Obesity, or Excessive Corpulence: The Various Causes and the Rational Means of Cure

by J.-F. Dancel

Physical beauty, like virtue, is a type to which all approximate in different degrees, and which, when not wholly departed from, admits the possessor among the number of the accepted in the eyes of the world; but if, in the case of outward figure as with inward morality, any human attribute should appear distorted or unseemly, it gives rise immediately to a feeling of displeasure and aversion.

Occupied at present with the consideration of physical form only, it may be averred that one of the most frequent deformities of the human body consists in an excessive development of fat.

In accordance with the opinions of able physiologists, fat ought to constitute one-twentieth of the entire weight of the body in man (in the female about one-third more than in the male). It consists of a multitude of minute cells, frequently forming large masses held together by a very delicate membrane, the areolar tissue, which serves as a reservoir, and prevents the fat (which is fluid during life) from floating.

When once fat begins to make its appearance in more than ordinary amount, there is no reason why this augmentation should naturally cease at any given point. This corpulence continues to increase until some disease, often occasioned by the condition itself, terminates this frightful increase of size.

Cases of obesity are rarely met with in mountainous countries, and those having a great elevation above the level of the sea, where the atmosphere is dry; whilst they are frequent in valleys and plains at the level of the sea, having a moist atmosphere.

Men are less subject to obesity than women. The areolar tissue which contains the fat is firmer in the male than in the female, and is not so readily distended by the accumulation of adipose matter. Corpulence is usually developed after the body has acquired its full growth, but childhood is not exempt.

Not long ago, a child of four years old was exhibited at Paris, which weighed one hundred and four pounds. Dr. Coe, an English physician, makes mention of a man named Edward Bright, who weighed one hundred and four pounds at ten years of age; at twenty, three hundred and fifty-six pounds; and thirteen months before his death, five hundred and eighty-four pounds. Another person, a native of Lincolnshire, weighed five hundred and eighty-three pounds, and was ten feet in circumference: he died in his twenty-ninth year. In another instance a man weighed six hundred and nine pounds: his coat, when buttoned, could contain seven medium-sized persons. A case is recorded of a man who weighed six hundred and forty-nine pounds, and measured four feet three inches across the shoulders. In the "Javannah News," for June, 1853, the following case is communicated by a medical writer: "A young man, who lived about eighteen miles from Batavia, was remarkable for his great size. When twenty-two years of age, he weighed five hundred and sixty-five pounds. He continued to increase to over six hundred pounds. He lived upon his plantation in easy circumstances. Four weeks since, his weight began to increase at the rate of a pound and a half, and subsequently two pounds a day. He died one day last week, suddenly, while sitting in his arm-chair. Three days before his death, he weighed six hundred and forty-three pounds." Dupuytren has recorded the case of one Mary Frances Clay, of whom a plaster cast is preserved in the Museum of the Ecole de Médecine, at Paris. This woman, a native of Vieille Eglise, was of humble parents. Her husband travelled as a pedler from town to town. When thirty-six years of age, she was no longer able to accompany her husband, and took her place at the door of a church, to beg her bread. Her height was five feet one inch, and her circumference five feet two inches. Her head, which was small in proportion to her size, was almost lost between two enormous shoulders, giving her an appearance of immobility. A furrow, several inches deep, was the only boundary between the head and chest. Her breasts were enormous. Looking at her from behind, the shoulders were elevated by fat, and formed two huge protuberances. The arms stood out from the body, in consequence of cushions of fat in the armpits. On observing the plaster cast of this person, the right side will be seen to be much more developed than the left, owing to her habit of lying on that side, and the fat gravitating towards it. For several years she was able to walk from her dwelling to the station at the church door, about a mile; but finally she was compelled to stay at home. She suffered, while walking, from loss of breath, and had violent palpitations of the heart. She was unable to lie down, from a sense of impending suffocation, and was obliged to retain an upright position night and day, seated in an arm-chair. Under these circumstances, nature soon gave out. She fell sick, and was taken to the hospital, where she died. About twenty years ago there was a German in Paris, named Frederick Arrhens. He was then twenty years of age, and weighed four hundred and fifty pounds. In circumference he measured five feet five inches, which corresponded exactly with his stature. He was poor, and had lived chiefly on vegetable and milk diet.

It is almost unnecessary to describe obesity, since it is known at the first glance. The face is animated; the circulation is impeded, and renders the complexion turgid, and sometimes almost of a deep wine-colour. The eyes suffer from this impeded circulation; they are sparkling, and frequently suffused with blood. The ears, which are generally colourless in health, are, for the most part, red in those labouring under obesity. The circulation through the head being greater than through any other part of the body, and being impeded, an almost continual perspiration with great heat is established; thus it is that fat people can seldom bear to have the head covered; in some cases it even produces dizziness. As this condition progresses, if fortunate enough to escape threatened cerebral affections, the blood loses its chief characteristic, and becomes watery; such persons are pale and flabby. The integument of the lower part of the face is capable of great distension, and here, in obesity, fat accumulates, and forms on both sides an unsightly mass, sometimes reaching to the chest. A roll of fat is often found on the back of the neck. The trunk becomes enormously developed, and the breasts particularly enlarged. The arms are very fat; and as the areolar tissue which surrounds the wrist is of a close texture, fat cannot accumulate there, and the skin not being distended, a deep groove or furrow is formed, as is the case in very fat children. The hands usually participate in this excess of embonpoint, but at a later period than other parts of the body. The abdomen attains a vast size, and impedes walking; so that a person labouring under obesity carries the head erect, and the body thrown back, as in the case of a pregnant woman, in order to preserve the necessary equilibrium and not fall forward. The intestinal mass, with its surrounding fat, being connected with the kidneys, by its weight gives rise to a dragging sensation, and causes pain on walking. It also pushes up the diaphragm, compresses the lungs and the heart, and becomes one of the causes of the sense of oppression complained of by fat people. Many such, especially females, have between the abdomen and the thighs deep furrows, which become scalded, and require the application of starch, or of some other powder, as is the case with infants when very fat. The integument of the thigh is readily distensible, and allows the deposition of fat as far down as the knee joint. At this point the areolar tissue is more dense, and less in quantity. The skin of the thigh, being thus distended, forms large folds, falling over the knee joint. The legs become likewise enlarged, frequently engorged, and troubled with varicosities, more especially towards the lower portion of the limb. Gradually the feet participate in this engorgement.

This general view of the outward appearance of the body of a person labouring under obesity, may give some idea of the disturbance which an excessive amount of fat can produce when situated within the body. On the outer surface it causes an extraordinary distension of the integument, giving rise, as we have before said, to various diseases, such as pimples, boils, eczema, prurigo, &c., which can only be cured by a reduction of corpulence. In the interior of the organism this same excess of fat causes displacement of the viscera, interferes with the due performance of their functions (as we have already explained), and leads to the sudden death of the patient, whilst occupying his arm-chair rather than his bed, for he can rarely assume a recumbent position.