In the treatment of fatty overgrowth, the system introduced by Oertel, as I have observed personally, promises ex cellent results if faithfully employed. Among contra-indications that should be heeded are marked athcroma and chronic valvular disease of the heart, particularly in cases that have passed into the stage of "broken compensation. The method will "Ce briefly described, and comprises three parts: 1. The reduction of the amount ,of liquid taken with the meals and dur ing the intervals, the total for each day being 36 ounces (1064.0). Additionally, frequent bathing, and in suitable cases the Turkish bath and pilocarpine are employed to induce free diaphoresis. 2. The diet is composed largely of proteids, as follows:— 3f orning.—A cup of coffee or tea, with a little milk—about 6 ounces (178.0) al together; bread, 3 ounces (93.0).
Noon.--Three to 4 ounces (90.0 to 120.0) of soup; 7 to 8 ounces (218.0 to 248.0) of roast beef, veal, game, or poul try, salad or a light vegetable, a little fish; 1 ounce (32.0) of bread or farina ceous pudding; 3 to 6 ounces (93.0 to 186.0) of fruit for dessert. No liquids at this meal, as a rule, but in hot weather 6 ounces (178.0) of light wine may be taken.
Afternoon.—Six ounces (178.0) of cof fee or tea, with as much water. An ounce of bread as an indulgence.
rening .—One or two soft-boiled eggs, 1 ounce (32.0) of bread, perhaps a small slice of cheese, salad, and fruit; 6 to 8 ounces (178.0 to 236.0) of wine, with 4 or 5 ounces (120.0 to of water (Yeo).
3. Graduated exercise up slight eleva tions and inclines, the distance to be un dertaken each day being carefully speci fied, beginning with slight efforts and frequently, though gradually, increasing them. A similar plan is to be pursued with reference to the degree of inclina tion, and it is to be recollected that this is the most important part of the Oertel system, since it directly and methodically invigorates the heart-muscles.
The all-important element of the treat ment of obesity is that which has refer ence to overcoming the causal obesity. Here the diet should receive first con sideration. From this the stimulation of the bodily forces that oxidize and destroy the fat cannot be disassociated. These two measures in combination, if properly employed in individual cases, will serve to bring about a diminution in the body bulk, and tend to invigorate rather than weaken the patient. They may be briefly discussed in sequence for the sake of convenience.
(a) THE DIETETIC TREATAIENT.—The
ingestion of substances that are fat-form ing must be restricted. The principal systems of dietary are those known by the names of Banting, Ebstein, and Oer tel. In all of them the total amount of food is greatly diminished as long as there is an increase in the body-weight or a persistence of the sensations of dis comfort.
In "Bantingism" sugars, fats, and starches are greatly reduced in the diet list; water, however, is not restricted, and vinous and spirituous liquors are rather freely permitted. In those of a lithasmic, rheumatic, or gouty diathesis (often associated with obesity) Banting's heavy proteid and alcohol dietary is not to be recommended. It is best, I think, to exclude alcohol in most cases, owing to its effect in diminishing tissue-oxida tion and in retarding cell-metabolism.
In Ebstein's diet-list more than double the amount of fat and carbohydrates is permitted as compared with Banting's list, while the albuminous substances are diminished. Fat is freely allowed, while sugar and potatoes only are strictly for bidden. Oertel also allows more fat than Banting, but less fat and more (about double the quantity) proteids and car bohydrates than Ebstein. In addition to the 1 pint of water allowed in food, he permits 1 pint of free water daily. Oer tel's special diet-list in fatty infiltration, as given above, is based upon these facts.
Oertel's treatment of corpulence aban doned because the patients suffered greatly from thirst and hunger, and were disturbed in their general health; many of the patients so treated became severely neurasthenic and sleepless; the loss of fat was, in most cases, considerable for some weeks, but after that it seldom bore any relationship to the trouble and suffering caused by the dietary.
The following program has been found much more satisfactory:— 6.30 Ax.—Cold sponge; walking or other exercise for half to three-fourths of an hour. 7.30 A.m.—Breakfast: tea or coffee with cream; one slice brown bread thickly spread with butter. 3.15.— Vapor-bath every second day, alternated with cold bath. 9.30—One egg or a slice of fat bacon. 10-12.30.—Exercise. 12.3Q —Lunch: bouillon and egg; fat meat with salad, an apple, some brown bread, mineral water, and one thyroid tablet. 1.30 and then a cup of tea or coffee. 3.15-6.15.—Exereise. 6.30.— Cold douche. 7.—Dinner of proteid food and green vegetables chiefly; one thy roid tablet. Billiards or skittles may fill up the evening.