DIAGNOSIS 



159 



the psychical life of the patient may be in order. It is commonly believed 

 that fat persons have a more phlegmatic, and, associated with this, an espe- 

 cially good-natured disposition. That there is a necessary connection between 

 obesity and a special temperament characterized by indifference and apathy is 

 certainly not true. I wish to issue a warning against the adoption of this very 

 common assumption as correct. [That this is the general view, not only 

 among the laity but even among philosophers and poets, is well illustrated by 

 the familiar quotation from Julius Caesar, Act 1, Scene II, lines 192, et seq. : 



Let me have men about me that are fat, 



Sleek-headed men, and such as sleep o' nights: 



Yon Casslus has a lean and hungry look ; 



He thinks too much: such men are dangerous. (J. L. S.)] 



It is true, however, that the obese individual is usually distinguished by a 

 less irritable nervous system. It is often declared that obesity hinders the 

 development of great mental power. With necessary limitations, we must 

 admit the truth of this assumption as regards the extreme types of obesity. 

 One who has a great burden of body fat to carry about with him can hardly 

 be expected to develop mental powers equal to those of persons not limited in 

 this way. So long as obesity is not excessive, strong, energetic, and talented 

 natures will be able to adjust themselves to the increase of their body fat and 

 the resulting restriction of their bodily movements without suffering any con- 

 siderable limitation of their mental functions. 



DIAGNOSIS 



The diagnosis of obesity is, as a rule, made correctly by the laity, for the 

 condition is obvious, and may be determined whenever one finds an immoderate 

 development of fat in the subcutaneous connective tissue. More perplexing 

 is the decision whether the superfluous fat development has proven detrimental 

 to other structures, for example, to the muscular tissue, as we should assume 

 in all of the more marked grades of obesity. But for the physician this offers 

 no great difficulty. Whether too much fat is formed and deposited in the 

 areas of the subcutaneous connective tissue which are most accessible to exami- 

 nation is readily learned in most cases by observation of those parts of the 

 body not covered by clothing, particularly the face. The cheeks, and espe- 

 cially the region of the chin, appear more massive than normal. The " double 

 chin " is a familiar feature. Yet there are fat individuals in whose faces the 

 fat does not reach decided proportions. The nude body, as a rule, shows accu- 

 rately to what extent fat is accumulated in the subcutaneous connective tissue. 

 All the landmarks of the body are displaced in obesity ; they appear as if they 

 had been forced downward or pushed laterally. There is great accumulation 

 of fat in the subcutaneous tissue of the mammary region, not only in fat 

 women but also in fat men; in the latter we often see the subcutaneous fat 

 heap up until it produces masses that in point of size are not much less than 

 the well-developed female mamma. Upon the abdominal walls thick trans- 

 verse rolls of fat may often be seen. Upon the lower portions of the thorax. 



