RESULTS OF THE DIETETIC - MECHANICAL TREATMENT - OBESITY.
If this dietetic-mechanical treatment of obesity, even in the ad vanced stages of the disease, but not in the final stages, is carried out according to the above rules, the result is without exception a cure, or in advanced degeneration or irreparable organic changes, the se curing of the very best possible condition. If the treatment is di rected according to the individual case, no further disturbances, and especially no fainting spells and no nervous excitation will appear. The physician has the whole process of fat-reduction well in hand and can regulate it, retarding or hastening it as the conditions pres ent indicate.
Since a too quickly progressing fat-reduction and decrease in the quantity of body albumin may favor inanition and conditions of weak ness, it is recommended that the fat consumption be carried out slowly and not too extensively. Where at the same time an abnor mal collection of fluid in the body, hythyemic and serous plethora, is present, the danger that the condition which at first was but a latent hydrops will be transformed into the actual disease, will be avoided by decreasing the amount of fluids taken in and increasing the ex cretion of water from the body.
This danger is all the more liable to occur the more the amount of fluid taken in is unrestricted, and it is even worse if the quan tity is increased while the heart power is insufficient and the excretion of urine is diminished.
As the reduction process advances, especially where fat and water in the body are reduced at the same time, the habitus and the appear ance of the patient change. In cases of plethora in young patients and those having hereditary predisposition, loss of weight and bulk takes place but slowly, and the skin filled out by the masses of fat is still in a condition to shrink over a limited surface. The circumference of the patient's body will be decreased in all its parts; he will usually appear younger in looks, but in rare cases older. If, on the contrary, the obesity has existed for a longer time, and has led to anemic states, and to accumulation of water in the blood and iu the tissues, and if the patients are in advanced life, and have a bloated appearance, with fatty masses presenting a flabby and doughy instead of a firm and solid feel, and if the loss of weight, especially that due to abundant excretion of water, has been rapid and marked, the yatient will seem to be debilitated and he will impress one as being ill on account of his flabby skin which is little or not at all reduced in extent of surface, is pale, and frequently covers in loose folds parts of the body which have become considerably reduced, especially over the face and neck. On the other hand the patient
feels himself in reality at last freed from his previous ailments, his circulatory disturbances which weighed him down, the heart is stronger and the dyspnceic oppression comes now seldom or not at all, and the ability to work reappears in conformity to his age, often in a most unhoped-for manner. Thus it may come about that the patient's friends worry and pity him on account of the contrast he presents compared with his former condition, when, though suffer ing considerably from the far advanced circulatory disturbances, he was envied for his fat appearance and his ruddy complexion (which was, however, really more cyanotic) and was believed to be in good health.
The disappearance of such changes in the habitus and looks and the harmonizing of these with the actual normal or almost normal conditions of health can only be effected after a longer period, not infrequently requiring half a year to a year. If the disease be so far advanced that medicinal treatment has to be resorted to on account of life-threatening conditions, there is no longer room for the treatment of obesity.
The result of combating these conditions depends then only upon slight palliative action of the few medicinal remedies with which we are accustomed to meet the same symptoms under other circumstances.
The great number of deaths arising from fatty heart, heart paraly sis, arteriosclerosis, and dropsy are not ordinarily to be regarded as unavoidable consequences of disease, but for the most part are the result of conditions which the patient has brought upon himself and which he can avert by the use of sure means and methods, even in the advanced stages, if he has the will power to do so. In this re gard he is the master of his own health.