Chapter 9

For the obese from default of disassimilation, Robin recommends a regimen 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 patient by twelve and a half pounds, her measurement 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.

M. Dujardin Beaumetz, who professes to have given most close and careful study and attention to regimen for the obese, outlines the following, provided there is no evidence of fatty degeneration of heart.

_Breakfast_ (at 8 a. m.)--Three-fourths of an ounce of bread "_en flute_"--that is abounding with crust; one and a half ounces of cold meat, ham or beef, six ounces weak black tea, _sans_ sugar.

_Lunch_ (at 1 p.m.)--An ounce and a half to two ounces of bread, or a _ragout_, 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, or _ragout_; ditto of green vegetables, salad, half an ounce of cheese, fruit _ad libitum_.

At meal times the patient may take only a "glass and a half" of liquid--approximately ten ounces--though a greater amount may be permitted if he abstains during the intervals.

Special alimentary regimen, however, does not constitute the sole treatment of obesity. Concurrently 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 dilation 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 semicircle forward. Zantz particularly insists upon arm and leg exercise for the obese, especially the former, since with the same amount 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 dehydration, which is made good by absorption of the fluids employed as beverage; the fluids are claimed by Germain See to act as accelerants of oxidation.

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 percent. of fat. Further physical activity is useful in exercising the voluntary muscles, and thus opposing the invasion by 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 labor. With the anæmic obese, however, it is necessary to be most circumspect in prescribing forced exercise; also with the elderly obese possessed of enfeebled or fatty heart.

Hydrotherapy, especially in the form of cold douches, particularly when combined with massage, is often of considerable value in relieving obesity; the method of Harmman, 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 employment. Hot baths elevate the temperature of the body and increase the organic exchanges, hence, as Bert and Reynard 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 gradually raised in the course of thirty or forty minutes to 140° F.

It has already been intimated, the chief feature of the treatment of obesity is acceleration of the exchanges; and this is in the main true, though it must also 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 oxidating treatment will not only fail, but prove positively injurious.

The bile throws out fat, therefore, to accelerate nutritive oxidations, the liver and nervous system must be acted upon, _i.e._, stimulated. Everything that tends to diminish the activity of the former, or depress the latter, must be avoided. Hence intellectual labor 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, Homburg, Carlsbad, Brides, 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.

Everything tending to increased or fuller respiration is to be encouraged, for the fats are thus supplied with oxygen, hastening their disintegration and consumption.

Direct medicinal treatment presents no very wide scope. Bouchard imagines lime water may be useful by accelerating nutrition, but this is problematical, since fat in emulsion or in droplets does not burn. Nevertheless, alkalies in general, alkaline carbonates, liquor potassa, soaps, etc., aid in rendering fat more 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 See, 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 gluttons--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:

+----------+----------+--------------- Author. |Albuminous| Fatty | | Matters. | Matters. | Hydrocarbons. -------------------------+----------+----------+--------------- Voit. | 118 | 40 | 150 Harvey-Banting. | 170 | 10 | 80 Ebstein. | 100 | 85 | 50 Oertel. | 155-179 | 25-41 | 70-110 Kisch (plethoric). | 160 | 10 | 80 " (anæmic). | 200 | 12 | 100 Normal ration. | 124 | 55 | 455 -------------------------+----------+----------+---------------

There is, therefore, as Dujardin-Beaumetz asserts, autophagia in the obese, and all these varieties of 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.

Paris, France.

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STILT WALKING.

Sylvain Dornon, the stilt walker of Landes, started from Paris on the 12th of last March for Moscow, and reached the end of his journey at the end of a fifty-eight days' walk. This long journey upon stilts constitutes a genuine curiosity, not only to the Russians, to whom this sort of locomotion is unknown, but also to many Frenchmen.

Walking on stilts, in fact, which was common twenty years ago in certain parts of France, is gradually tending to become a thing of the past. In the wastes of Gascony it was formerly a means of locomotion adapted to the nature of the country. The waste lands were then great level plains covered with stunted bushes and dry heath. Moreover, on account of the permeability of the subsoil, all the declivities were transformed into marshes after the slightest fall of rain.

There were no roads of any kind, and the population, relying upon sheep raising for a living, was much scattered. It was evidently in order to be able to move around under these very peculiar conditions that the shepherds devised and adopted stilts. The stilts of Landes are called, in the language of the country, _tchangues_, which signifies "big legs," and those who use them are called _tchanguès_. The stilts are pieces of wood about five feet in length, provided with a shoulder and strap to support the foot. The upper part of the wood is flattened and rests against the leg, where it is held by a strong strap. The lower part, that which rests upon the earth, is enlarged and is sometimes strengthened with a sheep's bone. The Landese shepherd is provided with a staff which he uses for numerous purposes, such as a point of support for getting on to the stilts and as a crook for directing his flocks. Again, being provided with a board, the staff constitutes a comfortable seat adapted to the height of the stilts. Resting in this manner, the shepherd seems to be upon a gigantic tripod. When he stops he knits or he spins with the distaff thrust in his girdle. His usual costume consists of a sort of jacket without sleeves, made of sheep skin, of canvas gaiters, and of a drugget cloak. His head gear consists of a beret or a large hat. This accouterment was formerly completed by a gun to defend the flock against wolves, and a stove for preparing meals.

The aspect of the Landeses is doubtless most picturesque, but their poverty is extreme. They are generally spare and sickly, they are poorly fed and are preyed upon by fever. Mounted on their stilts, the shepherds of Landes drive their flocks across the wastes, going through bushes, brush and pools of water, and traversing marshes with safety, without having to seek roads or beaten footpaths. Moreover, this elevation permits them to easily watch their sheep, which are often scattered over a wide surface. In the morning the shepherd, in order to get on his stilts, mounts by a ladder or seats himself upon the sill of a window, or else climbs upon the mantel of a large chimney. Even in a flat country, being seated upon the ground, and having fixed his stilts, he easily rises with the aid of his staff. To persons accustomed to walking on foot, it is evident that locomotion upon stilts would be somewhat appalling.

One may judge by what results from the fall of a pedestrian what danger may result from a fall from a pair of stilts. But the shepherds of Landes, accustomed from their childhood to this sort of exercise, acquire an extraordinary freedom and skill therein. The _tchanguè_ knows very well how to preserve his equilibrium; he walks with great strides, stands upright, runs with agility, or executes a few feats of true acrobatism, such as picking up a pebble from the ground, plucking a flower, simulating a fall and quickly rising, running on one foot, etc.

The speed that the stilt walkers attain is easily explained. Although the angle of the legs at every step is less than that of ordinary walking with the feet on the ground, the sides prolonged by the stilts are five or six feet apart at the base. It will be seen that with steps of such a length, distances must be rapidly covered.

When, in 1808, the Empress Josephine went to Bayonne to rejoin Napoleon I, who resided there by reason of the affairs of Spain, the municipality sent an escort of young Landese stilt walkers to meet her. On the return, these followed the carriages with the greatest facility, although the horses went at a full trot.

During the stay of the empress, the shepherds, mounted upon their stilts, much amused the ladies of the court, who took delight in making them race, or in throwing money upon the ground and seeing several of them go for it at once, the result being a scramble and a skillful and cunning onset, often accompanied with falls.

Up to recent years scarcely any merry-makings occurred in the villages of Gascony that were not accompanied with stilt races. The prizes usually consisted of a gun, a sheep, a cock, etc. The young people vied with each other in speed and agility, and plucky young girls often took part in the contests.

Some of the municipalities of the environs of Bayonne and Biarritz still organize stilt races, at the period of the influx of travelers; but the latter claim that the stiltsmen thus presented are not genuine Landese shepherds, but simple supernumeraries recruited at hazard, and in most cases from among strolling acrobats. The stilt walkers of Landes not only attain a great speed, but are capable of traveling long distances without appreciable fatigue.

Formerly, on the market days at Bayonne and Bordeaux, long files of peasants were seen coming in on stilts, and, although they were loaded with bags and baskets, they came from the villages situated at 10, 15, or 20 leagues distance. To-day the sight of a stilt walker is a curiosity almost as great at Bordeaux as at Paris. The peasant of Landes now comes to the city in a wagon or even by railway.--_La Nature_.

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REMAINS OF A ROMAN VILLA IN ENGLAND.

A correspondent of the _Lincolnshire Chronicle_ writes: For some weeks past, remains of a Roman villa have been exposed to view by Mr. Ramsden's miners in Greetwell Fields. From, the extent of the tesselated pavements laid bare there is hardly any doubt that in the Greetwell Fields, in centuries long gone by, there stood a Roman mansion, which for magnitude was perhaps unrivaled in England. Six years ago I drew attention to it. The digging for iron ore soon after this was brought to a standstill by the company, which at the time was working the mines, ceasing their operations. Then the property came into other hands, and since then more extensive basement floors of the villa have from time to time been laid bare, and from tentative explorations which have been just made, still more floors remain to be uncovered which may be of a most interesting and instructive character. What a pity it is that the inhabitants of Lincoln have not made an effort to preserve these precious relics of the grandeur of the Roman occupation, an occupation to which England owes so much. From the Romans the people of this country inherit the sturdy self-reliance and perseverance in action which have helped to make England what it is, and from the Romans too, in a great degree, does England also inherit her colonizing instincts, which impel her people to cover the waste places of the world with colonies. If the Roman remains which have been so abundantly discovered of late years in Lincoln and its vicinity had been collected and laid out for exhibition, they would have formed a most interesting collection of antiquities worthy of the town, and well worth showing to visitors who now annually make Lincoln a visitation. Although these relics of a remote age are being dug up and are being destroyed, it is not the fault of Mr. Ramsden, for he not only preserved them as long as he conveniently could, but he also had the soil removed from over them, and had them thoroughly washed, in order that people might have an opportunity of seeing their extent and beauty. One of these patches of pavement extended 48 yards northward from what might be called the main building, which had previously been broken up. This strip was 13 ft. in breadth, and down its center ran an intricate pattern worked in blue tesseræ. The pattern is much used in these days in fabrics and works of art, and is, I think, called the Grecian or Roman key pattern. On each side of this ran alternately broad ribbons of white and narrower ribbons of red tesseræ. There is also another strip of pavement to the south of the preceding patch, which has been laid bare to the extent of 27 yards. This patch is about 10 ft. in breadth, and its western portion is cut up in neat patterns, which show that they formed the floors of rooms. From the eastern extremity of these floors evidently another long strip of 48 or 50 yards still remains to be uncovered. Doubtless there are other remains beneath the ground which will be laid bare as the work of mining goes on. All these floors were not deeper than from 18 to 30 inches below the surface of the soil. The bones of animals and other relics have been found in the covering soil and have been turned up by the miners from time to time. The pavement is all worked out with cubes, varying in size from an inch and a half to two inches square, each piece being placed in position with most careful exactness. The strip which extends 48 yards and is 13 ft. wide runs due north and south. There is a second patch, running east and west, and this is 27 ft. long by 10 ft. wide, while a third is 27 ft. long by 11 ft. wide, this also running in a northern direction. To the north of this latter piece, and separated only by about two feet (about the width of a wall, which very possibly was the original division), there is a strip of tesseræ 16 ft. wide, which had been laid bare 40 yards. It was thought probable that at the end of the last named strip still another patch would be found. Mr. Ramsden, the manager of the Ironstone Works, is keeping a plan of the whole of the pavement, which he is coloring in exact imitation of the original work. This, when completed, will be most interesting, and he will be quite willing to show it to any one desirous of inspecting the same. Many persons have paid a visit to the spot where the discoveries have been made, and surprise is invariably expressed at the magnitude and beautiful symmetry of the work.

Several interesting fragments of Roman work have been brought to light in the course of excavations that are being made for building purposes at Twyford, near Winchester. About a month ago, a paved way, composed entirely of small red tiles, six feet in width and extending probably a considerable distance (a length of 14 ft. was uncovered), was found while digging on the site for flints. The more recent excavations are 20 ft. west of this passage, and there is now to be seen, in a very perfect state of preservation, an oven or kiln with three openings. Five yards away from this is a chamber about eight feet square, paved with tiles, and the sides coated with a reddish plaster. On one side is a ledge 15 in. from the ground, extending the whole length of the chamber; on the floor is a sunk channel with an opening at the end for the water to escape. This chamber evidently represents the bath. Portions of the dividing walls of the different chambers have also been discovered, together with various bones, teeth, horns and ornaments, but very few coins. It is probable that an alteration in the plans of the house which was about to be built on the spot will be made so as to preserve all the more interesting features of these remains in the basement. These discoveries were made at a depth of only two or three feet from the surface of the ground, and are within about a quarter of a mile of other Roman remains which were similarly brought to light a few months ago.

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[Continued from SUPPLEMENT, No. 830, page 13110.]

GUM ARABIC AND ITS MODERN SUBSTITUTES.[1]

[Footnote 1: A paper read before the Society of Chemical Industry, London, 1891. From the Journal]

BY DR. S. RIDEAL AND W.E. YOULE.

Subjoined is a table giving the absolute viscosity of various gums. A comparison of the uncorrected viscosities with the corrected shows the great importance of Slotte's correction for dextrins and inferior gum arabics; in other words, for solutions of low viscosity, while it will be observed to have little influence upon the uncorrected [eta] obtained for the Ghatti gums and the best samples of gum arabic.

TABLE OF ABSOLUTE VISCOSITIES OF 10 PER CENT. GUM AND DEXTRIN SOLUTIONS.