uld 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 anaemic 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 deg. F., when it may
be gradually raised in the course of thirty or forty minutes to 140 deg. 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 el