OBESITY - MECHANICAL TREATMENT HEALTH RESORTS.
The mechanical part of the treatment is just as important as the dietetic, in so far as it has to do not only with extensive decomposi tion of fat accumulated in the body, but also with the preservation and increase in the general amount of albumin present.
The question of the possibility of maintaining the amount of albu min during the reduction treatment has been recently discussed from various sources. In the question before us we must above all not lose sight of the fact that not only the fat but organic albumin is like wise used up by muscular activity, and that consequently the increase in volume of the muscles, i.e., the main fund of albumin of the body, the flesh, depends principally upon the regular activity or exercise of the muscular apparatus. The heart makes in this regard no excep tion to the muscles of the rest of the body. (See Distribution of fluids.) The means and methods by which an increase in the muscular work is effected are of several different kinds but by no means of equal value. It is evident that the opinions of authors vary accord ing to their observations, whether made more or less exclusively in a gymnasium by the employment of machines, apparatus, etc., or with out these adjuncts simply making use of bodily exercise. In judging of these observations it is easily understood that they are ofttimes not made in a strictly unbiased manner.
Since the object of treatment is not only the diminution of fat, especially in cases of aummia and hydrtemia, but also the formation of blood and muscular tissue, and above all the strengthening of the heart and increasing the volume of its muscular walls, which are in a state of fatty infiltration, atrophic, and functionally insufficient, it follows that increased muscular power is not exactly caused by a large amount of work in itself, which besides might be the cause of dangerous conditions, but rather by the length of time during which the muscles are active. This manner of increasing muscular strength is the rule in all cases of debility of heart action. It is not sufficient that the patient goes through with a gymnastic exercise or active work for an hour or an hour and a half a day, because the amount of muscular work is too small to produce the necessary decomposition of the fat, and furthermore activity concentrated in this limited period, that is to say, intense muscular exertion kept up for a short time, is apt to carry with it the danger of overtaxing the heart. If we are to expect success ful results from our therapeutical methods muscular activity must be extended over at least four to five hours daily, best in the morning and afternoon hours. The reason for this is that the muscles are better nourished and absorb more of the food supply in direct proportion to the length of time muscular action is continued. If, as some authors claim, the success of the treatment for obesity is to be expected only after a long period, say a year, and if the patient is supposed to lose but a few pounds within such a time, it is no longer worthy of being called a therapeutical measure. The method to be chosen must make it possible to increase the muscular activity gradually from the least to the most intense exertion, either slowly or quickly covering the necessary period. The two indications in question, i.e., the decom
position of the fat and the preservation and increase of the albumin of the body, are best met by exercise which consists iu walking and climbing in open-air health resorts.
Such places make it possible to increase the exercise from a sim ple walk on the level for a certain length of time up to the climbing of paths having an incline of twenty degrees; beginning with a few steps and grpdually increasing to an hour's walk each morning and evening.
For those health resorts I have selected different places in various climates in order to permit of treatment being carrie d out at all sea sons, such places being chosen as offer the advantage of proper lay of. the laud for the walking and climbing exercises. These "health paths" are located partly in the plane, partly winding about hills, and are divided into four categories : Paths of the first order with an incline from 0° to 5° " " second " 10° " " third " 10° " 15° " " fourth " 44up to 20' The paths themselves are divided by columns, wooden poles and other signs into distances corresponding to fifteen (sometimes ten) minutes' normal walking time. This manner of dividing the path is absolutely necessary for measuring the amount of muscular exercise prescribed. If we let the patient measure the exercise by the watch, the work clone will rarely accord with the patient's strength and will not meet the indication of the given case.
The lazy and indolent patient will limit his exercise to the short est possible walk and do but imperfect and unsatisfactory work, while the overzealous walks or climbs in the same time possibly twice as much as is good for him, and thus overexerts himself.
By dividing up the paths in the way described we can regulate the mechanical element of treatment in the most accurate manner, and at the same time, in the individual case, we may increase the work ac cording to the indications, such as the state of the heart's strength and of that of the general muscular system, by advising a walk ou an incline from 0 to 15° and 20°, and from a short time up to a number of hours.
At these health resorts the paths are marked by differently colored signs ; the level paths are indicated by red, those having slight in cline by blue, and those of greater incline green or violet, and finally those of the largest admissible incline yellow. The time (10 to 15 minutes) is indicated by marks. There are a number of these resorts in Germany, Austria-Hungary, and Switzerland.
Patients who have already visited other regional health resorts and have some experience in gymnastic treatment may carry out a "terrain" cure also at Ischl and at various other places in the Salz kammergut and the Bavarian Alps. The measure of exercise to be performed may be regulated with a pedometer instead of in the way mentioned, but only if the patient has a good instrument at his com mand, which is not always the case. The so-called pedometers are mostly unreliable and fail to register, say, one hundred steps out of a possible one or two thousand, or else they record as a step the slightest movement of the body. In using these instruments on cer tain inclines they must always be carefully watched and controlled.