636 POPULAR SCIENCE MONTHLY. 



For those who habitually ingest too much rich and nitroge- 

 nous food and take too little exercise, whether suffering from typ- 

 ical gout or not, the systematic use of the muscles, together with a 

 less hearty diet, is of the greatest value. It should be remembered, 

 however, that when gout is developed, severe or unaccustomed 

 exercise may precipitate an attack ; systematically and judicious- 

 ly employed in the intervals, exercise will tend to ameliorate the 

 condition and prevent the recurrence of attacks. In diabetes, 

 another disorder of imperfect metabolism, it has not been suffi- 

 ciently appreciated that the surplus of sugar may be largely oxi- 

 dized through carefully prescribed exercise. Walking is the 

 most convenient form, and the amount should be graduated ac- 

 cording to the patient's capacity and training. The aversion of 

 the diabetic to exertion may be overcome by allowing limited 

 amounts of bread as a reward for each mile walked. Those who 

 have tried this plan find a decided advantage over a stricter diet 

 and insufficient exercise. 



The relation of exercise to the treatment of cardiac and circu- 

 latory affections has entered on a new phase since Oertel's original 

 work. The dominant idea had been hitherto to relieve a weak 

 or damaged heart of strain by avoiding exercise. Oertel teaches 

 that the work of the staggering or flagging heart may be cut 

 down by reducing the amount of ingested fluids, and the heart 

 trained and strengthened by graduated daily exercise in walking 

 on level and sloping paths. The results reported confirm the 

 value of the method, and it is hardly too much to say that by 

 accurately dosing and systematically applying this common ex- 

 ercise to meet the need of individual patients he has not only 

 given the profession a valuable remedy, but a new point of view 

 in the treatment of these serious affections. Oertel's cases are 

 largely those of cardiac debility from imperfect nutrition of the 

 heart and system, evidenced by fatty deposits in or about the 

 heart, and not rarely elsewhere. This condition is usually the 

 result of a too inactive muscular life, and in Germany is often 

 associated with the ingestion of large quantities of beer, so that 

 the ill-nourished heart has an increased amount of fluid to pump. 

 In such cases a large reduction of ingested fluids is a necessity 

 while attempting to invigorate the heart by graduated and 

 divided doses, at first small, of walking and climbing exercise. 

 Where valvular disease, with or without dilatation, presents 

 similar indications, a similar course may be followed, but such 

 prescriptions must be made with accurate discrimination and 

 analysis of the actual state and needs of the economy. 



