One great result of the anti-obesic treatment is, that while destroying the excessive amount of fat, it causes women to become regular, and thus favours conception.
Thin men in general possess greater virility than those surcharged with fat, and in proportion as this fat is developed virility is impaired and finally lost. This infirmity happens to many corpulent men at fifty, forty-five and even forty years of age. Some who were very very fat at the age of puberty, have been impotent throughout life. There are facts which prove that virility in man, like fertility in woman, may be restored on losing a superabundance of fat.
CHAPTER III.
The human skin is capable of great extension. It may be distended to four times its size, yet is not endowed with much elasticity. On this account we may notice, in very fat persons, rolls of fat about the neck, back, buttocks, arms and pubis. The epidermis, which constitutes the external layer of the skin, is but slightly capable of extension. When distended beyond a certain point, it tears, and produces those white streaks which are to be seen on the abdomen of pregnant women, or of those who have borne children, and also of those who have laboured under severe dropsical ascites. These white streaks may be formed upon all parts of the body, when the skin is considerably distended: thus they have been seen in a young woman twenty-eight years of age, who weighed three hundred and four pounds. In her case these white streaks were to be seen upon the arms, the shoulders, the breasts, &c.
The skin of the abdomen would not be sufficient to retain the abdominal viscera in situ, were it not that between these organs and the integument there exists a fibrous or muscular layer, in some places double, consisting of a stronger and less extensible tissue than the skin, in order to strengthen the abdominal walls. It sometimes happens that this fleshy layer, having yielded to a certain amount of distension, occasioned by the volume of the intestines, and of their surrounding fat, and being thereby unduly stretched, permits the passing between its fibres of a certain portion of intestine or of fat, which, lying immediately under and pushing the skin before it, constitutes what is termed a hernia. Dropsy or pregnancy are frequently the primary cause of the various descriptions of hernia, termed inguinal, crural, &c. Umbilical hernia is that which is usually produced by a too great development of fatty tissue in the abdomen. The umbilicus is that part of the abdomen which is the least susceptible of dilatation. When the belly becomes enlarged to a moderate extent, the navel becomes depressed, shewing that this part does not easily yield to the pressure from within; but it is supported by the recti muscles, those two bands of fleshy fibres lying immediately beneath the skin, and passing from above downwards, on each side and close to the navel. In extreme development of the abdomen, these muscles are displaced from their normal position near the umbilicus, and no longer lend it support. The fibres of the umbilical ring are thus separated by the pressure exerted by the abdominal fat, and a portion passing through the fibres pushes the skin before it. A small protrusion takes place, which is not yet outwardly apparent, because the remaining fibres of the umbilical ring still afford considerable resistance, and retain the ring concealed in the deep hollow which is observable in the navel of fat persons. In order to determine the existence of umbilical hernia at this early stage, the patient should be placed in the recumbent position. On introducing the little finger into the navel depression, and directing the patient to cough, we feel an impulse against the finger which is not to be felt, under the same circumstances, over any other portion of the abdominal walls.
In some cases of hernia it is not absolutely necessary to place the person in the recumbent position, but in this case it is indispensable: unless we do so the impulse cannot be felt, since it cannot take place in the upright position.
In the year 1851, a lady consulted me. She was then very fat, and the abdomen was greatly enlarged. I said to her, "You have probably umbilical hernia." "I have long feared that such was the case," she replied, "but happily I have not. Only a few days ago my own physician examined me, and he declared that I had not. He has advised me to wear an abdominal supporter." Noticing her great enlargement, I was not satisfied of the non-existence of hernia. I begged to be allowed an examination. Having obtained her consent, I immediately detected, by the means I have previously pointed out, a small hernia in the depth of the navel cavity. She had great confidence in her own physician, and told me positively that I was mistaken. I recommended her to see her own physician, and to be examined again by him in the same manner as I had examined her. There was no doubt in my mind but that he would detect it, and such was the case; but he said that it had occurred since his previous examination: possibly so. An umbilical truss was immediately adapted; for it is only in hernia at its early stage that we can hope for a cure by means of a truss, and by removing the cause, that is to say, by reducing the mass of fat existing in the abdomen.
If the development of a small hernia is not prevented, it gradually increases, and makes its appearance upon the walls of the abdomen. At first it is of the size of a small pear, a hen's egg; afterwards it increases to six, eight, ten, fifteen or twenty pounds weight. It then assumes more or less the shape of a mushroom, which is exceedingly troublesome, as it requires to be supported by means of a hollow truss, a species of box with springs. Umbilical hernia is to be met in more than one half the number of persons who measure fifty-five inches round the abdomen.