OBESITY 35 



interfered with. Cases of obesity complicated by hypertension, valvular 

 lesions or myocardial disease are especially prone to decompensation. 



It is not surprising therefore that the obese suffer from shortness of 

 breath and palpitation on exertion, and in the later stages often develop 

 the signs of cardiac insufficiency. 



Hypertension and arteriosclerosis are common among .the fat, and 

 an important place is usually assigned to overeating among the many 

 factors leading to these obscure conditions. There are some statistics in 

 favor of this view. Thus B. Moses reported from the records of a life 

 insurance company that while, in general, death from apoplexy occurred in 

 six per cent, in the case of the obese the rate rose to 11 per cent. Once 

 well established, the hypertension rarely yields to a reduction cure. 



The Lungs. Owing to the impeded respiration, obesity is apt to re- 

 tard the recovery from pulmonary infections, especially bronchitis, and 

 it may happen that cases which have resisted other forms of treatment, lose 

 their cough rapidly when their weight is reduced by diet. 



The Alimentary Tract. Fat people often suffer from carbohydrate 

 fermentation, with distention, colicky pains, flatulence and belching. 

 Constipation and hemorrhoids are common. 



The Liver. It is often stated that the liver is enlarged in obesity as 

 a result of fatty infiltration. This is contrary to the experimental evidence, 

 which shows that the liver contains more fat in starvation than in the 

 well-nourished, and that if both carbohydrate and fat are given to a 

 starving animal, glycogen, not fat, is deposited in the organ. The fatty 

 infiltrated liver is encountered post mortem chiefly in diseases associated 

 with cachexia, with the exception of the fatty cirrhotic liver, in which 

 it is fair to conclude that toxic influences are at work. In Cushing's 

 case of hypopituitarism with marked fatty infiltration the organ was not 

 enlarged. Clinically one meets enlargement of the liver in the cases 

 with cardiac decompensation or cirrhosis. 



The Pancreas. The relationship of obesity to diabetes is discussed 

 farther on. In the case of a rare disease, acute pancreatic necrosis, obesity 

 is an important predisposing factor, the extensive infiltration of the pan- 

 creas with fat facilitating the spread of the necrosis. 



The Kidneys. Obesity as such has no direct influence on the kidneys, 

 but the incidence of chronic nephritis among the obese past middle age 

 is quite high. Von Noorden(o) found this disease in 20 per cent of his 

 cases of marked obesity, and obesity was a factor in "at least a third" of 

 his cases of chronic nephritis. 



The Sexual Apparatus. In the male impotence is not very uncom- 

 mon, in the absence of endocrin disturbance; it is usually curable by re- 

 duction of the weight. Azob'spermia has been observed in a few in- 

 stances, in which, however, disease of the endocrin glands was not 

 excluded. 



