MEDICINAL TREATMENT OF TEE COMPLICATIONS AND THE FINAL STAGE - OBESITY.
There is in reality no such thing as a medicinal treatment of obesity. Only a number of intercurrent concomitant and dependent symptoms and complications, as well as those serious and hopeless conditions which usher in the final stage and continue until death, call for medicinal treatment.
The intestinal symptoms, accumulation of ingesta, persistent constipation and coprostasis, congestion of the portal system, require the use of more or less active cathartics. Here belong the various salts—Glauber, Carlsbad, Marienbad, which are to be taken in table spoonful closes in a glass of water, morning and evening. Further more rhubarb, aloes, jalap in powder or pill form, cold infusions of senna leaves (deprived of the resinous substances), castor oil, preparations of cascara sagrada in wine, tablets, or pill form, frangula, tamarinds, and still others. These medicines can be in tensified in action by a liberal supply of water in injections, or in jections of cathartic substances or glycerin, massage, or electricity.
Particular attention must be paid to intercurrent febrile disease. Since the loss of heat from the surface of the body caused by cooling off, or a cold bath, is less in obese patients than in others, the use of antipyretics by the mouth in requisite amount must supplement these therapeutic measures, with the proviso, however, that they do not weaken the heart. Any further modification of treatment is not indicated by the presence of obesity. We have only to carefully ob serve the condition of the heart in each affection and every phase of it, and all therapeutic measures must be regulated according to the existing strength of the heart.
Cold ablutions, cold rubbings, local baths, sitz baths, and other hydrotherapeutic procedures are furthermore indicated by the skin diseases dependent upon obesity, and exercise a favorable prophy lactic as well as curative effect.
Eczematous inflammatory processes, seborrhoea, require medicinal treatment on the one hand by dusting powders made from lyco podium or finely powdered starch, to which benzoic and rose oil may be added, dermatol, salicylic acid, tumenol, etc. Or, on the other hand, in a more serious eczematous condition, astringent salves of lead or zinc preparations, white precipitate, ichthyol, calomel, solutions of boric acid, tannin, sublimate, empla.strum diachyli Hebrfe, and others.
More advanced degrees of seborrhoea which cannot be removed by simple lotions will furthermore be favorably influenced by alcoholic or ethereal solutions, eau de cologne, etc. These ingredients dissolve a part of the sebum and thus remove it.
For pruritus the best remedy is tumenol sulphone, 1 to 20. If arte riosclerosis has developed, medicinal treatment is unavoidable aside from the dietetic-mechanical treatment which has to cope with this affection. For affections of the arteries sodium iodide, in doses of 15 to 30 grains per day, may be tried. This remedy alleviates further more the attacks of dyspncea and asthma caused by the sclerosis.
If uric-acid diathesis is present at the same time the alkaline waters, carbonate of sodium and lithium, the waters of Salzbrunn, Ober brunn, Wildungen, Fachingen, the Salvator Spring, Carlsbad, Miahlbrunnen, Vichy, Celestine are indicated, and their admin istration has to be regulated according to experimental researches which are first to be made in order to find out the amount of fluid which, when taken, produces the most extensive secretion of urine.
In cases of stenocardiac attacks nitrite of amyl 3 to 5 drops, nitroglycerin in solution (twenty drops of a 0.3 per cent. to 1 per cent. solution in 6 ounces water, three tablespoonfuls daily, or tablets' each containing 0.0005), nitrite of sodium (gr. xxx.— E; iv., three tea spoonfuls daily, the last to be taken in the evening) will often give the patient ease. If these should disappoint in action, small doses of morphine subcutaneously applied (gr. *) will remove the painful con dition or at least make it bearable. Mustard poultices, dry cupping, or the application of a hot-water bag over the heart region may abbre viate or alleviate the attack. If sclerosis and atheroma of the arteries of the brain have caused thrombosis and rupture of a blood-vessel (apoplexy), the treatment conforms to the gravity of the symptoms according to the localization and severity of the injury, following the lines of special therapeutics.
Should the heart weakness increase in the further development and final stage of the affection, and the ever-increasing dilatation fail to be compensated for by hypertrophy, and if oedema sets in, then the medicinal treatment with digitalis, strophanthus, and other heart remedies should be once more tried, especially after decreasing the amount of fluids taken, since these remedies are almost always more energetic in their action when administered in this way. Com pensation may thus be started or the -ever-increasing circulatory dis turbances may be held in check.
If one is no longer successful, or only imperfectly so, if the dropsy grows worse, and ascites, hydrothorax, and hydropericarclium come on, we still almost always get good results in the beginning by the use of diuretics or by employing surgical means, by tappings, scari fication, or the introduction of small trocars into the greatly swollen extremities, thus ridding the tissues of the accumulated fluid, and re lieving the patient for a considerable time; but at last these measures fail us too.
Should oedema of the lungs or paralysis of the heart make their appearance we may make local counter-irritation by mustard leaves, mustard hand baths, dry cuppings, and give internally ether, brandy, liquor ammonite anisatus, musk, castoreum, camphor by the mouth and hypodermatically (oleum camphorn). In this way we may post pone the catastrophe for a while until finally in the next attack or the next one after that death releases the sufferer from his deplorable condition.