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.

    1024/1108 page 996
    tissue, and in still greater part to complications, most of whicli are excited by the same causes as is tbe obesity itself. The abundant adipose tissue may obstruct the circulation in the smaller blood-vessels and capillaries inclosed within it. And, furthermore, the excessive development of fatty tissue probably leads to the growth of new blood-vessels, and, as a consequence, to an increase in the total vol- ume of the blood. This is one way in which the demands made upon the heart are rendered greater than normal, and explains why the corpulent frequently exhibit cardiac hypertrophy. Other influences are also at work to produce this same result: they are, in the first place, the same factor which occasions the obesity itself, namely, the ingestion of increased amounts of food and di-ink (see the chapter on cardiac hypertrophy), and, secondly, certain other lesions which are frequently associated with obesity and are referable to the same causes as it is. Chief among this latter class is general arterio-sclerosis. If this involve the coro- nary arteries, it may in turn occasion still further damage—for example, degenera- tive myocarditis (compare page 309.) Chronic interstitial nephritis is another not infrequent complication. This is in part I’eferahle to the same causes as is the obe- sity. Gout and diabetes are less frequent. We thus see that obesity is often merely one of many injurious results occa- sioned by an improper mode of life. It is, in a certain sense, the first danger- signal, warning the patient and his physician to avoid the graver disturbances which threaten. This is a point of great practical importance; for, when once we have a comhination of obesity with cardiac hypex'trophy, fatty infiltration of the heart, arterio-sclerosis, or interstitial nephritis, the various causes and effects act and react upon one another in a way most perilous to health, and even to life. There is no need of desci’ibing the grave disturbances which invai’iably develop at the close of the scene. They are the result of chronic cardiac insufficiency, and have been fully described under cardiac disease. In every case of obesity the physician should examine the heart, lungs, vascur lar system, and kidneys, particularly if there be already subjective disturbance. The examination of the heart may present considerable diffichlties, because the results of palpation and ixercussion are so obscured by the thick cushion of fat which covers the thorax. We can, however, have recourse to auscultation, and can feel the pulse. The pulse may be either rapid, or slow, or irregular. We need not mention any minute particulars as to the examination. It may be stated, however, that a hejxatic enlargement is often found, but it is much less often the result of fatty infiltration than of simple hypertrophy or passive congestion. We have thus seen that corpulence may sometimes be associated with grave and dangerous lesions; but, on the other hand, it should be stated that this unfor- tunate condition hy no means invariably exists. Not infrequently the corpulence remains moderate, in which case it is not really dangerous, however incon- venient. This is true of a proportion of those cases which are due to the in- gestion of a large amount of nourishment, associated with defective oxidation, and where there ai-e no other unfavorable influences at work. The obesity of hard drinkers is almost always a more or less dangei-ous condition, while that seen in many eldeidy persons and in women is often comparatively free from peril. These latter individuals are, to be sure, discommoded by their great weight, can accomplish less than they used to, are easily put out of breath, and have a certain tendency to catarrhal inflammations and rheumatic difficulties; but they escape the severer lesions above enumerated. Even these apparently harmless conditions should not be disregarded by the physician, as he can never be abso- lutely certain that grave complications may not be developed eventually. Treatment of Obesity.—To cause the disappearance of the accumulated fat, it is necessary to promote its oxidation in the system and to prevent the ingestion of
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