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most eminent practitioners and teachers. A reference to one of these you may find in Horace, who in his first book, Epistle VI., speaks of Antonius Musa, who much to his spiritual disgust but physical betterment treated him at Baiae by cold baths in midwinter. We have it on the authority of Suetonius that Musa restored the enfeebled Emperor Augustus to health by a rigorous cold water treatment, after other physicians had failed, and that the grateful Cæsar bestowed upon him and upon the entire medical profession the privilege of citizenship and ordered a statue to be erected to him by the side of Esculapius.
Of Galen, too, every well informed layman has knowledge. He ranks next to Hippocrates as the most eminent physician and medical author of antiquity. He was the body physician of the Emperor Commodius. The influence of his teachings was lasting. Galen was a warm advocate of water as a remedy; he furnishes in his twelfth book philosophical explanations of its action in fever, which are in almost perfect accord with the ideas prevailing at the present time.
Another scholar of Esclepiades, the water doctor, was Cornelius Celsus, who advises baths and ablutions in fevers. In the third book of De re Medica he details such cases and makes an observation which I have had frequently to emphasize in recent discussions, viz., that the early stages of acute disease offer the most valuable field for the application of water. That he, too, was not an Empiric is attested by the fact that he was the bosom friend of Cicero and Fabius Maximus.
In those days of intellectual gloom, which followed the destruction of the Alexandrian library and school and the downfall of the Roman Empire, medicine also suffered from the universal intellectual decay. But not for long. From 561 to 634 appeared Alexander of Tralles and Paulus Ægineta, who were regarded as the greatest physicians of their time. They cast aside the teachings of the schools, which had been blindly followed, and demonstrated a true philosophical spirit by regarding every case as a distinct problem and being guided in its treatment by the age, constitution and mode of life of the patient. These wise physicians were enthusiastic advocates of water in the treatment of many diseases. Indeed, Paulus Ægmeta first suggested the cold douche in sunstroke.
In the middle ages water was rarely used as a remedy. The only prominent advocate of this time. was Savanarola, the grandfather of the unhappily famous professor of Ferrara. Harvey opposed the water treatment and Von Belmont said that there
must be a cause for the fever which should be removed, and that its treatment by cold water only combats the heat, which is a secondary consideration. To-day we know that there are other important effects from cold baths in fever, besides the valuable one of temperature reduction. In the seventeenth century, D. Floyer, an Englishman, wrote a remarkable treatise entitled: "Psychrolusia," which was translated into several languages and which was instrumental in restoring water to its proper position as a remedy in disease. The most illustrious physician in EuropeFriedrich Hoffman-was induced by it to teach hydrotherapy from his chair in the university, and thus disseminate it in France, Italy and England. Twoother English physicians-Drs. Wright and Currie— have exercised great influence by their scientific application of water in acute diseases. Their works, like that of Floyer, were extensively translated and became the means of enlisting men like the great Hufeland in Germany and Mylins of Russia in the
It is singular that although the most valuable contributions to this subject in modern times emanated from English physicians, the water treatment is at the present time least known and appreciated in English speaking countries, as will be shown later.
The value of water in chronic diseases although from time to time acknowledged by eminent medical authority, remained to be clearly brought out by a layman.
Vincent Priessnitz, an uneducated peasant, recognized its value by empirical observation, and devised various methods of application, many of which have attained a permanent position. He established an institution at Graefenberg. His success was phenomenal. By this talisman he attracted enormous numbers from all ranks of society, physicians being among the number. The lack of physiological and pathological knowledge led him into many errors and excesses. Regarding water as a universal curative agent, which purged as it were, the disease-producing impurities from the blood by critical eruptions and excretions, his aim was to produce the latter. He was and is still followed by a large number of hydropaths, water cure doctors, natural physicians, etc., who loudly proclaim the virtues of water as a panacea for all ills and indignantly spurn the idea of influ encing disease by any medicinal agent. In their zeal to line their pockets, they inveigh against educated physicians as purveyors of poisons which destroy the blood and point to the simplicity of their treatment in contrast. It is to be regretted that the medical profession has permitted these gentry to create a distrust in the value of water, a remedy which even the fathers of medicine taught centuries ago. I fear that a
false dignity is at fault here and has led to this estrangement from a remedy honored by Hippocrates, Celsus, Galen, Hufeland, Hoffman and other justly eminent men. Germany is to-day taking the lead in restoring water to its legitimate place in medicine. Hydrotherapy is now pursued as a specialty of many educated physicians, and it is taught from one of the chairs in the largest university (Vienna).
In this country, I regret to say, great and unreasoning prejudice still exists against hydrotherapy, which it shall be my mission to aid in removing.
To-day the most eminent teachers in Europe do not hesitate to proclaim the value of water as a remedy in disease. History repeats itself as it never has done in any question of medicine before.
HISTORY REPEATS ITSELF.
What Hippocrates and Esclepiades, Galen and Celsus taught 2,000 years ago is now taught by Ziemmssen in Munich, Winternitz in Vienna, Fræntzel in Berlin, Du Jardin-Beaumetz and Peter and Charcot in Paris, and Semmola in Naples. The most able work on therapeutics in recent years is the book of F. A. Hoffman, Professor in Leipzig University, a
book of which Professor Ewald of the Berlin University said in a review last year: "These lectures rise so far above the level of every-day wares and present so animated an expression of a ripe and extensive clinical and medical knowledge deeply based on physiology that they are destined to fill a real want and commend themselves to the widest circles." In this work there are forty-four distinct references to water in the treatment of various acute and chronic diseases. He says:
PROF. HOFFMANN'S REMARKABLE OPINION Of Water. "I am convinced that in time all chronic diseases of the organs will be brought into the domain of the bath treatment."
I trust that this testimony from one of the most justly eminent teachers of medicine of the present day, confirming as it does the observations of the ancients, may lead you as laymen, to further the effort now being made to rescue the treatment of water from the hydropathic empirics into whose hands it has fallen by reason of a false sense of dignity on the part of the medical profession.
It is difficult to remove the prejudice existing against cold baths in the lay, and I may say also in the professional mind. Cold appears to be regarded as the hydra-headed monster which lurks everywhere and which must be avoided. As in most popular superstitions there is a substantial basis for this idea. Bnt while the suppression of the functions of that large surface-the skin-is an acknowledged factor in producing many diseases, the careful application of cold by means of water is not only free from danger,
but its invigorating influence upon the nervous and vascular tissue elements of the skin, counteracts the teudency to and neutralizes the effect of so-called colds.
[To be Continued.]
RESUME OF THE TREATMENT OF OBESITY.
DR. PAUL CHERON, PARIS.
[Continued from Page 84.]
Method of M. Robin.-Obesity arises from two distinct sources:
1. Augmentation of assimilation.
2. Reduced disassimilation. In the former he insists that water must be interdicted, while in the latter it may be allowed ad libitum.
Again, in order to recognize the exact variety of obesity, he divides his patients into three classes, each recognizable by the volume of urea excreted. In the first, there is an increase above normal; in the second the volume of urea is stationary; in the third decreased, increased or stationary.
When the urea is stationary, which is most frequently the case, it is necessary to calculate the coefficient of oxidation; that is, the relation existing between the solid matters of the urine and the urea. The elevation of the coëfficient is prima facie evidence the obesity is due to excess of assimilation, while depression of the coëfficient indicates fault of assimilation. In the first case, water and liquids must be denied as far as possible, the same as if there was no augmentation of urea; in the second, the same as if there was diminution of urea, the patients may be permitted to imbibe fluids at pleasure.
For the obese from default of disassimilation, Robin recommends a règimen of green vegetables and bread chiefly the latter in small quantities, however, and fluids as may be desired. By this means, on one occasion, he was able, in the course of one month, to diminish the weight of a female person by twelve and a half pounds, her measure around the waist at the same time decreasing 5.2 inches, and across the stomach 4.8 inches.
M. de St. Germain achieved good results by combining judicious exercise with moderate alimentation, excluding wine and bread. When there is no evidence of fatty degeneration of heart, his menu is
Breakfast (at 8 a. m.).-Three-fourths of an ounce of bread abounding in crust; one and a half ounces of cold meat, ham or beef, six ounces weak black tea, no sugar.
Lunch (at 1 p. m.)—An ounce and a half to two ounces of bread or two eggs; three ounces green vegetables; one half ounce of cheese; fruits at discretion.
Dinner (at 7 p. m.).—An ounce and a half to two ounces of bread; three to four ounces of meat; ditto
of green vegetables; salad; half an ounce of cheese; douches, particularly when combined with massage, fruit ad libitum.
At meal time the patient may take only "a glass and a half of liquid-approximately ten ounces— though a greater amount may be consumed during the intervals.
Special alimentary regimen, however, does not constitute the sole treatment of obesity. Concurrntly must be employed a number of practical adjuvants
which are oftentimes of the utmost assistance. For one thing, exercise is indispensable; all authorities agree on this point. The exercise taken in the gymnasium is one of the best, notably the "wall exercise," which is more particularly suited to those afflicted with pendulous and protuberant abdomens as the result of feebleness of the hypogastric muscles, to accumulation of fat under the skin and in the omentum, and to dilatation of the stomach and intestines. In the "wall exercise," the patient stands erect against an absolutely straight and plumb wall, lifts his hands (carrying a weight) straight over the head and causes them to describe a semi-circle forward. Zuntz particularly insisis upon arm and leg exercise for the obese, especially the former, since with the same amonnt of effort a larger amount of oxygen is consumed than is possible by the latter.
However, of whatever character, the exercise should be continued to the point of fatigue or dyspnoea-three thousand movements daily, gradually increased to twenty-five thousand, if the system can bear it; and under such conditions, not only is there consumption of hydrocarbons, but there is provided a veritable greed for air that augments waste. The experiments of Oertel indicate that loss of weight due to fatiguing exercise, arises more particularly from de-hydration, which is made good by absorption of the fluids employed as beverage; the fluids are claimed by Germain Sée to act as accelerants of oxidation.
is often of considerable value in relieving obesity; the method of Hamman of St. Germain, which has in many instances induced rapid loss of adipose, is of this class. Tepid saline baths and vapor baths have many advocates, and may afford material aid when the heart and circulation do not inhibit their employ
ment. Hot air baths elevate the temperature of the body and increase the organic exchanges, hence, as Bert and Renaud have pointed out, tend to the elimination of oxygen and carbonic acid; but when employed, the patient should be introduced while the temperature is below 130 F., when it may be graduually raised in the course of thirty or forty minutes to
It has already been intimated, the chief feature in the treatment of obesity is acceleration of the exchanges; and this is in the main true, though it must be borne in mind that, while there are obese who excrete little urea and have a depressed central nervous temperature, many may be azoturic, and besides eliminate phosphate in excess, when an oxydating treatment will not only fail, but prove positively injurious.
The bile throws out fat, therefore, to accelerate nutritive oxydations, the liver and nervous system acted upon, i. e. stimulated. Everything that tends to diminish the activity of the former, or depress the latter, must be avoided, hence intellectual abor should be encouraged, or in lieu thereof, travel advised. Exercise should be taken chiefly while fasting; the limits of sleep confined to strict necessity, and siestas after meals and during the day strictly forbidden; the skin stimulated by hydro-therapeutic measures, including massage under cold affusions, during warm salt baths, etc.
To increase the activity of the liver, salicylate of soda may often be advantageously administered for its cholagogue effect; or resort may be had to saline purgatives such as are afforded by the springs of Marienbad, Kissengen, Hombourg, Carlsbad, Bridés, Hunyadi or Chatel-Guyon; and it is somewhat remarkable that while undergoing a course of these waters, there is often no appreciable change in weight or obesity, though the decrease becomes most marked almost immediately upon cessation of treatment.
During exercise, there is obviously more abundant absorption of oxygen, and consequently greater elimination of carbonic acid, and as a consequence (as shown by researches of Voit), the reserve fat of the economy is attacked and diminished; in intense labor there is an average hourly consumption of about 8.2 per cent. of fat. Further, physical activity is useful in exercising the voluntary muscles, and thus opposing the invasion of interstitial fat of the muscle fibrils. Extreme exercise also, to a certain degree, exerts a favorable influence on the cardiac muscle, augmenting both its nutrition and its capacity for Direct medicinal treatment presents no very wide labor. With the anæmic obese, however, it is unscope. Bouchard imagines lime water may be useful necessary to be circumspect in prescribing forced ex- by accelerating nutrition, but this is problematical, ercise; also with the elderly obese possessed of en- since fat in emulsion or in droplets does not burn. feebled or fatty heart. Nevertheless, alkalies in general, alkaline carbonates, Hydrotherapy, especially in the form of cold liquor potassa, soaps, etc., aid in rendering fat more
Everything tending to increased or fuller respiration, is to be encouraged, for the fats are thus supplied with oxygen, hastening their disintegration and consumption.
soluble, and consequently more susceptible to attack. The alkaline waters, however, are much less active in obesity than the saline mineral waters, unless, as sometimes happens, there is a complication of diabetes and obesity.
Purgatives are always more or less useful and often. required to be renewed with all the regularity of habit. Then, too, the iodides, especially iodide of sodium or potassium, as recommended by M. Germain Sée, frequently prove of excellent service by aiding elimination and facilitating the mutations.
According to Kisch, the cold mineral waters containing an abundance of sulphate of soda, like Hunyadi and Marienbad, are to be preferred to the hot mineral waters, such as Carlsbad, because of their lesser irritant action on the vascular system, and because they strongly excite diuresis through their low temperature and contained carbonic acid; Carlsbad deserves preference only when obesity is combined with uric acid calculi, or with diabetes. For very anæmic persons, however, the weak alkaline and saline waters should be selected; or they should confine themselves to chalybeate waters containing an excess of sulphate of soda. Water containing sulphate of soda is also indicated as a beverage where there are troubles of the circulatory apparatus; it is contraindicated only in accentuated arterio-sclerosis.
As a matter of fact, I find the suggestion of M. Dujardin-Beaumetz, that the obese should be divided into two groups, a most practical one, for some are strong and vigorous-great eaters, perhaps even gluttous-while others, on the contrary, are feeble and debilitated, with flesh soft and flaccid; and upon the former may be imposed all the rigors of the reducing system, while the latter must be dealt with more carefully.
In general, it must be noted, the regimen prescribed for the obese is insufficient, as. the following table, prepared by M. C. Paul, abundantly proves:
treatment have but one end, viz.: Reduction of the daily ration. But the quantity of nourishment should not be too greatly curtailed for, manifestly, if the fat disappears the more surely, the muscles (rich in albumen) undergo too rapid modification. It is progressive action that should always be sought.
The quantity of aliment may be reduced either by imposing an always uniform regimen, which soon begets anorexia and disgust, or by withholding from the food a considerable quantity of fat, or, finally, by forbidding beverage during meals. Emaciation is obtained readily enough in either way, and demands only the constant exercise of will power on the part of the patient; but unhappily, severe regimen cannot always be prescribed. When the obese patient has passed the age of forty; when the heart suffers from degeneration; or when the heart is anæmic-in all, rigorous treatment will serve to still further enfeeble the central organ of circulation, and tend to precipitate accidents that, by all means, are to be avoided. In such cases, by not treating the obesity, the days of the patient will be prolonged. In degeneration of the heart, however, the method of Ebstein may be tried; and when there is renal calculi and gouty diathesis, that of Germain See may prove satisfactory.
KINESIPATHY AND DIETETICS.
C. A. F. LINDORME, PH. D., M. D., ATLANTA, GA. [Kinesipathy is the treatment of disease by gymnastic or calisthenic movements of the parts of the body involved.] -(Gould).
There is among the public a grotesque misconstruction of the medical value of Kinesipathy, which the profession ought to correct. I was blamed once, by a lady to whom I applied general massage, for an insufficient display of manipulation. She told me
she had been treated by a "regular rubber," and, he went it, up and down, all along the body," quite differently than my modest treatment, which had due regard the course of veins and lymphatirs. She took, therefore, the regular rubber, again, who went deep as the bones.
A point, which comes in here, in books on Kinetic theory, even, is not made. It is the direct influence of the manipulation of the nerves: In giving the rules of treatment, all the stress is laid on the mechanism of the proceedings, and punctiliously, up to affectation, a certain manual nicety is insisted in, which, it is claimed, is conditio sine qua non of success. Irrespective of the peculiarity of the special manipulation, however, there is a nervous influence exerted, which makes more for the cure than all the ulterior art of treatment. A neglect of the latter, harshness, is even very likely to spoil it, in as much
as it is only the mildest manipulation, which commands the influence over the nerves. The first case of sprained ankle I cured by massage, I did not handle at all secundum artem; I was afraid to cause pain; the thing was new to me; and I did not use any harsher treatment than a sort of effleurage, which, moreover, was a fingering of my own invention ad hoc. Nevertheless my case, whom at 5 P. M. I had to carry on my arms up stairs, to the bedroom, three hours afterwards, put shoes on and marched downstairs to supper. This shows the virtue which is in the gentleness of a manipulation, and goes far to prove, that the influence exerted was less mechanical than a nervous one.
Another point is missed by those who associate all movement cure with forcible exercise. This is the promotion of resorption and secretion. Any moderate treatment is here as much of purpose as heavy muscular exertion. This is on account of the physiological provisions of nature in the anatomy of the body. That is the reason why regular rubbers, who ride rough shod out and out, working their hands by catering to the prejudice, that a swashing neck and crop treatment is what shows the right man, do not know anything about it. Our organism is the most wonderfully economical arrangement which can be imagined. The highest aim reaches he, who with the sweet associates the useful, says Horatius, and this problem was solved in the human body. Squeamishness is shocked by the little consideration that nature has for it. But squeamishness is neither an æsthetical nor a biological, but only an hysterical sentiment, and from a sensible standpoint the arrangements which nature was compelled to make, for the sake of usefulness, digestion and reproduction, have regard to beauty in as handsome a way as ever artists were able to imagine, this genial tribe of the most extravagant thinkers never as yet having been able to outrun nature in the architecture of her design; wherever in our body there is a need of facility of circulation, the latter is lodged, as much as possible, in the joints, and here the veins, as needing more outward supply of propeling force than the arteries, are placed more superficially, the arteries being, besides, deeper in more in their right place, because of the better protection from injury. These blood vessels on the other hand adapt themselves to the movements of the body; they are tortuous where abundant motion requires it, as in the lips, or where a check of the bloodstream is desirable, as at the base of the brain, and bifurcations, which might be a check where this would not be desirable, are taking place mostly in joints, the motion in which prevents all stowage which might threaten. And then to the circulation of the blood this refers more yet to the lymphatic system. This, as a matter of course, has its netting all through the body. But
the distribution of the glands is strictly in keeping with the distribution of mobility; it is the neck, the axilla, the spinal column, especially its lumbar region, the pelvis, and finally the groin, where the glands are lodged to the function of which is due the important metabolism of the chyle. That is why we may claim that kinesipathy is a necessary outgrowth of anatomy and physiology. Nature herself, by her biological economy, points to the movement cure, and likewise, as in the case of massage, to gentleness of treatment. There is no need of the swaggering fob who sets his hands to the work, neck and heels, bouncing and jolting, but of a sensible walking of the ways of nature, by harmoniously developing the potentialities of the same from which all the kinesis of our body derives. And if, among the long list of triumphs of the movement-cure there is none more glorious than that on the dietetic field, this is due precisely to the circumstance to which our article refers. In civilized man there is no commoner derangement than one from venous and lymphatic clogging, Even chlorosis, although seemingly a disease, the etiology of which points to insufficient nourishment, is benefitted by no treatment so much, nor with a similar certainty, as by kinesitherapeutics, showing thereby its causation by insufficient oxygenation in the pulmonary circulation. That is the reason why individuals with insufficient outdoor exercise, cæteris paribus the disease does not occur, and why there is a keener appetite in those who have such exercise than in people with sedentary habits. It is not the work as such which gives an appetite; overwork is apt to spoil it; but the removal of effete matter from the system, which by most kind of work is promoted. Hence walking all day in the open air gives more appetite, is healthier than bicycling on the same road. Bicycling is a more one sided movement; it leaves the points of the trunk and upper limbs, those, even, of the neck and head, with less function than a march. There is not the swinging of the arms, not the frequent turning of the neck, nor the manifold twisting of the spinal column. Again, a tourist's walk, cheerful and merry, turning here from the road, climbing there for a flower, is more beneficial than a soldier's march twenty abreast, long legs and short legs, but all the same rythm and no fun, which give a relish to the locomotion, but all stiff and machine like. That causes the enormous power which the kinesipathist wields, who knows the anatomical chances he has to supply the physiological wants, as by magic he dispels incipient abdominal troubles, may they consist in contraction or relaxation of the tissues, overabundant or deficient metabolism, and it must go hard with it, if the more inveterate case of dyspepsia is not benefitted. If a cure is at all yet possible, kinesitherapeutics will accomplish it. It is true there are needed in some cases specific manipulations