OBESITY - DIAGNOSIS.
The diagnosis of obesity in general is not a subject of any great difficulty. The form of the body and the habitus of the patient allow of no doubt concerning the kind of nutrition disturbance in question. The matter is different when we have to distinguish more exactly just what form presents itself before us and in what stage it is, how the heart-power and disturbances of circulation are to be taken into consideration, how the single symptoms are to be ex plained, by what complications the disease is influenced, and in what degree.
The plethoric and anomie forms are easily recognized in most cases, when the general state of nutrition of the patient, the putting on of fat, formation of blood, complexion, color of the skin, pale ness and cyanosis of the mucous membranes, as well as the other symptoms fully described under symptomatology are examined in a more careful manner. Even the hyth.cernic form developing finally from these other forms will be usually distinguished very easily from the two others upon the same grounds, and especially when the dura tion of the existing disturbances of nutrition is considered. But there are many cases where it is not possible to determine the quality of the blood from the existing symptoms, and a direct ex amination of the blood, taken into account with the existing dis turbances of circulation, can alone lead to a positive diagnosis. At the same time it is to be remembered that in most cases we receive for investigation only venous blood, and therefore we must judge of the quality of the patient's blood with great care, and only after investigat ing the amount of contained, the specific gravity of the whole blood, and especially of the serum, perhaps also by counting the blood corpuscles, but never from an estimation of the haemoglobin or blood corpuscles alone. According to the degree of disturbance of the circulation we have to deal with an accumulation of the solids in the venous blood—stasis and concentration, as I have desig nated this manifestation. The amount of Hemoglobin, as well as the specific gravity of the whole blood with especial reference to the number of blood corpuscles, may be considerably increased and not withstanding this hydrmnia may be present, the specific gravity of the serum being very low and the blood containing much water.
The faulty conclusions drawn from the examinations of blood made by Lichtheim, Bamberger, and others, have their origin in the fact that there have been conditions overlooked by them. A too large percentage of ha noglobin is always suspicious, although the patient's other symptoms permit of no conclusions as to the ad vanced disturbances of circulation. By testing the specific gravity of the serum in such cases we find it to be below the normal stand ard, and we have nothing else to deal with than a blood rich in albu min and lifemoglobin. On the other hand, the specific gravity of the serum alone or even together with the blood corpuscles would not in dicate at all the amount of haemoglobin, and though the latter may seem to be normal, anaemia and chlorosis can be present. In all forms of obesity experimental researches are to be made as to the fluids taken in and the secretion of urine, both while the patient takes his usual allowance of liquids and when the latter are greatly diminished.
Important for prognosis and therapeutics is the early recognition of the arteriosclerosis that often develops even in the earliest stages of obesity. Although we may not be able to observe changes in the vascular apparatus, yet resistances are created by the very beginning of the sclerotic process, resulting in decided tension of the pulse. A rise of blood pressure to 150 mm. of quicksilver or over may be regarded as a sign of sclerotic process, even if latent. In the further course of the affection the artery becomes tortuous under the high blood pres sure, although a rigidity of the walls may not yet be appreciable to the touch. Where the artery is superficially situated, such as is the temporal, or more rarely the radial, the fact of its being more or less sinuous, especially under conditions of excitement, is clearly apparent or can be made visible by cautious friction with the hand or a piece of cloth, etc., thereby irritating the dilators and causing enlargement of the vessel's lumen. In advanced cases a failure to recognize the rigidity of the vessels is no longer possible if careful palpation is made.