For those who habitually ingest too much rich and nitrogenous food and take too little exercise, whether suffering from typical gout or not, the systematic use of the muscles, together with a less hearty diet, is of the greatest value. It should be remembered, however, that when gout is developed, severe or unaccustomed exercise may precipitate an attack; systematically and judiciously employed in the intervals, exercise will tend to ameliorate the condition and prevent the recurrence of attacks. In diabetes, another disorder of imperfect metabolism, it has not been sufficiently appreciated that the surplus of sugar may be largely oxidized through carefully prescribed exercise. Walking is the most convenient form, and the amount should be graduated according to the patient's capacity and training. The aversion of the diabetic to exertion may be overcome by allowing limited amounts of bread as a reward for each mile walked. Those who have tried this plan find a decided advantage over a stricter diet and insufficient exercise.
The relation of exercise to the treatment of cardiac and circulatory affections has entered on a new phase since Oertel's original work. The dominant idea had been hitherto to relieve a weak or damaged heart of strain by avoiding exercise. Oertel teaches that the work of the staggering or flagging heart may be cut down by reducing the amount of ingested fluids, and the heart trained and strengthened by graduated daily exercise in walking on level and sloping paths. The results reported confirm the value of the method, and it is hardly too much to say that by accurately dosing and systematically applying this common exercise to meet the need of individual patients he has not only given the profession a valuable remedy, but a new point of view in the treatment of these serious affections. Oertel's cases are largely those of cardiac debility from imperfect nutrition of the heart and system, evidenced by fatty deposits in or about the heart, and not rarely elsewhere. This condition is usually the result of a too inactive muscular life, and in Germany is often associated with the ingestion of large quantities of beer, so that the ill-nourished heart has an increased amount of fluid to pump. In such cases a large reduction of ingested fluids is a necessity while attempting to invigorate the heart by graduated and divided doses, at first small, of walking and climbing exercise. Where valvular disease, with or without dilatation, presents similar indications, a similar course may be followed, but such prescriptions must be made with accurate discrimination and analysis of the actual state and needs of the economy.
