But should much alcohol be ingested with the other liquids, or should strong alcoholic liquors be chiefly consumed, the gravest forms of dyspepsia set in. The gastric mucosa which is altered by the •on gestive catarrhs, and the food in the process of digestion, are par ticularly acted upon by the alcohol in an unfavorable manner and the progress of digestion is retarded.
The first damage suffered by the intestine and its functions through the ingestion of large quantities of food consists likewise in distention by the bulk of its contents and by the gases resulting from the abnormal decompositions, and in an impeded peristalsis. The intestine is unable to propel the great masses in an adequate man ner, it becomes ectatic, constipation and obstruction follow, and in their turn cause intestinal irritation with frequent thin-fluid evacua tions which, however, do not remove the bulk of the hardened feces. In the presence of diarrhoea the patients complain of insufficient evacuation and constipation, of pressure on the chest, difficult res piration, and palpitation of the heart; they feel psychically out of sorts and resemble hypochondriacal sufferers from hemorrhoids. A phlegmatic temperament, slight bodily activity, and a sedentary occupation or mode of life particularly favor the abdominal distur bances. A true inflammation may also result from the constipation, especially in the ciccum in which the farces remain the longest and in the surrounding structures, namely, typhlitis and perityphlitis, which are apt to assume a serious character and end fatally.
Should a catarrhal inflammation develop in the intestinal mucous membrane from the constipation, the latter is soon followed by chronic diarrhoea, which is also frequent in obesity associated with alcoholism.
The last mechanical effect of the accumulation of fat in the dominal cavity to be mentioned is the formation of fat hernias and necrosis. The hernias owe their origin to the proliferation of fat into a hernial sae, vascular opening, or into fissures of the inal wall whose tissues have separated here and there under the high pressure of the viscera, most frequently in the linea alba between the umbilicus and the ensiform process, more rarely above the sis. After the reposition of the soft, easily reducible but painful
tumors the opening in the linea alba through which they have caped can be distinctly felt. Should the fatty tumors situated of the peritoneum drag the latter along like a blind sac, truehernias may result. The same cause, the slight resistance of the ab dominal walls, may also give rise to true abdominal hernias, espe cially umbilical hernias, which of course are more frequent in women than in men. When hernias are present in connection with constipa tion the penetrating feces may cause incarceration, which always leads to dangerous complications by reason of the thick superincum bent masses of fat.
In the adipose tissue, especially that proliferating between the glandular lobules of the pancreas and its surroundings, there has been observed, first by Balser, then by Ponfick, E. lob, and Chiari, a cir cm:scribed necrosis, fat necrosis, which develops in patches without inflammation. At other points, too, in the mesenteric adipose tissue, in the °mental bursa, in the subpericarclial and subpleural adipose tissue, also in the panniculus adiposus and in the bone marrow, opaque yellowish-white patches were found, which were punctiform or from the size of a pin-head to that of a pea ; some of them could be enucleated or were softened and doughy, others were undergoing calcification. They produced no symptoms recognizable during life. Whether glycosnria was present with the disease of the pancreas was not stated; probably no attention was paid to it. Chiari considers this necrosis as a concomitant phenomenon of a grave marasmus, as he found it present only in connection with serious diseases of the body (cf. section on diabetes mellitus).
Sexual Oiyans.—The sexual organs also suffer from the excessive accumulation of fat iu the body. Even the mechanical influence of the enormous masses of fat with the associated circulatory anomalies must exert a similar influence upon the sexual organs as upon other viscera, and produce disturbances which prejudice their nutrition, de velopment, and function as well as sexual life in general.