366 CORPULENCE. 



242 CORPULENCE. The addition of too much fat to the body is a pathological pheno- 

 menon which is attended with disagreeable consequences. With regard to the causes of obesity, 

 without doubt there is an inherited tendency (in 33 to 56 per cent, of the cases) in many 

 families and in some breeds of cattle, to lay up fat in the body, while other families may be 

 richly supplied with fat, and yet remain lean. The chief cause, however, is taking too much 

 food, i. c, more than the amount, required for the normal metabolism; corpulent people, in 

 order to maintain their bodies, must eat absolutely and relatively more than persons of spare 

 habit, under analogous conditions of nutrition ( 236). 



Conditions favouring Corpulence. (1) A diet rich in proteids, with a corresponding addition 

 of fat or carboh ydraUs. As llesh or muscle is formed from proteids, and part of the fat of the body 

 is also formed from albumin; the assumption that fats and carbohydrates fatten, or, when taken 

 alone, act as fattening agents, is completely without foundation. (2) Diminished disintegra- 

 tion of materials within the body, e.g., (a) diminished muscular activity (much sleep and little 

 exercise) ; (b) abrogation of the sexual functions (as is shown by the rapid fattening of castrated 

 animals, as well as by the fact that some women, after cessation of the menses, readily become 

 corpulent) ; (c) diminished mental activity (the obesity of dementia), phlegmatic temperament 

 On the contrary, vigorous mental work, excitable temperament, care and sorrow, counteract 

 the deposit of fat ; (rf) diminished extent of the respiratory activity, as occurs when there is a 

 great deposition of fat in the abdomen, limiting the action of the diaphragm (breathlessness of 

 corpulent people), whereby the combustion of the fatty matters iwhich become deposited in the 

 body, is limited ; (c) a corpulent person requires to use relatively less heat-giving substances in 

 his body, partly because he gives oft" relatively less heat from his compact body, than is done 

 by a slender long-bodied individual, and partly because the thick layer of fat retards the con- 

 duction of heat ( 214, 4). Thus, corresponding to the relatively "diminished production of 

 heat, more fat may be stored up ; (/) a diminution of the red blood-corpuscles, which are the 

 great exciters of oxidation in the body, is generally followed by an increase of fat fat people, 

 as a rule, are fat because they have relatively less blood ( 41) women with fewer red blood- 

 corpuscles are usually fatter than men ; (g) the consumption of alcohol favours the conservation 

 of fat in the body, the alcohol is easily oxidised, and thus prevents the fat from being burned 

 up ( 235). 



Disadvantages. Besides the inconvenience of the great size and weight of the body, corpu- 

 lent people sutler from breathlessness they are easily fatigued, are liable to intertrigo between 

 the folds of the skin, the heart becomes loaded with fat, and they not uufrequently are subject 

 to apoplexy. 



In order to counteract corpulence we ought to (1) Reduce uniformly all articles of diet. 

 The diet and body ought to be weighed from week to week, and as long as there is no diminu- 

 tion in the body- weight the amount of food ought to be gradually and uniformly reduced (not- 

 withstanding the appetite). This must be done very gradually and not suddenly. A moderate 

 reduction o, fat and carbohydrates in a normal diet, at the same time leads to a diminution of 

 the fat of the body itself. Let a person, who is capable of muscular exertion take 156 grms. 

 proteid, 43 grms. fat, and 114 grms. carbohydrates ; but in those where congestions, hydremia, 

 breathlessness have taken place, take 170 grms. proteid, 25 grms. fat, and 70 grms. carbo- 

 hydrates (Ocrlel). It is not advisable to limit the amount of fat and carbohydrates alone, as is 

 done in the Banting-cure or Bantingism. Apart altogether from the fact that fat is formed 

 from proteids, if too little non-nitrogenous food be taken, severe disturbance of the bodily- 

 metabolism is apt to occur. (2) It is advisable during the chief meal to limit the consumption 

 of fluids of all sorts (even until three-quarters of an hour thereafter), and thus render the ab- 

 sorption and digestive activity of the intestine less active (Oertel). (3) The muscular activity 



ought to be greatly developed by doing plenty of muscular work, or taking plenty of exercise, 

 both physical and mental. (4) Favour the evolution of heat by taking cold baths of consider- 

 able duration, and afterwards rubbing the skin strongly so as to cause it to become red ; further, 



dress lightly, and at night use light bed-clothing ; tea and coffee are useful, as they excite the 

 circulation. (5) Use gentle laxatives ; acid fruits, cider ; alkaline carbonates (of Marienbad, 

 Carlsbad, Vichy, Neuenahr, Ems, &c.) act by increasing the intestinal evacuations and dimin- 

 ishing absorption. (6) If from accumulation of fat there is danger of failure of the heart's 

 action, Oertel recommends hill-climbing, whereby the cardiac muscle is exercised and strength- 

 ened. At the same time the circulation becomes more lively and the metabolism is increased. 



[Oertel's Method goes on the idea of strengthening the cardiac musculature, which is sought 

 to be accomplished by (1) limiting the amount of fluids consumed, and (2) carefully regulated 

 muscular exertion. The amount of food is first reduced one-half, and the water to a still lower 

 amount, while the nitrogenous elements in food are increased, the non-nitrogenous are decreased. 

 The person is then instructed to take exercise under certain medical precautions, first, on level 

 ground, and then on gradually increasing gradients.] 



Fatty Degeneration. The process of fattening consists in the deposition of drops of fat 

 within the fat-cells of the panniculus and around the viscera, as well as in the marrow of bone 

 (but they are never deposited in the subcutaneous tissue of the eyelids, of the penis, of the red 

 part of the lips, in the ears and nose). This is quite different from the fatty atrophv or fatty 



