BALNEOLOGICAL AND HYDROTHERAPEUTICAL TREATMENT - OBESITY.
The so popular for ages, which yield cold alkaline and saline waters, such as Marienbad, Tarasp, etc., and which contain beside sulphate of soda, bicarbonate of soda in large quantities, can not be considered specifically efficacious in the treatment of obesity, a resulting decomposition of fat not having as yet been demonstrated. Cures with these mineral waters can only be looked upon as adjuvant to dietetic and mechanical treatment in the first stages of obesity, abdominal plethora, and chronic stasis of the large intestines. After the use of Glauber's salts and other salines the cathartic action of which consists principally in exciting intestinal peristalsis, the feces contain, according to Radziejewski's experiments, large quantities of peptones from the small intestine and of fat, and indeed in much larger quantities than is found normally. These substances escape digestion and absorption because of the excessive and violent peristalsis, and are thrown off without being made use of. The cures at Marienbad, Tarasp, etc., are in consequence essentially starvation cures, which prevent part of the nourishment from being used in the economy. Obese patients with anemia and hydrmia, whose quantity of body albumin has already suffered loss, and who no longer con sume an excessive quantity of food, always do badly under the process of throwing qff unused food substances containing both al bumin and fat-forming material, and the conditions of weakness promptly setting in prevent a continued extensive use of these mineral waters.
The cathartic mineral waters are only to be used in cases where a slight starvation cure can still be well borne, as in the plethoric form of obesity affecting individuals who are accustomed to the pleasures of a rich table with great variety of dishes and of drinks, and who have developed a chronic dilatation of the stomach and intestines. The discrepancy between supply and waste in these cases is corrected by the laxative action of mineral waters. The surplus taken in by
the mouth leaves the body unused, per anion. The action of the min eral water may be likened in its effect, mutatis mutandis, to that of the peacock feather used by the ancient Roman in his banquet feasts. The diet employed during these mineral-water cures, which aims more or less at a diminution of fat-formation and is far inferior in quan tity to the excessive diet of obese persons in general, suffers a further reduction through the alkaline and saline waters, and nutrition is correspondingly diminished.
Of advantageous influence, however, is the action of the waters mentioned above, upon the abdominal plethora existing in these cases, upon the stasis in the portal circulation, in the hemorrhoidal vessels, and in the disturbances of the stomach, intestines, and genito urinary apparatus, referred to in the chapter on symptomatology. The success which may follow is often very decided and is increased furthermore by a combination with walking and climbing exercise, or better, by a " terrain cure " strictly adapted to the power of the heart's action and the general strength of the patient.
We can sum up the indications for mineral-water cure briefly by stating that they are only to be recommended in the first stages of obesity of plethoric character, in disturbances of the portal system, and in advanced cases where these disturbances prevail.
In order to accomplish the above result it is absolutely requisite that the mineral water should not be retained in the system, but that it quickly produce emptying of the bowels and is thus eliminated. Therefore if catharsis does not take place the two other therapeutical effects, as pointed out above, are obviously excluded; now comes into consideration, on the other hand, the influence of increased fluid sup ply upon the heart and vascular apparatus as well as the effect of the sulphate of sodium contained in the water upon the blood.