This section is from the book "The Home Hand-Book of Domestic Hygiene and Rational Medicine. Volume 2.", by J. H. Kellogg, M.D.. Also available from Amazon: The Home Hand-Book of Domestic Hygiene and Rational Medicine, Volume 2.
The characteristics of this disease are so well known that it is unnecessary to go into an elaborate description of the condition of the system in corpulency. The disease may occur at any time of life, but is by far the most frequent in early infancy and after forty years of age. Women are more frequently affected than men, the disease usually making its appearance in them at, or near, the change of life. In such extraordinary cases of obesity as that of Mr. Bright, of England, who attained the enormous weight of 609 lbs., or those in which the weight of the body is increased from two to four times that in health, there is, of course, no difficulty in discovering the disease; but in many cases it is by no means easy in a given case to decide whether the condition is one of obesity or of slightly increased fatness, which is usually termed "good condition." Indeed it is probable that the condition of moderate rotundity which is consistent with the enjoyment of the highest health passes by such slow degrees into a condition of disease from superabundance of food that there is no distinct dividing line. For practical purposes, however, it must be said that a person is in a morbid or diseased condition on account of the increase of fat whenever the accumulation becomes so great as to perceptibly interfere with any of the vital functions. In addition to the symptoms already mentioned, various local symptoms are often observed, as varicose veins in the lower limbs, unnatural redness of the face, and especially of the nose, clumsiness of gait, and a sediment in the urine. In consequence of the body being covered with a thick layer of fat, there is a marked tendency to the accumulation of heat, which is conducted away from the body very slowly, so that the person is made to suffer greatly with heat, especially in the summer season and upon making violent exertion. To guard against injury from this source, nature sets up a profuse perspiration whenever the system is exposed to an unnatural degree of heat from either internal or external causes, by which the patient is often very greatly weakened.
Singular as it may appear, the condition previously described as plethora is by no means constant in obesity. In many cases the condition of the blood is that of anaemia, there being a marked deficiency in the proportion of red blood corpuscles. Indeed, there must be a decided tendency to anaemia manifested, sooner or later, in nearly all cases of obesity. This is an important point to be borne in mind, as it has a practical bearing on methods of treatment. The excessive accumulation of fat is not, as may be supposed, confined to the outside of the body. Post-mortem examinations of corpulent persons have shown that nearly every organ and structure of the body, internal as well as external, suffers from the excessive deposit of fat. The liver is usually more or less enlarged, sometimes greatly so, and is infiltrated with fat. The kidneys are not only imbedded in a mass of fatty tissue, but their substance is also filled with it. The heart is generally loaded down with fatty accumulations, and the walls of the arteries are more or less weakened by the exchange of their normal tissues for fat. The muscles, also, are invaded by the fatty deposits in a very marked degree. In fact, very few, even of the most delicate organs of the body, escape the general morbid tendency. These changes in internal organs are what are known and have been previously described as fatty degeneration, and the consequences of these morbid processes entail upon the sufferer from obesity the most serious effects of this disease. The deficiency in the number of red blood corpuscles gives rise to an unpleasant, and often serious dyspnoea, or difficult breathing, which is occasioned by any unusual ex ercise. The change in the structure of the heart is the cause of frequent, and sometimes serious palpitation. In severe cases the heart's action becomes extremely weak and irregular. One point which may be worthy of particular mention is that obesity not only entails upon persons subject to it certain inconveniences which arise directly from this morbid condition, but renders them in a very unusual degree liable to suffer from various other diseases, among which may be mentioned as those to which corpulent people are particularly liable, apoplexy, rheumatism, gout, diabetes, severe colds, fevers, and inflammatory affections of all sorts.
The tendency to apoplexy as being characteristic of this disease is readily accounted for by the changes in the blood-vessels, by which their walls are weakened and thus rendered much more liable to rupture from any degree of pressure induced by exercise, emotion, excitement, or any other cause. The frequency of rheumatism and gout in fleshy persons is undoubtedly occasioned by the retention of the waste products, or excrementitious principles, in the system, which results from the torpid, inactive state of the liver, kidneys, and other excretive organs. It is this gross condition of the system also which predisposes an obese person to febrile and inflammatory affections; and we should not omit to remark that when the last-mentioned diseases occur in very corpulent people they almost invariably manifest an unusual degree of severity and fatality. On account of the grossness of the blood and the lowered vitality of the tissues in consequence of their impaired condition, certain skin diseases, particularly eczema, are very common accompaniments of obesity. This is particularly true of young children, in whom excessive fatness is the most common cause of the often very troublesome affection known as intertrigo, or chafing.
When left to itself the disease finally terminates in death, which may be either the direct result of the enormous accumulation of fat through interference with the operation of the vital organs, or, as is much more frequently the case, death may result from apoplexy, syncope, or from any acute or chronic disease with which the patient may become affected, eiher independently or as a direct result of his obesity.
The only diseases at all likely to be confounded with obesity are general dropsy and emphysema. The first condition may bo readily distinguished by means of the phenomena of bloating (see "Dropsy"); the second morbid condition, which is a peculiar affection in which the tissues become distended with air, may be readily distinguished by the resonance produced by tapping or percussing the affected part.