OBESITY 49 



purin-free diet, but it is important that at least 50 grams of protein should 

 be ingested, for otherwise there is danger of weakening the patient. This 

 amount can be readily supplied in the form of milk, green peas and beans, 

 with a limited amount of bread or cereal. Von Noorden, on the contrary, 

 advises the use of meats during the reduction, preferring an attack of 

 gout to the risk of cardiac weakness. 



Nephritics without renal insufficiency and cases of essential hyper- 

 tension may be reduced without limitation of protein. Cases with uremia 

 on the other hand are seldom fat, and do not require reduction. 



The use of thyroid extract in the treatment of simple obesity is seldom 

 necessary, and should be restricted to cases that resist reduction on a 

 greatly restricted diet. Such cases usually belong to the endogenous group, 

 but the distinction is not always easy. 



II. The Treatment of Endogenous Obesity. Diet and exercise are 

 important in this form also, but of themselves are not usually sufficient 

 to effect a cure. 



In the thyrogenous form, thyroid extract acts as a specific. It should 

 be given in moderate doses, three to five grains a day, over periods of 

 about eight weeks, with pauses of a week or two between. The effect of 

 the drug should be watched, marked acceleration of the pulse or glycosuria 

 indicating its withdrawal, or diminution of the dose. 



The obesity of hypopituitarism is sometimes remarkably relieved by 

 the administration of pituitary extract; in other cases no effect is ob- 

 served. Thyroid extract is sometimes efficacious. Surgical treatment of 

 the pituitary lesion usually does not relieve the obesity, for obvious rea- 

 sons. 



Obesity associated with syphijis of the thyroid or hypophysis may 

 be favorably affected by antisyphilitic treatment. 



The adiposity of dysgenitalism usually yields to dietetic measures, and 

 glandular therapy does not often help here. 



In adiposis dolorosa thyroid extract sometimes has a striking effect 

 both as regards the obesity and the other symptoms. Often, however, 

 it leaves one in the lurch, and then pituitary gland may be administered. 



