A text-book of medicine : for students and practitioners.

  • Adolph Strümpell
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine : for students and practitioners. Source: Wellcome Collection.

    1022/1108 page 994
    ages. There can be no doubt that intemperance in this regard plays a prominent part in many instances. Sufficient illustration is furnished by brewers, hotel, keepers, and the inhabitants of countries like Bavaria, where beer drinking is prevalent. In this particular it is evident that beer works more harm than does wine or strong liquor; for beer contains, in addition to the alcohol,an appreciable aihount of starchy material, making the sum total from the beer drunk during tire entire day a considerable one. Many persons who would be extremely indig- nant if called “ tipplers,” habitually take five or six glasses of beer a day, equiva- lent to 150 grm. of starch, or, in other words, one half the total amount of starch required by the system. Even this quantity is frequently exceeded. Of course, the three or four per cent, of alcohol which the beer contains also promotes the deposition of fat. Alcohol is readily oxidizable, and it thus shields to a consid- erable extent the fat already present in the body; and it also, in all probability, works such an injury to the tissues as to diminish then’ power of effecting decom- position. We must also remember that most beer drinkers take little exercise. The long sitting at the beer table, and the mental and physical sluggishness which immoderate indulgence in beer always causes, and finally the increasing corpulence itself, make it clear why most beer drinkers dislike protracted exercise. We have thus seen that in by far the larger number of cases obesity is mainly due to the ingestion of too much food. No weight need be attached to the usual statement of corpulent persons, that they eat no more than others. Few of them have any idea how much noui’ishment they do consume. Others, ha^nng already become corpulent, eat less, to be sure, thao they used to, but nevertheless an amount sufficient to maintain the acquired weight. Other factors may no doubt exert an influence upon the increase of adipose tissue by diminishing the consumption of fat in the system. The most important factor of this class is physical inactivity. Muscular contractions lead to the decom- position of a large amount of fat. This explains why people of sedentary habits, and those who sleep long and exercise little, are more apt to become corpulent than are manual laborers. Again, there are certain diseases which seem to promote corpulence. In anaemia there is sometimes a strilring tendency to obesity, in part due to the diminished supply of oxygen and in part to diminished muscular activity. This same inactivity is probably the main cause of corpulence in paraly- sis (hemiplegia). It may be, however, that disturbances of the nervous system may directly affect metamorphosis. Thus, idiots and other subjects of congenital defects of the brain ai’e liable to obesity. Distui’bances of the circulatoiy system seem to favor the production of corpulence by impaij’ing oxidation. Tliis is seen in many young persons with cardiac disease, although it is not easy to exclude in this case the influence of still other factors, such as a sedentary life. Finally, some cases of obesity seem to result from a constitutional and inborn predisposition. Young children sometimes suffer from obesity; and the condi- tion seems in many cases to be hei’editary. Many races and nations exhibit an especial tendency to corpulence—for example, the Jews. Age and sex have some importance in this regard: extreme obesity is seldom seen previously to the thir- tieth year; and women appear to be somewhat more subject to the disease than men. The importance of a “ tendency ” to obesity should not be overrated. Upon careful investigation, we shall almost invariably find in the habits of the indi- vidual, as regards food and exercise, a satisfactory explanation of his obesity. Strictly speaking, the condition can not be regarded as a disease unless the habits as to diet and exercise fail to account for it. Pathology.—After corpulence has passed a certain point the condition is evi- dent at the first glance. The subcutaneous cellular tissue is one of the chief places in which the fat is deposited. Consequently, the panniculus adiposus soon attains
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