Obesity and Emaciation. 435 



tion, ocular troubles, and dropsy or coma, the whole being con- 

 firmed by the dense, high colored viscous, saccharine urine. 



Lesions. As already noticed the most constant lesion is hyper- 

 trophy of the liver, which is swollen unevenly, has thickened 

 borders, is yellow or red, very friable and often fatty, or caseated. 

 The capsule of Glisson is thickened and fibrous. Hyperthropy 

 and fatty degeneration of the thyroid have been found in differ- 

 ent cases, and in one instance insufficiency of the mitral valve 

 with systemic venous congestion. Ocular troubles are constant. 



Treatment. Put the patient on an exclusive diet of skim or 

 buttermilk, or if this is impossible it may be conjoined with lean 

 meat — raw or cooked — keep warm and dry, but give plenty of 

 open air and sunshine. Avoid fatigue and over exertion. Re- 

 stricted diet is of great importance. During the siege of Paris 

 the short rations led to the disappearance of glycosuria from 

 many human patients. 



Among medicinal agents, cholagogues come first, sulphate of 

 soda with chloride of sodium, bicarbonate of soda, salicylate of 

 soda, salol, nitromuriatic acid, may be named. For the febrile 

 condition, antipyrine, acetanilid, or phenacetin may be employed, 

 and iodoform, ergot or codeine may be tried when other measures 

 fail. Bitter tonics and mineral acids may be beneficial, and lastly, 

 blisters to the region of the liver may prove of service. 



OBESITY AND EMACIATION. 



Sugar essential to growch. Ratio of liver to active increase in weight. 

 Obesity and fatty degeneration. Small inactive liver and stunted growth, 

 or loss of weight. Biliary fistula, death in 12 months. Influence of pan- 

 creas. Nitrogenous food for obesity, outdoor life, exercise, cholagogues, 

 salines. Saccharine and starchy food for emaciation, hepatic, and pancreatic 

 stimulants. Mild laxatives and cholagogues, pure air, green, succulent food, 

 pure water, bitters, tonics, moderate exercise. 



There is reason to believe that both of these occur as results of 

 hepatic disorder. The generation of sugar in connection with 

 rapid cell growth in germinating seeds and growing plants, and 

 also in rapidly growing animal tissues as in the body of the foetus 



