PROPHYLAXIS IN MORE ADVANCED LIFE AND AFTER EFFECTIVE REDUCTION OF THE FAT UNDER TREATMENT.
In this section we shall consider the prescriptions suitable for a patient whose surplus fat has been reduced to the norm by thera peutic measures, which will depend entirely upon previous changes in the organs which resulted in the accumulation of fat, and upon the condition of the organs after the consumption of the superfluous fat, especially taking into consideration the existing condition of the heart, the circulation, the blood, the amount of albumin, the activity of digestion, and the functional power of the muscular apparatus.
Prophylaxis, therefore, has mainly to be adapted to the individual case and has to be in harmony with the therapeutic measures, espe cially in reference to the dietetic-mechanical treatment under which fat reduction has taken place. We shall return to the subject of pro phylactic treatment after successful reduction, in a subsequent para graph.
The prophylaxis against adiposity in later years in adults whose condition of health is otherwise normal but who have an hereditary taint consists more in general dietetic measures, regulation of diet, promotion of muscular activity in order to quickly burn rip superflu ous fat-forming substances which have been introduced to the econ omy. The diet of such persons has to be regulated in the following manner : 1. So that the quantity of albumin is not imperfectly burned up in case the diet is maintained for a long time, i.e., for years. In the latter case uric acid would accumulate in the blood, especially if there should be present an hereditary disposition to the uric-acid diathesis and to gout. In the same way a too exclusive meat diet may produce dyspeptic symptoms, catarrh of the stomach, and diges tive disturbances. 2. The supply of fat and carbohydrates ought not to be diminished so that the fat which is normally present is attacked and the albumin of the body is thus endangered. The quantity and quality of food and liquids must be the same for patients as men tioned above, that is, must be the same as for those who have lost their superfluous fat by dietetic and mechanical treatment (see below). In regard to bodily exercise the same rules must be followed, and visits to health resorts and a prolonged stay in mountainous regions should be encouraged. Alpine excursions must be prohibited at first and ascensions of mountain peaks must be allowed only when the heart action is normal. Gymnastics, horseback riding, bicycling, rowing, swimming, if not carried out in too sportsmanlike a manner or to extremes, will increase the strength, the formation of body albumin and of blood, while the formation of fat will be limited by these measures.
Dietetic Treatment - TREATMENT OF THE ABNORMALLY INCREASED FORMATION AND STORING UP OF FAT IN THE BODY. a. In cases where there is an abnormally increased quantity of fat in plethoric patients with unimpaired or only beginning changes in the heart action, the diet prescribed aims at (1) increased supply of albumin; (2) decrease in the fat-producing substance ; and (3) little or no diminution in the supply of liquids below the physiological amount (1,500 c.c.).
b. Cases of adiposity in anaemic patients, viz., serous plethora. These require (1) an increase of the quantity of albumin, and simul taneously (2) a diminution of the fat-forming substances and even tually of the liquids taken.
c. Cases of adiposity in adults with hydrtemic symptoms, in whom not only the amount of albumin but also the abnormally in creased amount of fat is slowly wasting away. The nourishment of such patients requires, (1) together with the increase of albumin taken, a sufficient allowance of fat and carbohydrates, or even an in crease in the same, in order to prevent a sudden falling off of fat, and (2) a diminution of the liquids taken. The dietetic rules as laid clown by me for the treatment of general adiposity are based in the first place upon pathological changes in the heart and the amount of circulatory disturbance caused by the latter. In this way they differ materially from the dietetic rules formulated by pre vious authors. In order not to overburden the action of the heart and the circulation it is necessary to consider not alone the quality but above all the quantity of solids and fluids taken. If the circula tory function is disturbed only a slightly excessive quantity of both liquids and solids, or of water alone, will do harm. The usual con sequences, then, are a feeling of oppression, palpitation, dyspnoeic excitement of a sudden and distressing nature, and difficulty of breathing. After a too hearty meal or too free consumption of liquids death may ensue in pronounced cases even after slight exercise or bodily exertion through paralysis of the heart. It follows that the temporary amount of fulness of the digestive apparatus, its displace ment on the side of the thorax, and the overburdening of the blood by the food and liquids absorbed must determine the apportionment of the several meals. Only when these factors are kept in view, factors which bear upon the insufficiency of the heart and changes in the cir culation, can a diet based on increased oxidation of the body fat be thought of. In patients whose circulatory apparatus is relatively sound, that form of obesity which is purely of a plethoric character, the change in the quantity and quality of food as laid down in the rules governing the nourishment (see etiology), together with a change in the patient's manner of life, i.e., a change from too much rest and ease to muscular exercise and activity, are sufficient to produce an ex tensive reduction of the stored-up fat by oxidation, and at the same time to prevent an additional new formation of the same out of those articles of food which are least liable to be transformed into fat.