THE CONSERVATION OF ENERGY. 411 



more particularly, there is oftentimes a sudden gain in weight, some- 

 times to a very annoying and disabling degree, following the change 

 of life. This is an abnormality, and is sometimes based upon patho- 

 logic changes in the thyroid gland analogous to myxedema. In men 

 at about the same relative period an enormous gain in weight occa- 

 sionally arises and is a serious annoyance and anxiety. A few points in 

 regard to the control and reduction of this warrant discussion, although 

 they need not be elaborated. Where this gain in weight seems to be free 

 from any abnormality except difficulties in the elimination or utilization 

 of fat, it is proper to initiate active treatment by careful diet accord- 

 ing to the methods of Banting, Ebstien, Oertel, along with specially 

 directed exercises. In persons who are obviously not vigorous, as in 

 those instances where marked anemia is present, there should be a care- 

 ful search for evidences of disease beginning, or established, and treat- 

 ment for the condition outlined accordingly. Von Noorden emphasizes 

 the necessity of being on our guard in treating conditions of obesity 

 which arise in women from fifty to sixty years of age. The greatest 

 precautions must be used in dealing with these, because under almost 

 any regime they will lose strength, frequently to an alarming extent, 

 and what is more fail to regain it. The same statement holds good, to 

 a less degree, in men of the same age. It would be interesting to 

 formulate the different kinds and degrees of obesity and the pathologic 

 changes which often accompany this state, forming it may be the cause 

 on which the obesity arises, or again the results, direct or indirect, of 

 the excessive weight. It is enough for our purpose here to offer some 

 directions as to how this objectionable state may be relieved without 

 producing harm. First, it is necessary to bear in mind that under the 

 direct advice and continued attention of the physician is the only safe 

 mode of procedure. Where there is found, as often happens, marked 

 weakness of the heart and circulation the greatest care must be observed, 

 and measures should be adopted having direct regard for the possi- 

 bilities of the individual and varied from time to time under intelli- 

 gent supervision. It is always a dangerous thing for persons to under- 

 take their own treatment for obesity if they make use of drugs, because 

 great harm can be done ; it may be irretrievable. There is no objection, 

 however, to moderating the diet, increasing exercise, and, above all, to 

 employing systematized physical training for the purpose of improving 

 elasticity in all the tissues. It is only safe to do so under medical 

 advice. Oertel in 1885 and after, has done work which marks an 

 epoch. The principle upon which he proceeds is that even where 

 there is found to be pronounced weakness of the heart muscle, and 

 other disturbances in circulation, these may be met by steadily in- 

 creasing the amount of physical work done, especially by hill climb- 

 ing. This walking up slopes has the merit of bringing out skin 



