In men the anemic form of corpulence is less apt to develop. Those in whom it does develop are usually convalescents from grave, acute wasting diseases (typhoid fever, scarlatina, articular rheuma tism, cholera, pneumonia, etc.), who accumulate fat by rest, excessive and unsuitable diet; also the subjects of scrofula and a tuberculous ten dency, persons suffering from pernicious anaemia, habitual drunkards, cachectic individuals, and syphilitic patients after mercurial treat ment in whom a deposition of fat occurs on an anaemic basis, but who soon present the signs of a rapidly progressive hydraania.
If we come to consider the nutrition of those patients in whom the obesity develops we find the diet to consist in the main of fat forming substances, but the quantity is always rather small as com pared to that of other persons, especially of those who work hard, who live for months almost exclusively upon fat and carbohydrates, of which they consume considerable amounts without becoming fat (woodmen, laborers iu the mountain forests, etc.).
There can be no doubt that the principal cause of the abnormal accumulation of fat in these cases rests on the quality of the blood, i.e., on the diminished oxidation processes in consequence of the slight hmnoglobin contents of the blood and the insufficient oxygen ation dependent upon it. How greatly combustion and heat forma tion are reduced in the bodies of such patients can be recognized even from their low temperature which is almost without exception subnor mal, with a heat deficit ranging between 0,2 and 0.5 or even 0.8 C. The diminished absorption of oxygen by the hremoglobin and forma tion of oxyhmmoglobin, together with the slight oxygenation of the tissues, are associated secondarily with the insufficient nutrition and the slight functional capacity of the muscular apparatus, whose ex tent determines the decomposition of fat and the resulting amount of force and heat.
As we may argue a diminished decomposition of fat from the sub normal temperature of the body, so the quality of the muscles, their tone, their relaxed and slightly resistant condition, their small vol ume in the resting and contracted state, their insufficient contractile power and rapid fatigue, permit us to deduce the possible performance work and the combustion of fat caused thereby. The early occur rence of fatigue, and the usually pre-existing shortness of breath, dyspina, and palpitation with any relatively greater physical exer tion of such persons, e.g., walking, stair-climbing, etc., are likewise
signs of the slight absorption of oxygen during respiration and are proportionate to it. The oxygen absorbed by the insufficient ha no globin is used up by slight muscular labor. The respiratory centre is supplied with blood deficient in oxygen, and blood charged with carbonic acid becomes stagnant. The equally weak and inefficient heart muscle exhausts itself in hurried, weak, and incomplete con tractions in order to propel the blood, arriving in larger amounts owing to the muscular labor, from the right heart to the lungs, but without complete success. The blood accumulates in the entire venous system, a venous hyperaemia develops even in the central or gans, and produces marked irritation of the respiratory and cardiac centres.
Rapid relaxation of the muscular contractions, fatigue, and ex haustion are the immediate effects of these processes in the respira tory and circulatory apparatus, and a further result is that the pa tient can decompose only small quantities of fat. If such a patient takes in his food any considerable amount of fat-forming substances they will soon be no longer completely transformed and utilized, and being superfluous material they are changed into fat and deposited in the reservoirs. The patient under inferior nutrition still accumu lates fat.
The accumulation of fat effected under such conditions, and with a rarely abundant ingestion of fat-forming substances and hyper-nu trition, will always be kept within certain limits which are still more restricted by the facts that the digestive apparatus, like the muscular apparatus, is impeded in its activity by the afflux of anomie blood deficient in oxygen; that the digestion proceeds but slowly ; that the craving for food, the appetite, is lessened, and that in this way not sufficient material is supplied to the. body for an excessive formation of fat. In the amemic form of obesity, therefore, the deposition of fat is never as great as in the plethoric form in which the weight may become remarkable. The quality of the fat, too, does not seem to be the same as in persons who have become plethoric by the ingestion of enormous quantities of albuminous food, fat, and carbohydrates. While the subcutaneous cellular tissue in the latter is firm and gran ular, elastic and hard to the touch, in anemia it appears flaccid, soft, loose, and is readily pinched into folds.