176 OBESITY 



lished the results in the Deutsche medicinische Wochenschrift, 1899, p. 1. 

 When this treatment was introduced it became highly popular, but it proved 

 by no means so harmless as many at first maintained. I shall content myself 

 with the following statement in regard to it. I do not advise thyreoid treat- 

 ment in obesity because, in the first place, the loss of weight produced by it is 

 quite inconstant, and always ceases at once with the discontinuance of the 

 thyreoid preparation. Further, this method of treatment is not rational be- 

 cause the danger in the loss of body albumin is a considerable one. Finally, 

 it is quite unnecessary because we are in possession of dietetic rules for the 

 treatment of obesUy which are as successful as they are devoid of danger. 

 This view in regard- to thyreoid gland treatment in obesity seems now likely 

 to be generally accepted. 



In regard to the two other curative factors made use of by v. Hoesslin, 

 namely, hydrotherapy and augmentation of the processes of oxidation by 

 increased muscular exercise, there can be no objection to their use in conjunc- 

 tion with an appropriate diet. It must be admitted that when these curative 

 agents are wisely regulated by an able and experienced hand, and are indi- 

 vidualized, the result is not only hastened, but in many respects heightened. 

 R. V. Hoesslin, as physician-in-chief of the institution in New Wittelsbach near 

 Munich, certainly has the advantage of splendid facilities and has acquired 

 great experience. But with the remedial agents just discussed it is as true 

 as it is of the dietetic measures that a permanent result may only be expected 

 when the persons in question continue their muscular exercise. 



What is the character of the muscular movements which are of especial 

 importance in the treatment of obesity? Those especially should be prac- 

 tised which will influence most favorably, and to the greatest extent, the total 

 metabolism, i. e., muscular movements in which most or all of the muscles 

 are brought into action, as in the so-called free exercises of German turners 

 and in exercises with gymnasium apparatus. The former, because they call 

 for only a comparatively slight use of power, are particularly suitable for 

 persons with feeble muscles. 



Muscular exercises of this kind practised in the open air, passing grad- 

 ually and regularly from the light to the severe, are preferable as a rule to the 

 exercise involved in games or sport. The latter may only be prescribed for 

 the obese when they can be practised in moderation, and when they call for 

 the most varied action of all the muscles. In permitting the practice of any 

 sport we must make sure of course that there is a sound, competent heart and 

 normal kidneys. This is especially true of Ucycling, which is now in such 

 vogue. But for obese persons of active habits, the best form of exercise is 

 manual work performed in the field or the garden. This is, after all, the 

 most natural. Besides this, walking, especially in a region of diversified scen- 

 ery, mountain-climbing, and all sorts of mountain sports, provided always the 

 heart is normal, are factors not to be underrated in the treatment of obesity. 

 They are much preferable to spas and water cures, but need, nevertheless, to 

 be carefully controlled. A weak heart which, even when the patient is at 

 rest, does not function properly, cannot be expected to endure the strain of 

 muscular exercise and exertions of this kind. When the heart is weak, passive 



