154 OBESITY 



incontestable proof that a predisposition to' obesity exists may be seen in the 

 fact that there are many persons who eat whatever and as much as they wish, 

 and nevertheless do not become obese. In- what this predisposition to obesity 

 consists is very difScult to say. I look upon oiesity, gout, and diabetes mel- 

 litus as well, as forming a single group of interrelated diseases whose basis 

 I designate as " a general disease of protoplasm resting on a hereditary pre- 

 disposition." The epithet " hereditary " is not to be strictly construed. The 

 predisposition may, but need not, be hereditary. By protoplasm I understand 

 not only the cell body but also the cell nucleus, therefore the cell in toto. 

 One may readily conceive that in the production of each of the three diseases 

 just mentioned cell body and cell nucleus are implicated in different ways, 

 Wt I shall not follow these hypotheses any further at present. The investi- 

 gations so far published regarding the respiratory interchange of gases in the 

 obese do not Justify any definite and certain opinions, but we may assume 

 that the consumption of fat in a person predisposed to obesity is slighter than 

 in one not so predisposed provided both live under the same conditions. Fur- 

 ther investigations into the respiratory interchange of gases in the obese made 

 with the large Pettenkofer respiratory apparatus, and lasting longer than 

 twenty-four hours, are much needed. Experiments of shorter duration do not 

 justify us in forming any opinion. 



The predisposition to obesity may become apparent at any time in the 

 patient's life, and the manifestations vary much in intensity. Bunge believes 

 that there is no predisposition to obesity which cannot be overcome by muscu- 

 lar activity. Whether this assumption be correct can, of course, never be 

 proven with certainty. In my opinion there are cases which cannot be cured 

 by exercise unless there is also a limitation of the ingestion of nourishment! 

 The predisposition to obesity rarely shows itself in childhood to any unbecom- 

 ing degree. I have already mentioned that even in utero and in the first 

 years of life there is normally a certain plumpness which rarely increases so 

 as to exceed physiologic limits. I have, however, seen several exceptions to 

 this rule. Occasionally children with a monstrous development of fat are 

 exhibited in shows. What I have seen of these makes me believe that in cases 

 of this kind there is an excessive development of the whole body, a sort of 

 gigantism, rather than a pure lipomatosis universalis, although the latter is 

 favored by their very unnatural mode of life, for they pass their time almost 

 exclusively in a sitting posture, and eat especially such food as decidedly pro- 

 motes the accumulation of fat. Evidently this so-called polypionia infantum 

 (which, in many cases at least, is associated with the condition described by 

 Schonlein, called chlorosis gigantea) is quite rare. More frequent is an 

 abnormal accumulation of fat in adolescents, especially in women at the 

 period of puberty and in combination with various disturbances of menstrua- 

 tion. In boys also, when the normal development of the sexual organs at the 

 time of puberty is retarded, an increased development of the body fat is not 

 infrequently noted. That eunuchs are fatter than normal beings, although 

 often maintained, appears to me to be insufficiently proven. In animals, how- 

 ever, castration favors fattening. On the other hand, there can be no doubt 

 that women who were previously thin, after several labors, very frequently 



