THE TECHNIC OF OVER-NUTRITION AND UNDER-NUTRITION 69 



It may be said in general that slight obesity does not especially demand 

 slow and careful reduction of weight, although, to prevent excessive corpulence 

 and for many other reasons, this is often very desirable. 



2. Indications for antifat cures when obesity is complicated by other 

 diseases. — Diseases of various kinds, from slight functional disturbances of 

 vital organs to severe anatomical changes, may influence the physician in his 

 decision of the antifat question. More frequently than otherwise, it is the 

 complicating conditions that we meet which lead us to combat obesity. 



Such complications may lead us to undertake an antifat cure when if we 

 found a normal condition of all the organs there would be no indication for 

 treatment. 



Among the disturbances whose course and prognosis are influenced by 

 obesity, and which for this reason may necessitate the reduction of moderate 

 and even slight corpulence are the following : 



Disturbances of the organs of circulation, such as valvular diseases, myo- 

 carditis, myocardiac degeneration of the heart, fatty heart, or better, cardiac 

 weakness in obesity, arteriosclerosis, aortic aneurism, etc. 



Eenal diseases, particularly contracted kidney, on account of the implica- 

 tion of the heart and the arteries which is always associated with it. 



Certain chronic diseases of the respiratory organs, such as chronic bron- 

 chitis, pulmonary emphysema, extensive bronchiectases, bronchial asthma, 

 adhesive pleurisy; kyphoscoliosis also may be here included. 



Chronic articular rheumatism. 



Gout in all severe forms. 



Other diseases characterized by loss or difBculty of motion or locomotion, 

 for example, hemiplegias, chronic diseases of the spinal cord, some cases of 

 peripheral paralysis, many surgical affections of the bones and joints, large 

 varices, chronic ulcer formation upon the leg, deformities of the lower 

 extremities, etc. 



Diseases of the nervous system. That neurasthenics and hysterical per- 

 sons in general are in better condition when their fat is somewhat profusely 

 developed has already been mentioned; therefore these are the patients who 

 frequently require forced feeding (see above). But as these neuroses do not 

 always disappear under forced feeding, neither does corpulence always pre- 

 vent their appearance. Where the neurosis is combined with corpulence, care- 

 ful antifat treatment and the re-establishment of the normal nutritive con- 

 dition may be indicated, and may be as potent in relieving the neurosis as 

 forced feeding is in thin, poorly nourished persons. 



6. REMARKS REGARDING THE TECHNIC OF OVER-NUTRITION 

 AND UNDER-NUTRITION 



It is an old axiom which constantly demonstrates itself anew that dietetic 

 cures originating with this or that author, and advised for this or that disease, 

 degenerate in practice into mere formulaj. The " cure," the method, is forced 

 upon the patient, instead of the method being adjusted to the patient and its 

 main principles applied to the unending variety of cases. Boutine precludes 



