68 OVER-NUTRITION AND UNDER-NUTRITION 



will always be beneficial to the whole body. It will be noted that this favorable 

 opinion is based upon a number of provisos which, although apparently sim- 

 ple, require careful consideration and good judgment. 



'l shall mention only the most important of the indications as these have 

 been elsewhere extensively discussed.^ 



1. Simple obesity in otherwise healthy persons.— (a) Extreme obesity is 

 almost always an indication for an antifat cure. The dangers which may 

 result from a further gain of fat are great, and we must endeavor to prevent 

 them. Certain modifications are required by the age of the patient. In chil- 

 dren and in adolescents up to about the twentieth year, we should be content 

 with preventing an extreme development of obesity, and only from time to 

 time, during short periods of from four to five weeks, should an effort be made 

 to reduce the superfluous fat (intermittent antifat cures). In the aged antifat 

 cures are prohibited, as almost invariably there is a rapid loss of strength. 



(&) Moderate obesity (body-weight about 15 to 25 kilograms above the 

 average for the age, sex and height) is most frequent and at the same time 

 best suited for treatment. In most cases it can be let alone without any great 

 danger to health, but it cannot be denied that corpulence brings many evils 

 in its train; for if any acute disease occurs (infections, diseases of the heart, 

 of the lungs, of the kidneys, the joints, etc.) or after unusual exertion (such 

 as over-strain of the heart) the obesity may become dangerous. Here, also, 

 the rule holds that in the aged this treatment must not be attempted, and 

 in childhood and in youth only in slow tempo and with the greatest caution. 



(c) Slight obesity (body-weight upon the average 5 to 15 kilograms above 

 the normal) in healthy persons never necessitates an antifat cure, but, if the 

 corpulence steadily increases, measures may be taken to check its further 

 development. ISTevertheless, very often, particularly in women, the aid of a 

 physician is sought because of a desire to reduce weight and to attain slen- 

 derness. In many cases the physician will all the more willingly comply 

 with the wishes of his patients as he may thus gain control of their entire 

 mode of life, in which usually much should be amended. Although in the 

 effort to reduce early obesity, and in the timely regulation of detrimental 

 habits, vanity rather than bodily ill is sometimes the motive power, we as 

 physicians should not criticise this. It may amuse us, but it must be wel- 

 comed as a therapeutic opportunity. 



Care is always necessary. Many a woman, as the result of a too rapid and 

 too far reaching antifat cure, acquires in exchange for her moderate corpulence 

 various derangements of the abdominal organs, such as constipation, ruptures, 

 gastrectasis, movable kidney, sometimes also of the uterus; or, after the dis- 

 appearance of fat, the liver and gall-bladder are more exposed to the pressure 

 of the corset, the flow of bile is impeded, and gall-stones result. All these 

 evils are much more frequent in slight corpulence than when it is marked. 

 In the latter the antifat treatment is rarely carried to such an extent that 

 decided pressure changes occur in the abdominal cavity; enough fat always 

 remains to protect the viscera and preserve them from injury. 



1 V. Noorden, " Sammlung Idinisclier Abhandlvmgen," Heft 1, Berlin, 1900. 



