohibited and but little beer is allowed. In the anemic form, where danger of a loss of albumin is still present, carbohydrates together with a suffi cient diet of albumin may be allowed in a somewhat larger proportion, since they greatly favor the preservation of the latter. On the other hand the amount of fat taken should be small. The list of liquids, which in women should never exceed an amount representing 1,200 to 1,500 c.c., can include strong wines and beer in small quantities, according to the state of nutrition and general condition of strength. They should be limited in amount or entirely omitted if the pa tient's state of health no longer requires them, or a sufficient forma tion of fat makes itself noticeable.
If hydnemia has already been in existence and if a loss not only of albumin but also of fat has occurred, fat as well as carbohydrates have to be admitted to the diet list, but only to such an extent that the patient never takes an insufficient amount of albuminous food.
In sclerosis, either already present or threatening, alcoholic bev erages must be avoided as much as possible and allowed only tempo rarily in adequate amount where there is indication for the employ ment of stimulants. The amount of fluid taken must be limited to the smallest quantity, 1,000 to 1,500 c.c., and is best regulated according to the results of experimental research.
Distribution of Diet.—According to my experience, which is the result of many years of observation, I will give the following general rules as regards the distribution of the diet, without anticipating rules for the individual case: Morning: A cup of coffee or tea with some milk, 150 to 200 c.c.,
and 75 grams of bread.
Forenoon : In cases of preceding anaemia and hydriemia one to two soft-boiled eggs or thirty to forty grams meat, cold or freshly broiled, 100 c.c. wine (in conditions of weakness, 50 c.c. of port wine, and a little bread).
Noon : 100 c.c. soup; 150-200 grams meat of various kinds, vari ously prepared boiled or broiled beef, veal, game, or fowl not too fat, salad or easily digested vegetables at discretion; likewise fish cooked without much grease, 25 grams of bread or some other fari naceous food, at most 100 grams; for dessert fruit 100 to 200 grains, best fresh or preserved (especially after Naegeli's method). For drink to litre of light wine or beer; some water.
Afternoon : Again 150 to 200 c.c. coffee or tea with about litre of water, bread about 25 to 50 grams if there is a desire for it.
Evening : Meat as above, or eggs, 25 grams of bread, possibly a little cheese, salad, and fruit. Beverages : Wine, with or without water, or beer, best taken some time after the meal, up to 300 or 500 c.c. Delicacies, oysters, caviar, etc., by reason of their nourishing qualities, may be eaten before or between meals, but so that they do not too much augment the total quantity of the food.
h. As to what concerns the second object of treatment, viz., the preserratiwt of the heart power, accumulation of albumin, and the burn ing up V the supeifiuous fat, the patient after recovery has still to pay special attention to exercise of the body and gymnastics : daily walks of an hour or more must be undertaken. In the spring, summer, and fall months he must visit a terrain cure resort or some other place with hilly surroundings, where it is possible to use paths of the proper incline such as he has become acquainted with from his pre vious stay at a terrain resort. In winter or in unfavorable weather gymnastics performed in the various institutions, home gymnastics, or Swedish movements, work with the ergostat, splitting of wood, etc., must constitute the mechanical treatment. It must be left to the physician to regulate and watch the work.
c. Where the circulatory apparatus has suffered to a considerable extent, where congestions of its venous portion have made their ap pearance and entire compensation has not been effected, the regula tion of the amount of fluid taken in and the amount of urine excreted must be carefully watched by the patient after his recovery. Experi mental researches comparing the amount of fluid absorbed with that of the amount of urine secreted must be undertaken from time to time.
If the danger of a large accumulation of water in the blood and in the tissues reappears, it must at once be met by prophylactic and curative measures, consisting in diminution of fluids allowed and in stimulation of excretion, by encouraging perspiration, by advising climbing exercise, Roman baths, Russian baths, or by the hypoder mic administration of pilocarpine.