First we must mention the diminution of the copulative capacity and fertility. The large masses of fat on the abdomen in man may obstruct coition, and prevent it even when obesity is not present in both sexes. But the virility and the sexual appetite of men likewise decrease. The semen of such individuals contains remarkable few or almost immobile spermatozoa. Azoospermia is not rarely present. In sonic regions of the Orient where the men are remarkable for their obesity male impotence is said to be truly endemic.
In women the deposition of excessive masses of fat causes on the external sexual organs, the breasts and the vulva, changes of form, increased volume, and tumefactious which by their more bulk partly destroy the symmetry, partly give rise to numerous inconveniences. The breasts, in a few rare, cases, may reach an enormous size by the excessive development of fat. Fisch describes a breast meas tiring 31 cm. in length and 60 cm. in circumference. Portalupi re moved a breast weighing 52 lbs., and from a woman aged twenty-one years Robert and Amussat extirpated the mainline which weighed re spectively 80?,- and 201 lbs. Such breasts require special supporting apparatus in the erect and recumbent positions, etc. Then the pres sure, friction, and sweat cause, especially at the folds under the breast and at their inner surface, erythema, excoriation of the skin, eczema, and intertrigo which are apt to become painful and heal with difficulty.
At the vulva the labia majora and minora may appear more or less enlarged by deposits of fat, or tumors may develop on them or on other parts whereby urination is interfered with and inflammatory alterations are produced in the skin at the inner surface of the labia, which are increased by the hypersecretion of the usually coexistent inflammation of the vaginal mucosa. Owing to the difficult or ne glected cleansing of the parts, erythema, eczema, pruritus, inflamma tion of the hair and sebaceous follicles of the labia majora, and numerous small furuncles appear, while at the same time the skin of the upper and inner surface of the thighs is excoriated and inflamed by the escaping secretion, the sweat, and the friction.
The internal organs also suffer by the pressure, displacement, stretching, and dragging caused by the masses of fat in the abdomen and pelvis, by the intestines filled with ingesta of various kinds, and the frequent constipation; they are further influenced by the impeded circulation in the portal system, by the arterial aiimmia and venous hypermmia, which give rise to nutritive disturbances, hypersecre tion, inflammatory processes, and exudations.
Hence on the one hand displacement of the uterus, anteflexion and retroflexion, anteversion, and prolapsus of the uterus and vagina, and on the other hand menstrual anomalies, amenorrhoea, scanty menstru ation, metrorrhagia, chronic metritis, and leucorrhcea constitute fre quent diseases among corpulent girls and women. The sterility of
such women is mainly due to these morbid conditions which explain the fact observed already by Hippocrates that the obesity of women— as an instance he cites the women of the Scythians—is the cause of their sterility.
Lastly the frequent occurrence of abortion in corpulent women is connected with the crowded space of the pelvis and abdomen in which the pregnant uterus cannot enlarge. The effect of the masses of fat is the same as that of other abdominal tumors which lead to abortion by the crowding and pressure.
The Skin.--Among the or2;anic diseases mention should be made of some symptoms presented by the skin.
The increased secretion of sweat has been already referred to. It is largely connected with the circulatory disturbances dependent upon the insufficiency of the heart muscle and the augmented heat produc tion. But the sebaceous glands of the skin are also overactive, and the fatty and oily secretion elaborated by them in large amounts spreads over the surface of the skin, especially that of the face, and gives it a shining appearance. Withal the sebaceous glands are usu ally filled with secretion which can be expressed in the shape of soft white plugs, or when thicker is retained in the glands and forms mil let-seed to hemp-seed sized nodules, comedones, in the centre of which a dirty-gray or black point marks the efferent duct of the gland.
The increased secretion of the sweat and sebaceous glands causes at various parts of the body where two cutaneous surfaces come in contact—on the neck, in the axillw, under the female breast, at the umbilicus, at the folds of the abdomen and the inguinal region, on the scrotum and the labia, on the inner surface of the thighs, which are kept moist by the perspiration and the sebaceous secretion— maceration of the epidermis and, by the friction, hyperemia, excori ation, and intertrigo.
Other well-known diseases of the skin in obesity are furunculosis and the formation of caruncles, while with the abuse of alcohol, and sometimes in women about the menopause, acne rosacea is of common occurrence.
As regards the hair, both hypertrichosis and alopecia occur in corpulence. The excessive growth of hair then extends also to those parts where, in accordance with the age or sex, no hair or at most lanugo is normally present: in women on the upper lip, chin, and cheeks, or on the breast, back, ,arms, and thighs. In the majority of cases, however, we may observe a deficient growth of the hair and heard, or an entire absence of the beard and prematute baldness, as well as falling of the hair on other parts of the body such as the genitals.