PROPHYLAXIS IN EARLY LIFE.
As to the first category we have to do principally with an heredi tary disposition. The children of such parents, according to the liter ature, already at birth show a high degree of adiposity, or they may take on abnormally large quantities of fatty tissue a few months after birth. When such cases come under treatment the physician has first to ascertain if the character of this adiposity, hereditary in that special family, is of the plethoric or of the aufeinic form, and in what manner this hereditary character manifests itself in the individual in question.
0. If the hereditary obesity shows itself in the family in the pleth ori• form and if a young or older child shows the unmistakable signs of this form, the dietetic treatment will consist principally in a dimi nution of the fat-forming substances in the dietary. The principles of treatment of obesity as formulated further on will here as well hold good, taking into consideration the age and individual conditions.
Children and nursing infants who are well nourished and full blooded, and whose progenitors suffer from the plethoric form of obesity, have to be raised on as rational a plan as possible, either on the mother's milk or artificial food.
If the mother suffers from obesity and at the same time is able to nourish the child, it is not advisable to permit her to do so, if it can be avoided, but it is better to allow the child to be brought up by a suitable wet-nurse in whose family no hereditary predisposition to this affection is present. If the child is, however, nursed by the mother, the diet of the latter must be so regulated as to exclude all superfluous fat-producing substances (especially beer in those coun tries where it is the customary beverage). The nurse's diet must also be similarly regulated, though strict directions are not required. If the child is raised artificially cow's milk is best used prepared with Soxhlet's sterilizing apparatus. Farinaceous substances and other infant foods of whatever name are to be altogether excluded so long as the child's fat-production does not sink below the norm.
After the first years are passed we must choose from among the various articles of food, according to their proportion of albumin and fat, those which are favorable to the retardation of fat-production. In cases where there is but little adiposity present the carbohydrates, butter, and articles prepared with fat are admissible. Where there is a preponderance they have on the contrary to be diminished as much as possible, and at the same time the child's growth, blood produc tion, digestion, powers of assimilation, the action of its heart, and the functional power of its muscular apparatus must be kept in sight and taken into consideration. In the later years, especially in youth and
adolescence, on entering upon the age of puberty, the conditions re lating to the development of sexual activity, as they affect the growth of the bodily tissues, are the indications according to which the in dividual has to be nourished. If there is little tendency toward obes ity iu these years, the supply of fat-forming substances must not be too much reduced. Furthermore it is important not to lose sight of the fact that the amount of albumin of the body depends upon the quantity of the fat, and that if the latter suffers too great a reduction, the body cannot preserve its required proportion of albumin, and the formation of blood will therefore soon sink below the normal. The muscular development will be retarded or diminished, so that the individual finds himself weak, powerless, and unable to work. The laws of nutrition must always be fresh in the physician's mind. The exertion of the muscular apparatus caused by activity and all kinds of gymnastics which heighten the nourishment of the muscles and re tard the accumulation of fat, are especially to be considered in boys and youths but even in girls this must not be neglected, nor put too much into the background whenever the education calls forth mental activity or where studies or more sedentary occupations prevail.
b. If the signs of are noticeable in infants at the breast or in older children in the first years of life, along with a pronounced obesity, preparations of iron are early indicated and should be given, according to the age of the child, in addition to a dietary which aims at regulating the amount of albumin and fat. In later years the activ ity of the muscles is to be stimulated in proportion to the existing functional power of the muscular apparatus. Mineral baths contain ing iron and salt baths should be prescribed to meet the indications furnished by the presence of scrofula. Sojourn in the fresh, pure air of the woods, mountains, or at the seashore, cold ablutions and cold frictions once or twice a day are advisable. Cool baths stimulate powerfully the circulation and increase the powers of resistance of the surface of the body against external injuries.
The influence of these measures upon resolution of the fat, and upon what is commonly called metabolism, must not, however, be too largely depended upon.