It is therefore always necessary to regulate the quantity of the mineral water exactly according to the result of experimental research and to subtract it from the total amount of fluid which the patient may be allowed. Experimentation will demonstrate whether distur bances of circulation have taken place through the inability of the vascular system to accommodate itself to the fluids taken in and to excrete the same.
A course of mineral water doubtlessly yields better results if car ried out at a watering-place than if attempted at home under the usual conditions which have been only slightly changed. At the resort the patient not only takes his daily quantity of water regularly as prescribed, but the diet also is perfectly adapted to the treatment. Furthermore example and the disquieting stories in circulation among the guests concerning the bad consequences, for instance, catarrh of the stomach and intestines, colics, diarrheeas, and other distressing conditions caused by overloading the stomach, prevent even the gour mands who are accustomed to a bountiful table from trespassing be yond the prescribed diet limits.
Likewise there are provided at these places walks, and the strict advice of the physician and the emulation of the patients among themselves induce even the easy-going and lazy patient, in the ma jority of cases, to perform sufficient bodily exercise to reduce his weight by a few pounds at least.
Since the patient, after having gone through a mineral-water course, relapses into the old routine life, it is necessary to repeat the cure, as a rule, the following year.
After some years, however, disagreeable consequences follow either gradually or suddenly with the usual decrease in weight of greater or lesser extent. After a limited use of the strongly cathartic min eral waters, which cause the albumin as well as the fat-forming sub stances to leave the intestinal tract without having been of use in the economy, the patients feel extremely weak and debilitated. The phy sician as well as the patient himself under these circumstances be comes afraid to continue treatment in the usual manner. Changes are made in the quantity and quality of the mineral water, and after a time their use is entirely given up and some other method of treat ment is tried.
The reason why this peculiar change takes place during a course of mineral water, lies in the transition of the plethoric form into the anemic and hydrmmic, which means a considerable decrease in the amount of albumin of the body, a growing insufficiency of the heart, and an accumulation of water in the blood and tissues. If in such cases the cure is continued in spite of these warning symptoms, dropsy will soon develop and the life of the patient will be imme diately endangered.
For the ancentic form of obesity the indications have also been for mulated—the use of slightly cathartic mineral water containing at the same time a certain quantity of iron. For instance, the waters at Franzensbad, Tarasp, Kissingen, Wiesbaden, Cudowa, and others. The success which has been noted following the use of these waters is not so much due to the tonic effect of the iron in the water as to the general dietetic regipie carried out at such resorts.
Besides these, many other both natural and artificial iron waters and iron preparations are made use of : the waters of Levico (weaker and stronger springs), Roncegno, the Guberquelle (containing iron and arsenic), pyrophosphate of iron water, etc. ; Blaud's pills, ferri albuminas and Ferri manganas, the hemalbumin and hemoglobin preparations, and still others.
Hydrothe•vy is often employed in the treatment of obesity. The real benefit derived from cold as well as from hot steam baths is very slight, according to the experiments of Rubner made upon the regulation of heat, and especially in reference to such baths. I have pointed this out in my " General Therapy of Circulatory Distur bance," 4th edition, p. 320 et seq. With cold baths of 15° C. and of a quarter-hour duration (the extreme possible limit), 10.7 grams of fat are decomposed (Rubner) and this figure is increased to 19.7 grams through the cooling-off process and the after-effects. Ten baths of a half-hour's duration each will only decompose 394 grams of fat, and in order to use up four kilograms of fat one hundred such baths would be necessary, provided any one could stand such continuous bathing. This shows the slight effect of such baths where we have to deal with a body weighing from 110 to 120 kilos (240 to 2G0 pounds) and over. In steam and hot-air baths decomposition of fat is at any rate so slight that they have practically no therapeutic value. The great loss of weight noted after such baths has for its explanation, according to Rubner's and my own experiments, the extensive loss of water during the sweating in the baths. Cold baths are, however, to be made use of as adjuvant, stimulating, and generally invigorating means. They may be so combined with the terrain cure, Le., the fat-reduction through walking and climbing exercises, that the time of the after effect of the bath is made use of for such exercises. At. this time, the regulation of body heat and the whole circulatory apparatus are under the influence of the cold water just used, the effect of which is added to that of the terrain cure. The action of the heart has been strengthened by the thermal stimulation. The heart beats slower, the blood is driven into the dilated network of pe ripheral arteries under a stronger impulse and remains longer in the cool skin (Winternitz).
Dry warm-air baths, hot-air baths, and Roman. baths are princi pally to be used in ancemic and hydiwinic cases in order to reduce the amount of water accumulated in the blood and tissues. They must be employed in combination with a decrease in the supply of liquids as mentioned above. Steam baths are not so well suited to obese patients with circulatory disturbances, since the air saturated with steam frequently interferes with respiration and causes dysp nceic symptoms and asthma. The number of Roman baths allowed ought not to exceed three per week. The patient remains under con stant observation of the physician and undergoes frequent examina tion. Threatening symptoms from the side of the brain, the respi ratory, and the circulatory apparatus obviously contra-indicate the use of these baths.