Attacks of stenocardia and cardiac pain are peculiar to sclerosis, and differ essentially from a neurosis by reason of occlusion of the vessel from embolism and thrombosis of the coronary arteries and of consequent myocarditis, myomalacia, formation of callosities, aneurisms of the heart, and heart rupture. The attack is only dis tinguished by considering together all the symptoms which go to make an existing sclerosis of the artery probable, more particularly the intensity of the heart pain, the characteristic radiation toward the left arm, the great sense of prostration, and swooning attacks which may even go on to actual fainting fits, and especially the coin cident existence of dyspucea. In cases of functional trouble, the stenocardia may be of extraordinary severity and may even be ac companied by the characteristic radiation of pain toward the left arm ; but in these cases we always miss the severe dyspncea which is never absent where there is arteriosclerosis, and which is, there fore, a valuable diagnostic criterion.
The frequent association of arteriosclerosis with obesity, espe cially at about forty years of age and upward, and the fatal conse quences which result directly from overlooking the same, make it our duty to consider as carefully as possible in each case of obesity in its later stages the existence of an arterial change.
When atheroma of the vessels has been produced, the degenera tion of the vessel's walls may be immediately recognized by exami nation of those arteries which are superficially situated and accessible to investigation. On the other hand, in cases of simple sclerosis we must always think of the possibility that one or another of the vessels existing in the interior of the body may have undergone atheroma tons degeneration and may produce by rupture a dangerous hemor rhage, especially in the brain.
ust as easily perceptible are the foe/ and the diathesis frequently connected with obesity and atheroma. Disease of the joints, the presence of gouty pains, and the investigation of the urine soon leave no doubt as to the existing complication.
The condition of the kidneys, conyestion-albuminuria, contracted kidney, and genuine parenchymatous nephritis (Bright's disease) will be shown by the chemical analysis of the urine and the microscopic examination of the sediment. Occasional slight attacks of albumi nuria and the appearance of hyaline casts in the urine always prove existing congestion.
The early recognition of diabetes mellitus has the. greatest influ ence upon the patient's future. When without physiological or therapeutical reason we observe our obese patient spontaneously and rapidly losing weight and becoming emaciated, it is of the ritmcst importance that we test the urine, even if no marked thirst is com plained of and the amount of urinary secretion has hot been greatly increased. In these cases we shall almost invariably find a more or less advanced condition of glycosuria.
If (Edema has set in during the last stages it is not very difficult to distinguish the tensely stretched masses of fat of ordinary adipose tissue from the doughy swelling of which so characteristi cally retains the mark of finger pressure for a long time.
Furthermore if emphysema of the skin has developed as is some times the case, it will scarcely be possible to mistake the swelling caused by air in the tissues, which gives a crackling under pressure, for deposits of fatty matter or for oedema.