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Page 30
When the weight has been sufficiently lowered, we add to the diet beef,
mutton, oysters, etc., and finally arrange a full diet list to include
but a moderate amount of hydro-carbons. Meanwhile, the milk remains as a
large part of the food, and the active Swedish movements are still kept
up as a habit, the patient being directed by degrees to add the usual
forms of exercise.
If we attempt to make so speedy a change in weight while the patient is
afoot, the loss is apt to be gravely felt; but with the precautions here
advised it is interesting and pleasant to see how great a reduction may
be made in a reasonable time without annoyance and with no obvious
result except a gain in health and comfort.
Cases of an�mia in women with excess of flesh have to be managed in a
somewhat similar fashion, but with the utmost care. In such persons we
have a loss of red blood-globules, perhaps lessened h�moglobin, weak
heart, rapid pulse, and general feebleness, with too much fat, but not,
or at least rarely, extreme obesity. The milder cases may profit by
iron, with rest and very vigorous massage, but in old cases of this
kind--they are, happily, rare--the best plan is to put the patient at
rest, to use massage, restrict the diet to skimmed milk, or to milk and
broths free from fat, and with them, when the weight has been
sufficiently lowered, to give iron freely, and by degrees a good general
diet, under which the globules rise in number, so that even with a new
gain in flesh there comes an equal gain in strength and comfort. The
massage must be very thoroughly done to be of service, and it is often
difficult to get operators to perform it properly, as the manipulation
of very fat people is excessively hard work. As to other details, the
management should be much the same as that which I shall presently
describe in connection with cases of another kind.
I add two cases in illustration of the use of rest, milk, and massage
in the treatment of persons who are both an�mic and overloaded with
fat.
Mrs. P., �t. 45, weight one hundred and ninety pounds, height five feet
four and a half inches, had for some years been feeble, unable to walk
without panting, or to move rapidly even a few steps. Although always
stout, her great increase of flesh had followed an attack of typhoid
fever four years before. Her appearance was strikingly suggestive of
an�mia.
She was subject to constant attacks of acid dyspepsia, was said to be
unable to bear iron in any form, and had not menstruated for seven
months. She had no uterine disease, and was not pregnant. Two years
before I saw her she had been made very ill owing to an attempt to
reduce her flesh by too rapid Banting, and since then, although not a
gross or large eater, she had steadily gained in weight, and as steadily
in discomfort.
She was kept in bed for five weeks. Massage was used at first once
daily, and after a fortnight twice a day, while milk was given, and in a
week made the exclusive diet. Her average of loss for thirty days was a
pound a day, and the diet was varied by the addition of broths after
the third week, so as to keep the reduction within safe limits. Her
pulse at first was 90 to 100 in the morning, and at night 80 to 95, her
temperature being always a half degree to a degree below the normal. At
the third week the latter was as is usual in health, and the pulse had
fallen to 80 in the morning, and 80 to 90 at night.
After two weeks I gave her the lactate of iron every three hours in full
doses. In the fourth week additions were made to her diet-list, and
Swedish movements were added to the massage, which was applied but once
a day; and during the fifth week she began to sit up and move about. At
the seventh week her pulse was 70 to 80, her temperature natural, and
her blood-globules much increased in number. Her weight had now fallen
to one hundred and forty-five pounds, and her appearance had decidedly
improved. She left me after three and a half months, able to walk with
comfort three miles. She has lived, of course, with care ever since, but
writes me now, after two years, that she is a well and vigorous woman.
Her periodical flow came back five months after her treatment began, and
she has since had a child.
Early in the spring of 1876, Mrs. C., �t. 40, came under my care with
partial hysterical paralysis of the right and hemi-an�sthesia of the
left side. She had no power to feel pain or to distinguish heat from
cold in the left leg and arm, though the sense of touch was perfect. The
long strain of great mental suffering had left her in this state and
rendered her somewhat emotional. Her appetite was fair, but she was
strangely white, and weighed one hundred and sixty-three pounds, with a
height of five feet five inches. As she had had endless treatment by
iron, change of air, and the like, I did not care to repeat what had
already failed. She was therefore put at rest, and treated with milk,
slowly lessened in amount. Her stomach-troubles, which had been very
annoying, disappeared, and when the milk fell to three pints she began
to lose flesh. With a quart of milk a day she lost half a pound daily,
and in two weeks her weight fell to one hundred and forty pounds. She
was then placed on the full treatment which I shall hereafter describe.
The weight returned slowly, and with it she became quite ruddy, while
her flesh lost altogether its flabby character. I never saw a more
striking result.
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