ANEMIC FORM - OBESITY In every-day life by the side of the corpulent persons with true plethora we meet with a number of patients likewise affected with an abnormal deposition of fat in the subcutaneous cellular tissue, at the various points of predilection, and in the internal organs, but who differ materially even on superficial observation from cases of the former type.
As this difference seems to be marked by changes in the quality and quantity of the blood, by and chlorosis, it manifests it self mostly in early stages and decreases as the corpulence advances and with its longer duration, until hydrminic conditions gradually develop as in the plethoric form and obliterate the last distinctive mark. But the course, too, and the time in which this transition occurs differ in the two forms of obesity, and while in plethoric cases it often takes many years until the blood becomes hydrxmic, this change may develop iu a much shorter time, often in a few years, in anmmia and chlorosis in which the quality of the blood predisposes to it.
Instead of the florid, more congested face of the corpulent with normal blood and beginning plethora, instead of the round shape, the tensely elastic feel of the body, the but slightly diminished muscular force and general power of resistance, the full pulse and vigorous heart-beats, there are presented to us pictures which lack so many characteristic traits that they hardly seem to resemble the former. Indeed an ample deposit of fat has occurred, the face is round and full, the circumference of the chest and abdomen exceeds the normal by far, the extremities are thick, plump, and shapeless ; yet the masses of fat are not tense and firm but flabby, doughy, non-resis tant to pressure. The face, the external skin, and the mucous mem branes are pale and the muscles are poorly developed, flabby, and weak, usually from the beginning; the pulse is small and thin; the heart's action is lacking in force; the general energy and the power of resistance of the body are depressed. The surface of the body feels cool and the temperature is frequently subnormal. While the
plethoric patient still develops much muscular power and is capable of great exertion, the strength of the corpulent patients is barely sufficient for slight daily work; they soon tire, often after slight exertion ; they rapidly lose breath, suffer from palpitation, and are therefore more inclined to take it easy ; they need rest, are lazy, they sleep much and long, often late in the day, and are with diffi culty induced to get up. They therefore look for sedentary occupa tions, but without any inclination for exhausting mental activity; they avoid also in their recreations anything in the way of games and walks requiring bodily movement and muscular exertion. Nor are they as a rule great eaters. The consumption of food not rarely is below the quantity appropriate to them, and while good juicy but lean meat is taken in small amounts and with aversion, fat-forming especially such as are rich in carbohydrates, constitute their chief diet. In the ingestion of fluids the patients are usually less abstemious. But it is not always alcoholic liquors, wine, beer, and whiskey, which are preferred and taken in abundance ; in the majority of cases, besides coffee and tea, plain water, sugar water, water with sweet fruit juices, lemonade, wine diluted with water form the staple drinks. Only those patients (men) whose amemic condi tions are due to the abuse of alcohol, prefer beer, wine, brandy, liqueurs, etc., and consume large quantities of these. Such patients use water but sparingly and unwillingly, frequently only when mixed with wine or brandy.
The majority of patients of this type are of the female sex: young chlorotic girls with much adipose tissue and of pale aspect. Men struation in them is nearly always abnormal, scanty, irregular, or painful. In the same way women become corpulent who have lost much blood, have suckled children for a long time, and then have taken large amounts of unsuitable nourishment (forced feeding).