CORPULENCE AND THE MEANS FOR ITS CORRECTION. 447 



consumed the body can deposit only one part of proteid, while nine parts are 

 decomposed. In addition, for two parts of decomposing proteid one part of fat 

 is formed from the carbohydrate supplied in excess. 



Excessive deposition in the body of man, corpulence, is to be considered an 

 abnormal manifestation of metabolism, which to the subject may be a source 

 not alone of inconvenience, but also of disorders or even of serious danger. With 

 reference to the causes of obesity, a certain degree of congenital predisposition 

 (in from 33 to 56 per cent, of the cases) cannot be denied, inasmuch as members 

 of certain families increase more readily in weight (as is likewise true of certain 

 breeds of animals) , while others, even when supplied with an abundance of food, 

 which may reach enormous amounts, remain thin. The principal cause, however, 

 is an habitually excessive supply of food beyond the normal metabolic average, 

 although almost every corpulent person will with complacent self-deception main- 

 tain that he really eats remarkably little. 



The mistake should be avoided of considering the corpulent individual as 

 always excessively fat. The process of overfeeding results at first in the deposition 

 both of fat and of flesh. On continuance of the process the development of 

 muscular tissue diminishes, because in consequence of his clumsiness and helpless- 

 ness the corpulent individual is rendered inactive. As a result, the nutrition of 

 the muscular structures is secondarily impaired. Some active corpulent individ- 

 uals, however, retain their large deposition of flesh throughout life. If, however, 

 those factors become especially operative later on that favor the production of 

 fat, corpulence may be transformed into obesity exclusively, as, naturally, is fre- 

 quently the case. 



The following influences favor the development of corpulence: (i) An excessive diet 

 of proteid, with a corresponding addition of fat or carbohydrate. The proteid of 

 the food serves for the deposition of albuminates in the body, while the fat is 

 produced by the ingestion of fat and carbohydrates. (2) Diminished consump- 

 tion of nitrogen in the body, in consequence of (a) lessened muscular activity (little 

 movement, much sleep), (b) Enfeeblement of the sexual functions, as shown by 

 the fattening of castrated animals, as well as the circumstance that women readily 

 become corpulent after cessation of menstruation, probably in consequence princi- 

 pally of withdrawal of the stimulating influence of vascular activity, (c) Dimin- 

 ished mental activity (obesity of idiocy), phlegmatic temperament, probably for 

 the foregoing reason. Conversely, vigorous mental activity, an excitable tem- 

 perament, anxiety and grief counteract the fattening process, (d) The corpu- 

 lent individual need consume relatively less material for the generation of heat 

 in his body, partly because his compact body, in consequence of the greater 

 concentration of mass, gives off less heat from the external integument than a 

 delicate slender body, and partly because of the thick layer of fat as a poor con- 

 ductor of heat prevents direct loss of heat by conduction. As a result of the 

 relatively lessened production of heat in the body thus required, there may be an 

 increased deposition of tissue, (e) A reduction in the number of red blood-cor- 

 puscles, which stimulate oxidation-processes in the body, is generally followed by 

 an increase in the amount of fat. Corpulent persons are, therefore, not rarely 

 fat because they are anemic. Women with a reduced number of red blood-cor- 

 puscles are generally fatter than men. (/) The use of alcohol favors the conserva- 

 tion of fat in the body, because, on account of the readiness with which it is 

 oxidized, it protects the fat in the body from combustion (the obesity of drunkards) . 



In addition to the great inconvenience due to the weight of the body, cor- 

 pulence, and particularly obesity, is attended with certain disadvantages and 

 dangers. Among these are dyspnea, readiness of fatigue, the development of 

 intertrigo in the folds of the skin and of so-called fat-hernia, and finally the danger 

 of fatty degeneration, of cardiac paralysis and of apoplexy. 



For the correction of obesity the following measures should be adopted: (i) 

 Uniform reduction of all of the articles of food to the proportions of the normal 

 diet. The obese patient should weigh himself and his daily amount of food from 

 week to week. So long as he observes no reduction in body- weight, the amount 

 of food (in spite of the appetite) should be gradually and uniformly reduced. 

 This course should be pursued slowly, without unduly sudden limitation. Almost 

 all good resolutions fail in the face of the excellent appetite. A moderate reduction 

 of the fat and the carbohydrates in the normal diet would at the same time result 

 in consumption of the fat of the body itself. Such individuals as are still capable 

 of muscular 'activity may be permitted 156 grams of proteid, 43 grams of fat, 

 114 grams of carbohydrates. Those in whom hypostasis, hydremia, and respira- 

 tory difficulty have developed may be permitted 170 grams of proteid, 125 grams 



