TREATMENT 177 



muscular exercise, and, best of all massage, are especially valuable. By light 

 clothing, the consumption of heat, and with it the metabolism of the obese, 

 may be decidedly increased. By clothing of this kind muscular exercise is 

 facilitated. In winter it is advisable to wear woolen underclothing. Unfor- 

 tunately when it is washed it generally loses its porosity, and with this its 

 greatest advantage, and thus becomes merely expensive. In summer, on 

 account of their great tendency to excessive sweat formation, the obese mostly 

 prefer porous cotton underclothing. 



A sensible mode of life in which moderation in eating and drinking is 

 maintained, and in which sufficient muscular exercise is secured, permits us 

 to predict with some degree of certainty that no superfluous body fat will 

 accumulate, and that, where already present, it will disappear. If an indi- 

 vidual predisposed to obesity will, after ridding himself of his superfluous fat 

 in this manner, adhere to the prescribed mode of life, he may expect that no 

 renewal of the accumulation of fat will take place in later life. 



I have endeavored in this article to suggest the methods known to us 

 to-day of which we may avail ourselves in assisting the obese to regain their 

 health without discomfort. Nevertheless, in the prognosis the physician is 

 not to give way to illusions. In the course of years I have collected a con- 

 siderable number of experiences which show that there are many obese per- 

 sons who prove to be very satisfactory patients; who, regulating their mode 

 of life in accordance with the condition of their bodies, improve, and may be 

 entirely cured within a short space of time. It is not well, however, to be too 

 sanguine. Often all hope is shattered by the epicurism and foolishness of 

 these patients. Many of them, it is true, will submit for a certain time to the 

 deprivations and obligations to which their condition subjects them, but will 

 then return to the habits which have produced the obesity. If they belong to 

 the minority who are in good circumstances, they go in the summer time to a 

 "cure" which they expect in a few weeks to make them perfectly well. In- 

 stead of pursuing the course of life which experience has shown to be sensible, 

 and by which they may avoid the downward path to which their condition 

 inevitably leads, they quietly pursue their sluggish way. For eleven months of 

 the year they commit all sorts of dietetic sins, and then in the twelfth month 

 submit to a mineral spring treatment and bath cure which is to cleanse the 

 body and wash away all its burdens. I adhere to-day to the opinion which I 

 have always expressed that every cure of this kind, as well as every drug treat- 

 ment, particularly by means of purgatives of any kind, is to be rejected in 

 obesity. This is particularly true of the treatment which Kisch has desig- 

 nated as his method for the cure of the plethoric form of obesity (Kisch, " The 

 Cure of Obesity," Berlin, 1891, p. 113, et seq.), and I am strengthened in my 

 adverse opinion by the example which Kisch quotes to show the efficacy of his 

 method, namely, a loss of 11 kilograms and 15 grams of weight within twenty- 

 eight days in an uncomplicated case of obesity in a man aged forty-two years 

 and weighing 146 kilograms and 75 grams. This procedure is by no means 

 to be recommended. The cure, as practised by Kisch, consisted (apart from 

 the dietetic treatment which in the main corresponded to the no-fat treat- 

 ment) in the use of Marienbad mineral waters internally, for bathmg, m 

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