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Obesity - Prognosis

fluids, quantity, secretion, favorable, patient, increase and urine

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OBESITY - PROGNOSIS.

Varying according to the causes, form, symptoms, and complica tions, the prognosis of obesity cannot be always uniform, but will present itself in all transition stages from one which is relatively or even positively favorable, up to one which is decidedly bad.

According to the fundamental causes, the prognosis depends iu the first place upon the hereditary disposition, or upon the distur bances of nutrition acquired by an unsuitable manner of living; in case of the latter it will be much more favorable than in the case of the former. The prognosis also varies with the form of obesity, and in case of true plethora is comparatively better than in the anaemic form. Of decided importance here is the individuality, since the essential results depend upon the patient's obedience and upon his subordination to dietary rules and upon his subsequently following out a suitable mode of life. The prognosis is most favorable in cases of the inherited form of obesity which comes on in the first years of life, where it is not very difficult to bring the children into a normal state of nutrition by proper regulation of the diet.

If on account of heart-insufficiency there exist any more or less extensive disturbances of the circulation, or if hydrminia or accumu lation of water in the blood and tissues is already present, the experi mental comparison of the amount of fluids regularly taken and of the quantity of urine regularly secreted within the twenty-four hours will supply the most reliable indications.

For this purpose the patient should take during two clays, for instance from S A.M. of one day to 8 P.M. of the following day, as much fluid as he is accustomed to, but this as well as the secretion of urine is to be measured and the amount written down together with a statement of the time within which both obervations have been made. After this for the next two clays the fluids taken ought to be reduced to 700-1,000 c.c., according to the size of the patient, especially with regard to the condition of his vascular apparatus, and the same notes are to be again made. If now with the reduced amount of fluids taken, a plus quantity of the urinary secretion, especially if a considerable increase of the same is produced, we can always draw the conclusion that the heart-power is not as yet too much weakened, and that the function of the kidneys is not much disturbed, therefore the prognosis will be the more favorable. That

will be all the more the case, if not only a relatively, but even an absolutely greater quantity of urine is excreted than when the patient was taking a disproportioually larger quantity of fluids.

But if by reducing the fluids not only no increase takes place but a very considerable minus quantity is noted, we may always consider this result of the experimental observation of unfavorable prognosis as to the course of the affection. On the other hand, if the quan tity of the urinary secretion is but a little under that of the fluids taken, it is to be considered as an increase compared with the nor mal secretion, because normally about 18 to 20 per cent. of the water of the fluids, taken as such, as well as the water contained in the solid food, is used up in respiration and perspiration, and a reduc tion of these percentages is to be considered an increase of the uri nary secretion.

Of prognostic importance is also the condition of the circulatory apparatus (hiring such physical exercise and muscular work as are re quired in walking and climbing. The prognosis becomes unfavorable when the heart muscle no longer reacts to motor impulses produced by physical exertions, when the pulse instead of becoming more fre quent and stronger becomes threadlike overfreqnent or irregular, and when, instead of as strong or at least plainly perceptible palpita tion, there is only dyspncea, excitement, oppression, and labored breathing.

When a patient subject to obesity is attacked by intercurrent febrile diseases, the prognosis of the latter is unfavorable as com pared with febrile diseases of equal gravity in other persons, for the reasons above mentioned. Furthermore, convalescence and recovery are very apt to be slow and incomplete, because of weakened regenerative power and slow formation of red blood corpuscles.

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