SYMPTOMATOLOGY 155 



even after their first child, acquire a decided increase of their panniculus 

 adiposis. The same also occurs at the menopause, and during the period of 

 involution in woman. In some men we note that the body fat may increase 

 enormously even during vigorous adult life. There can be no doubt that at 

 this period an improper mode of life decidedly favors the accumulation of fat. 

 Any one who goes to Munich, and watches the inhabitants, will be able to 

 confirm this. 



Of special interest is the previously mentioned obesity of women in the 

 involution period, which, however, is by no means an invariable occurrence, 

 but is observed in only about one woman in four during the menopause. 

 Nevertheless, the obesity of women at this age has almost become proverbial. 

 One speaks of "matronly proportions," and the Germans have a yet more 

 significant phrase, " fat as an old woman." It is often asserted that this 

 accumulation of fat is due to the cessation of menstruation, to the absence of 

 function of the sexual glands which causes a decidedly diminished consump- 

 tion of oxygen, and also that the decreased interchange of gases can be restored 

 to normal and more than normal in a comparatively brief space of time by the 

 use of oophorin, which compensates for the absence of ovarian activity. Fur- 

 ther investigations will show whether, and how far, this teaching is justified. 

 At any rate this much is certain, that a decided increase of body fat above the 

 normal is often observed without lesions of any special organ showing a 

 decidedly determinable influence. Thus, for example, obesity may occur after 

 recovery from severe illness, and is then usually explained by the long rest 

 in bed during convalescence, and by the increase of nourishment above the 

 normal after a long period of semi-starvation. We know that not infre- 

 quently, after recovery from severe enteric fever, the patient becomes quite 

 stout, and that the corpulence acquired in this way is often permanent. 



A factor of importance in the pathogenesis of obesity is the use of alcohol 

 I have already referred to the immoderate use of beer in Munich, and it is 

 not necessary to quote further examples. Bunge also declares alcohol to be 

 conducive to the accumulation of fat, and in the main explains this by suppos- 

 ing that alcohol, by its paralyzing action upon the brain, makes people lazy 

 and unwilling to exert themselves. 



SYMPTOMATOLOGY 



In discussing the symptomatology of obesity I shall follow the division of 

 obesity into three stages as proposed by me; if not pushed to a pedantic ex- 

 treme, this plan simplifies matters very much. For practical purposes this 

 division into three stages has shown itself to be very serviceable. In the 

 first stage the obese man is an enviable person, in the second a ludicrous one, 

 and in the third a pitiable one. 



The 3?iEST STAGE may be identified with polysarcia. The flesh, the mus- 

 cles, increase in due proportion to the fatty tissue. This is the type of obesity 

 which conveys a majestic impression. The body becomes fuller, the figure 

 fills out, the person reaches a proper embonpoint. This type is usually tound 

 in young persons whose youth is full of activity. In this stage obesity does 



