The object to be sought in reducing corpulent people is to take off the weight so that they are relieved from disturb ances attendant on the malady, and to accomplish it by the means that are least calculated to disturb the equilibrium. There should be nothing disagreeable about such a course; on the contrary, the patient should enjoy it and feel as each week or month passes by that he is gradually returning to his normal state; and that his faculties are getting keener for the rational enjoyments of life. The vitality of the patient should never be reduced. It should constantly increase. T. E. Satterthwaite (Post graduate, Mar., '99).
As the cause of the condition either in severe or slight form consists in tak ing in more fat-making food than the body can burn off, the treatment con sists in limiting food, both in quantity and in quality, and in increasing the combustion by accelerating the circula tion. Active muscular exercise is the best means of carrying out the latter point, but in severe cases the patients cannot take muscular exercise. In these massage is exceedingly valuable, but is alone not sufficient and must precede rather than supplant active exercise. The amount of food should be lessened in general by insisting that solids and liquids should be taken at different times. Many are apt to wash down food, especially farinaceous food, with out much chewing. if this starchy food were made dry,—like toast, rusk, and biscuit,—the quantity taken without the aid of fluid would be much less. Di gestion in the stomach has less tendency to form fat than when the digestive process is carried on in the intestine. This gives a good index of the kind of food most suited to these patients. It is necessary to secure active elimination of the products of combustion. Thyroid extract increases tissue-change and may be used to decrease obesity. But diet and exercise are safer and in the long run more reliable. T. Lauder Brunton (Medical News, March 22, 1902).
(b) The physical exercise (mechanical treatment) already mentioned is to be combined with the dietetic treatment.
If increase of muscular activity is pushed to a degree, the temperature of the body is raised, anaemia results, and there is a reduced capability of exertion. This may be avoided by artificially cool ing the body before the muscles are called into play. If a patient is treated for several days with cold sponge-baths, followed by steam-baths, the skin is soon brought into such a condition that this increase of temperature is avoided. Profuse excretion of sweat also assists in reducing the fat. After the steam bath the patient takes a bath in a tub, and then the prescribed walk. Later,
massage is utilized. This series of manipulations may be repeated twice, or, in some cases, three times daily. After the steam-bath, some patients are at once put into a cold tub-bath. By this treatment within a few weeks can be brought about a loss in weight of forty five pounds without weakening the pa tient and without altering the diet to any great extent. Winternitz (Med. News, Jan. 29, '98).
Restricted diet recommended, but one that is highly nutritious, this not de pending upon it for any marked reduc tion in weight. Gymnastic exercises with resistance recommended for all forms of fatty heart, since the resistance may be regulated to suit the weakest or the strongest heart.. Rest should never be indulged in after eating. Mass age proves efficient in promoting absorp tion of fat. The balneological treatment is very important. The baths usually get down to 76° F., and are increased :n length up to twenty minutes. Gradu ally increased concentrations of salt are used in the baths. T. Schott (Med. Record, Mar. 24, 1900).
It is especially in cases in which the subjective distress (dyspncea, palpita tion) is dependent upon cardiac dilata tion due to fatty overgrowth that Oer tel's system of graduated walking or climbing along "health-paths" is to be energetically recommended. The me chanical treatment is to be advised with extreme caution in cases presenting atheromatous vessels.
The well-known Nauheim or Schott treatment may sometimes be employed; but it is not to be thought of if there be present any of the more characteristic evidences of fatty degeneration of the heart. The medicinal treatment of obesity is far from satisfactory.
The use of thyroid extract is coming into favor with the majority of the pro fession, while being condemned by a minority. If judiciously employed, it offers good results in many cases. Leich tenstern, Wendelstadt, Ewald, and others have reported success in a num ber of instances, especially in those ex hibiting the anaemic, flabby, "myxce dematoid" variety of polysarcia. The loss of weight was two to three pounds in one week, and as high as twenty pounds in two to four weeks. In a num ber of my own cases belonging to this type of obesity the use of thyroid extract (desiccated) in small doses caused a pro gressive loss of weight ranging from two to six pounds per week, respectively, without impairment of the general health. The effect of this agent upon the circulation, particularly the cardiac action, must be carefully noted, and in some instances it is necessary to protect the organ against its disturbing influ ence by the use of stimulants and tonics (strychnine, digitalis).