OBESITY 47 



by obesity, the rate was plus 14 per cent. L. Zuntz(a)(&) has made a 

 careful study of the gas exchange in three women before and after castra- 

 tion for pelvic inflammatory disease. Two showed a normal rate, and 

 obesity ensued in one of them. In the third case, Zuntz concludes that a 

 definite lowering of the basal metabolism was present 16 months after the 

 operation, finding a diminution of the average oxygen consumption per kilo 

 of 20 per cent. If, however, only the lowest values for the oxygen con- 

 sumption are considered, the figures are the same both before and after, so 

 that even in this case it is hardly permissible to speak of a lowering of the 

 metabolism. In a case of oophorectomy for osteomalacia, Zuntz claims to 

 have found a lowering of .the metabolism two years after operation, but 

 since the patient lost 6 kilos in the meantime the very moderate reduction 

 might well have been due to undernutrition. In a later publication he 

 reports another case of castration for osteomalacia, with some lowering 

 of the oxygen consumption per kilo afterwards, but since the absolute 

 consumption was actually somewhat increased, and the patient gained 

 weight meanwhile, the basal metabolism was probably not affected. Two 

 female eunuchoids showed a normal gaseous exchange. 



Zuntz administered ob'phorin to all these patients, but was unable 

 to detect any effect on the basal metabolism. The observations of Loewy 

 and Richter therefore remain unconfirmed, at least so far as the genus 

 homo is concerned. 



It may therefore be concluded that obesity following castration is due, 

 so far as our present knowledge goes, to the same causes as ordinary obesity. 



The metabolism in obesity associated with disease of the pineal gland, 

 and in adiposis dolorosa, has not been investigated. 



The Treatment of Obesity 



I. The Treatment of Exogenous Obesity. Only the general prin- 

 ciples of treatment fall within the scope of this discussion. For the details 

 the reader may consult the excellent article by Locke(fo) and the exhaustive 

 monograph by von Noorden(o). 



The two most important points are diet and exercise. The weight may 

 be reduced by diet alone, but exercise is needed to maintain the tone of 

 the muscles, and to facilitate the loss of weight by increasing the total 

 combustion. A low fluid intake is neither necessary nor desirable, except 

 in cases with cardiac decompensation. Massage is of benefit to weak 

 patients, since it strengthens the muscles and thus facilitates the taking 

 of exercise. The direct effect is very slight compared with active exercise, 

 the oxygen consumption being increased by only ten per cent, or about 

 as much as by moving the fingers. 



In most cases it is best to reduce the weight very gradually, from five 



