In calling attention to the treatment of this disease we wish especially to impress upon the reader the fact that obesity is by no means so harmless and insignificant a disease as is generally supposed. This might well be inferred from the marked and grave character of the many effects occasioned by excessive fatness, to which we have already called attention. Hence it cannot be too much insisted upon that decided measures should be promptly adopted, not only for the cure of this malady whenever it is found to exist, but also for its prevention whenever there is known to be a hereditary tendency to it, or conditions which will be likely to induce it. Obesity is by no means so easy to cure as might be supposed. When once thoroughly established upon the system, and especially when of a hereditary character, it is found exceedingly difficult to cure, patients not infrequently relapsing after an apparent cure has been effected, and in many cases receiving little benefit by any mode of treatment which they can be induced to undergo. One of the great obstacles in the way of the efficient treatment and radical cure of the disease, is the reluctance manifested by many of those affected by it to comply with and assist in carrying out the measures of treatment essential to secure recovery. This is especially the case when the disease has been brought on by excessive indulgence in eating and indolence. The force of long-continued habit is so strong that in many cases the patient affirms that he would prefer to suffer the inconveniences of the disease and incur the risk of ultimate suffering and premature death which it involves, rather than forego the gustatory enjoyments to which he has long been accustomed. The strong aversion to physical exercise is another impediment in the treatment of this disease, the cure of which in many cases depends in great measure upon the cultivation of habits of regular, systematic, and even severe, physical exercise. The measures of treatment to be adopted for the cure of the disease, and also for its preven tion in cases where there is a marked tendency to it from any cause, are such as will secure the following conditions:

First, the diminution of the supply of food, especially fattening food, or that which has a tendency to induce obesity.

Second, an increased consumption of muscular tissue, thus creating a demand for food for the legitimate purpose of replenishing waste.

Third, the increased formation of red blood corpuscles, which are deficient in the many common forms of obesity.

Fourth, an increased supply of oxygen to the system, by means of which the surplus material which would otherwise be deposited as fat will be consumed and so removed from the body.

If such measures of treatment can be adopted as will secure the perfect realization of the four indications mentioned, cases of obesity in which recovery cannot be secured will be very rare indeed. The only difficulty is in securing the necessary conditions. The first of these may be secured in the manner already suggested; namely, by diminishing the amount of food taken by the patient, especially of those substances which have a tendency to produce fat. The mistake should not be made, however, of supposing that obesity is to be cured by starvation. The problem to be solved in the dietetic management of the disease is to diminish the amount of surplus and useless material in the form of fat without at the same time lessening the patient's strength and undermining his constitution.

The starvation cure, while it will undoubtedly rapidly diminish the weight, at the same time reduces the patients strength and induces a condition of anaemia, or poverty of the blood, which is very likely to result in a relapse into a condition far worse than the first, since obesity occasioned or accompanied by anaemia is far more obstinate to cure than any other form. Consequently, those measures of treatment which greatly weaken the patient are much more likely to do harm than good, so that the remedy will prove far worse than the disease. The patients diet should be reduced to a minimum in quantity, but it should be so carefully adjusted that sufficient nourishment shall be given him to maintain his strength. In extreme cases of obesity the restricted diet may be employed for a very short period; certainly not sufficiently long to in any very great degree weaken the strength of the patient. The regulation of the quality of the diet is of fully equal importance with the restriction with reference to quantity.

The following articles of food, on account of their tendency to increase fat, should be entirely forbidden: Butter, cream, fats of every description, rich sauces, pork, goose, duck, most kinds of game, salads, pastry, ices, raisins, dates, figs, all kinds of sweet and preserved fruits, nuts of every description, and, in fact, nearly all kinds of starchy, fatty, and saccharine articles of food.

The following articles may be eaten occasionally, but should be taken very sparingly indeed: New or unskimmed milk, eggs, potatoes, carrots, parsnips, and most other vegetables, rice, buckwheat, mutton, and beefsteak.

The articles in the following list, and those of a similar character, should form, almost exclusively, the diet of a person suffering with obesity: All kinds of green vegetables, such as asparagus, cabbage, green peas, beans, and spinage; and acid fruits, such as lemons, sour oranges, sour apples, and currants. Of the grains, cracked wheat, graham flour, rye, and oatmeal in moderate quantities, may be eaten. Meat should be used in moderation, the best varieties being venison, chicken, trout, and lean beef wholly free from fat. All the articles of food mentioned should be cooked entirely without the use of either fat or sugar. Very moderate quantities of salt should be employed.

Tea, coffee, chocolate, and cocoa should be entirely interdicted, as also should all kinds of alcoholic drinks, and stimulants and narcotics of all kinds. The idea that animal food is the diet par excellence, and that articles of food of this class may be taken in almost unstinted quantities without harm, is a very mistaken one. This statement is based upon the following facts: First, food of an exclusively albuminous character is capable of forming fat and thus contributing to the production of obesity. This is true, however, only when it is taken in excessive quantities, as has been shown by numerous experiments upon animals. Second, the use of large quantities of animal food favors the increased production of urea and the retention in the blood of the excrementitious principles, which, as previously remarked, are among the most potent causes of the many grave effects which result from obesity, particularly the great liability to inflammatory affections, fevers, rheumatism, and gout. In not a few cases in which an exclusive animal diet has been adopted in this disease, the patient has found himself in a much worse condition from the injurious effects of his clogging and stimulating diet than that occasioned by the original disease. This we regard as a very important point to be kept in mind in the treatment of obesity, on account of the wide-spread and popular character of the error and the serious evils resulting from it.

While the amount of solid food should be reduced to the minimum quantity, as before remarked, the fluid portion of the diet, at least if pure water be the only drink, may be increased to any extent required by the desires of the patient. It is even advisable to urge upon the patient the importance of drinking daily considerable quantities of pure water, preferably cold water, as warm drinks are not to be recommended in this disease on account of their tendency to increase the activity of the skin, which is already abnormally active. From six to ten, or even more, glasses of water may be taken each day with ben-fit, unless there is a marked disturbance of digestion of a character to contra-indicate the taking of so large a quantity of fluid. The object of this measure is to increase tissue change by increasing the fluidity of the blood. The efficiency of water-drinking as an agency for this purpose has been fully dwelt upon elsewhere.

The patient should be encouraged to take exercise to the full extent of his ability. It would, of course, be useless to recommend to persons advanced in years and excessively corpulent to engage in any very active or violent physical exertion. Such a recommendation might, in extreme cases, even prove fatal by occasioning excessive action of the heart or congestion of the brain, the results of which might be sudden paralysis of the heart on account of its weakened condition, or apoplexy through rupture of a blood-vessel in the brain. There are very few curable patients, however, even those who are the most remarkable specimens of obesity, who are unable to walk, at least for a short distance, and these should be urged to take as much exercise of this sort each day as they can endure, not of course attempting too long walks at first, nor continuing the exercise sufficiently long to produce very great exhaustion, but repeating it at sufficiently short intervals to secure the largest possible amount of exercise each day. For younger persons, those who suffer in a less marked degree, swimming, rowing, and the practice of gymnastics, may be recommended as a particularly efficient mode of exercise, as it brings into action the muscles of the upper as well as of the lower extremities and also those of the trunk. Only the lighter kinds of exercise should be taken, especially at first, but this should be done regularly and systematically, if possible under the eye of a tutor, at least at first, so as to secure thorough and methodical exercise of the whole muscular system.

Hippocrates recommended vigorous exercise as a sovereign remedy for excessive fatness. He also made what seems to us a very sensible suggestion, namely, that obese persons should accustom themselves to light, thin clothing in winter as well as in summer and the practice of exposing the uncovered body for a considerable length of time every day to the free action of cool air. By the adoption and faithful application of the hygienic measures already suggested, the great majority of fat people may reduce themselves to reasonable proportions. Not infrequently, however, a considerable length of time may be required, but the patient should persevere, feeling sure that the course which he is pursuing is the wisest one which can be adopted, and will, in all probability, secure for him the best results which can be obtained. If the dietary suggested becomes so unpalatable that the appetite is impaired and the digestion is in danger of suffering, a slight modification may be made for three or four days or a week to give the patient a little opportunity to recover his appetite and enable him to enter upon his regimen again with renewed vigor. It is better to adopt a rigid dietary and then interrupt it at intervals of three or four weeks in the manner suggested, than to endeavor to follow continuously a more liberal regimen.

All cases of excessive corpulency, and especially severe cases, may be greatly benefited, and the chances for recovery greatly increased, by other measures of treatment in addition to those already mentioned. The most useful of these are frequent cold bathing and the employment in plethoric cases of powerful eliminative measures. A cold sponge or shower bath may be taken daily with benefit. It should be of short duration and taken in a warm room, and great care should be exercised to secure thorough reaction. In addition to this treatment, one to three vapor or hot-air baths and wet-sheet packs may be taken each week with benefit. When there is great inactivity of the liver and kidneys, daily fomentations over these organs and the wearing of the abdominal bandage will be found of very great advantage. The excessive tendency to sweat which is present in this disease, although a remedial process, sometimes requires checking on account of its weakening tendencies. For this purpose cold shower and sponge baths are indicated. Another excellent measure of treatment is daily sponging of the body with an astringent wash composed of one part vinegar to three parts of a decoction of sage, oak-bark, or some other mild astringent. The increased secretion of fat will also be checked by this method of treatment. Much may be contributed to the patient's comfort by bathing the parts most affected with equal parts of alcohol and water, by which the excess of sebaceous matter will be removed.

We are aware that we have devoted more space to this affection than the general opinion of its importance would justify; but this wo have done on account of the fact that it is generally neglected by medical writers, and, as before remarked, is quite too commonly regarded as of too trivial moment to require serious attention except on account of its inconveniences. We cannot properly conclude this subject, however, without calling attention to two notorious evils. We refer to the tobacco cure of obesity and the numerous quack nostrums advertised and sold under the taking title of "Anti-Fat" remedies. With reference to the tobacco cure of corpulency, much might be properly said, but as we can say nothing better on the subject, we are glad to be able to quote the following excellent remarks by the eminent Prof. Immermann, of Bāle, which are worthy of special attention, coming as they do from a gentleman whose nationality is certainly not remarkable for antipathy to the weed: "While English and American physicians have celebrated tobacco-chewing as a very efficacious prophylactic against corpulence, and prescribed it, we can by no means coincide in such a recommendation in any case, since this nauseous habit can scarcely in our opinion act in a limiting manner upon the deposition of fat, otherwise than by undermining the appetite, and by setting up a chronic dyspepsia, provoking a certain degree of marasmus. The same holds good, and perhaps in a still higher degree, of other customs and vices, such as the habitual use of the preparations of coca and hashish, and of opium-smoking, and above all, of that senseless and injurious misuse of morphia in subcutaneous injection, which latter fashionable vice is, as we know, at the present day so much in vogue that in some places, and especially in medical circles it is looked on as quite the mode to be a slave to it."

The remarks of Prof. Immermann respecting the manner in which the excessive use of tobacco antagonizes obesity, apply with particular force to the numerous anti-fat nostrums advertised so extensively in the newspapers. We have known several instances in which these remedies have been employed by corpulent people, and in some cases with the most disastrous results. They are highly poisonous compounds, which destroy the digestion; and though these means will in some cases reduce fat, it is at the fearful expense of ruining the con stitution. Equally to be condemned as of essentially the same nature, is the practice once common among young ladies, and we fear not yet entirely out of vogue, of eating pickles and drinking vinegar for the purpose of exchanging a healthy plumpness for a slender form. Much more might be said, and perhaps with profit, but the limitations of our space forbid us to dwell upon this subject longer.