36 WILDER TILESTON 



In women disturbances of menstruation are common, usually in the 

 form of irregularity and decreased flow. The occurrence of amenorrhea 

 should arouse suspicion that the endogenous form of obesity is present. 



The Nervous System. A tendency to drowsiness is a frequent symp- 

 tom among the very obese, and may lead to great inconvenience. The 

 fat boy in "Pickwick Papers" is a familiar example. The tendency 

 to apoplexy in later life is explained by the associated hypertension and 

 arterial change. 



Relation of Obesity to Other Diseases. To Diabetes. It has long 

 been known that obesity favors the development of diabetes in those who 

 are predisposed to this malady. The association may be explained by the 

 overtaxing of the function of the pancreas owing to the excessive con- 

 sumption of carbohydrates. The importance of obesity in this connection 

 has been recently emphasized by Joslin(6), who states, on the basis of the 

 analysis of 1000 personal cases, that "the individual who is overweight 

 is at least twice, and at some ages forty times as liable to the disease." 

 And again, "it is rare for diabetes to develop in an individual above the 

 age of 20 years who is habitually underweight." It seems clear that, 

 though the predisposition to diabetes is not affected by diet, the outbreak 

 of the disease may be prevented by the prophylaxis and dietetic treat- 

 ment of obesity. 



Gout. The relationship to gout is somewhat similar. Gout is due 

 to an abnormality of the purin metabolism, often inherited. Excessive 

 consumption of protein food and of alcohol appear to be the chief predis- 

 posing factors. Gouty patients usually overeat in regard to fat and carbo- 

 hydrates also, hence the association with obesity. It should be noted how- 

 ever, that where gout is a result of lead poisoning the sufferers are 

 usually thin. 



Other Detrimental Effects of Obesity. It has been shown that fat is 

 the least resistant to infection of all tissues, and heals the slowest. The 

 distention of the abdominal cavity with fat is an obstacle in abdominal 

 operations, and the impaired vitality of the obese increases the post-oper- 

 ative mortality. Hence the fat person is obnoxious to the surgeon. The 

 mortality from the acute infectious diseases is notoriously higher among 

 the obese. 



Lipomatosis 



This condition is distinguished from obesity by the fact that the 

 fatty deposits show a peculiar distribution; it may or may not be as- 

 sociated with general adiposity. There are three main varieties: cir- 

 cumscribed nodular lipomatosis ; diffuse symmetrical lipomatosis, and 

 lipodystrophia progressiva. Dystrophia adiposogenitalis and obesity fol- 

 lowing castration belong more properly to obesity proper, while adiposis 



