Page:Popular Science Monthly Volume 64.djvu/415

more particularly, there is oftentimes a sudden gain in weight, sometimes to a very annoying and disabling degree, following the change of life. This is an abnormality, and is sometimes based upon pathologic changes in the thyroid gland analogous to myxedema. In men at about the same relative period an enormous gain in weight occasionally arises and is a serious annoyance and anxiety. A few points in regard to the control and reduction of this warrant discussion, although they need not be elaborated. Where this gain in weight seems to be free from any abnormality except difficulties in the elimination or utilization of fat, it is proper to initiate active treatment by careful diet according to the methods of Banting, Ebstien, Oertel, along with specially directed exercises. In persons who are obviously not vigorous, as in those instances where marked anemia is present, there should be a careful search for evidences of disease beginning, or established, and treatment for the condition outlined accordingly. Von Noorden emphasizes the necessity of being on our guard in treating conditions of obesity which arise in women from fifty to sixty years of age. The greatest precautions must be used in dealing with these, because under almost any regime they will lose strength, frequently to an alarming extent, and what is more fail to regain it. The same statement holds good, to a less degree, in men of the same age. It would be interesting to formulate the different kinds and degrees of obesity and the pathologic changes which often accompany this state, forming it may be the cause on which the obesity arises, or again the results, direct or indirect, of the excessive weight. It is enough for our purpose here to offer some directions as to how this objectionable state may be relieved without producing harm. First, it is necessary to bear in mind that under the direct advice and continued attention of the physician is the only safe mode of procedure. Where there is found, as often happens, marked weakness of the heart and circulation the greatest care must be observed, and measures should be adopted having direct regard for the possibilities of the individual and varied from time to time under intelligent supervision. It is always a dangerous thing for persons to undertake their own treatment for obesity if they make use of drugs, because great harm can be done; it may be irretrievable. There is no objection, however, to moderating the diet, increasing exercise, and, above all, to employing systematized physical training for the purpose of improving elasticity in all the tissues. It is only safe to do so under medical advice. Oertel in 1885 and after, has done work which marks an epoch. The principle upon which he proceeds is that even where there is found to be pronounced weakness of the heart muscle, and other disturbances in circulation, these may be met by steadily increasing the amount of physical work done, especially by hill climbing. This walking up slopes has the merit of bringing out skin