The placenta weighed 4 pounds, and there was an ordinary pailful of liquor amnii. Both the twins were muscular and well formed; the parents were of ordinary stature, and at last reports the mother was rapidly convalescing. Burgess mentions an 18-pound new-born child; end Meadows has seen a similar instance. Eddowes speaks of the birth of a child at Crewe, a male, which weighed 20 pounds 2 ounces and was 23 inches long.

It was 14 1/2 inches about the chest, symmetrically developed, and likely to live. The mother, who was a schoolmistress of thirty-three, had borne two previous children, both of large size. In this instance the gestation had not been prolonged, the delivery was spontaneous, and there was no laceration of the parts.

Chubb says that on Christmas Day, 1852, there was a child delivered weighing 21 pounds. The labor was not severe and the other children of the family were exceptionally large. d.i.c.kinson describes a woman, a tertipara, who had a most difficult labor and bore an extremely large child. She had been thirty-six hours in parturition, and by evisceration and craniotomy was delivered of a child weighing 16 pounds. Her first child weighed 9 pounds, her second 20, and her third, the one described, cost her her life soon after delivery.

There is a history of a Swedish woman in Boston who was delivered by the forceps of her first child, which weighed 19 3/4 pounds and which was 25 3/4 inches long. The circ.u.mference of the head was 16 3/4 inches, of the neck 9 3/4, and of the thigh 10 3/4 inches.

Rice speaks of a child weighing 20 1/4 pounds at birth. Johnston describes a male infant who was born on November 26, 1848, weighing 20 pounds, and Smith another of the same weight. Baldwin quotes the case of a woman who after having three miscarriages at last had a child that weighed 23 pounds. In the delivery there was extensive laceration of the anterior wall of the v.a.g.i.n.a; the cervix and perineum, together with an inch of the r.e.c.t.u.m, were completely destroyed.

Beach describes a birth of a young giant weighing 23 3/4 pounds. Its mother was Mrs. Bates, formerly Anna Swann, the giantess who married Captain Bates. Labor was rather slow, but she was successfully delivered of a healthy child weighing 23 3/4 pounds and 30 inches long.

The secundines weighed ten pounds and there were nine quarts of amniotic fluid.

There is a recent record of a Cesarian section performed on a woman of forty in her twelfth pregnancy and one month beyond term. The fetus, which was almost exsanguinated by amputation, weighed 22 1/2 pounds.

b.u.mm speaks of the birth of a premature male infant weighing 4320 gm.

(9 1/2 pounds) and measuring 54 cm. long. Artificial labor had been induced at the thirty-fifth week in the hope of delivering a living child, the three preceding infants having all been still-born on account of their large size. Although the mother's pelvis was wide, the disposition to bear huge infants was so great as to render the woman virtually barren.

Congenital asymmetry and hemihypertrophy of the body are most peculiar anomalies and must not be confounded with acromegaly or myxedema, in both of which there is similar lack of symmetric development. There seems to be no satisfactory clue to the causation of these abnormalisms. Most frequently the left side is the least developed, and there is a decided difference in the size of the extremities.

Finlayson reports a case of a child affected with congenital unilateral hypertrophy a.s.sociated with patches of cutaneous congestion. Logan mentions hypertrophy in the right half of the body in a child of four, first noticed shortly after birth; Langlet also speaks of a case of congenital hypertrophy of the right side. Broca and Trelat were among the first observers to discuss this anomaly.

Tila.n.u.s of Munich in 1893 reported a case of hemihypertrophy in a girl of ten. The whole right half of the body was much smaller and better developed than the left, resulting in a limping gait. The electric reaction and the reflexes showed no abnormality. The asymmetry was first observed when the child was three. Mobius and Demme report similar cases.

Adams reports an unusual case of hemihypertrophy in a boy of ten.

There was nothing noteworthy in the family history, and the patient had suffered from none of the diseases of childhood. Deformity was noticeable at birth, but not to such a degree relatively as at a later period. The increased growth affected the entire right half of the body, including the face, but was most noticeable in the leg, thigh, and b.u.t.tock. Numerous telangiectatic spots were scattered irregularly over the body, but most thickly on the right side, especially on the outer surface of the leg. The accompanying ill.u.s.tration represents the child's appearance at the time of report.

Jacobson reports the history of a female child of three years with nearly universal giant growth (Riesenwuchs). At first this case was erroneously diagnosed as acromegaly. The hypertrophy affected the face, the genitals, the left side of the trunk, and all the limbs.

Milne records a case of hemihypertrophy in a female child of one year.

The only deviation from uniform excess of size of the right side was shown in the forefinger and thumb, which were of the same size as on the other hand; and the left side showed no overgrowth in any of its members except a little enlargement of the second toe. While hypertrophy of one side is the usual description of such cases, the author suggests that there may be a condition of defect upon the other side, and he is inclined to think that in this case the limb, hand, and foot of the left side seemed rather below the average of the child's age. In this case, as in others previously reported, there were numerous telangiectatic spots of congestion scattered irregularly over the body. Milne also reported later to the Sheffield Medico-Chirurgical Society an instance of unilateral hypertrophy in a female child of nineteen months. The right side was involved and the anomaly was believed to be due to a deficiency of growth of the left side as well as over-development of the right. There were six teeth on the right side and one on the left.

Obesity.--The abnormality of the adipose system, causing in consequence an augmentation of the natural volume of the subject, should be described with other anomalies of size and stature. Obesity may be partial, as seen in the mammae or in the abdomen of both women and men, or it may be general; and it is of general obesity that we shall chiefly deal. Lipomata, being distinctly pathologic formations, will be left for another chapter.

The cases of obesity in infancy and childhood are of considerable interest, and we sometimes see cases that have been termed examples of "congenital corpulency." Figure 167 represents a baby of thirteen months that weighed 75 pounds. Figure 168 shows another example of infantile obesity, known as "Baby Chambers." Elliotson describes a female infant not a year old which weighed 60 pounds. There is an instance on record of a girl of four who weighed 256 pounds Tulpius mentions a girl of five who weighed 150 pounds and had the strength of a man. He says that the acquisition of fat did not commence until some time after birth. Ebstein reports an instance given to him by Fisher of Moscow of a child in Pomerania who at the age of six weighed 137 pounds and was 46 inches tall; her girth was 46 inches and the circ.u.mference of her head was 24 inches. She was the offspring of ordinary-sized parents, and lived in narrow and sometimes needy circ.u.mstances. The child was intelligent and had an animated expression of countenance.

Bartholinus mentions a girl of eleven who weighed over 200 pounds.

There is an instance recorded of a young girl in Russia who weighed nearly 200 pounds when but twelve. Wulf, quoted by Ebstein, describes a child which died at birth weighing 295 ounces. It was well proportioned and looked like a child three months old, except that it had an enormous development of fatty tissue. The parents were not excessively large, and the mother stated that she had had children before of the same proportions. Grisolles mentions a child who was so fat at twelve months that there was constant danger of suffocation; but, marvelous to relate, it lost all its obesity when two and a half, and later was remarkable for its slender figure. Figure 169 shows a girl born in Carbon County, Pa., who weighed 201 pounds when nine years old.

McNaughton describes Susanna Tripp, who at six years of age weighed 203 pounds and was 3 feet 6 inches tall and measured 4 feet 2 inches around the waist. Her younger sister, Deborah, weighed 119 pounds; neither of the two weighed over 7 pounds at birth and both began to grow at the fourth month. On October, 1788, there died at an inn in the city of York the surprising "Worcestershire Girl" at the age of five. She had an exceedingly beautiful face and was quite active. She was 4 feet in height and larger around the breast and waist; her thigh measured 18 inches and she weighed nearly 200 pounds. In February, 1814, Mr. S.

Pauton was married to the only daughter of Thomas Allanty of Yorkshire; although she was but thirteen she was 13 stone weight (182 pounds). At seven years she had weighed 7 stone (98 pounds). Williams mentions several instances of fat children. The first was a German girl who at birth weighed 13 pounds; at six months, 42 pounds; at four years, 150 pounds; and at twenty years, 450 pounds. Isaac b.u.t.terfield, born near Leeds in 1781, weighed 100 pounds in 1782 and was 3 feet 13 inches tall. There was a child named Everitt, exhibited in London in 1780, who at eleven months was 3 feet 9 inches tall and measured around the loins over 3 feet. William Abernethy at the age of thirteen weighed 22 stone (308 pounds) and measured 57 inches around the waist. He was 5 feet 6 inches tall. There was a girl of ten who was 1.45 meters (4 feet 9 inches) high and weighed 175 pounds. Her manners were infantile and her intellectual development was much r.e.t.a.r.ded. She spoke with difficulty in a deep voice; she had a most voracious appet.i.te.

At a meeting of the Physical Society of Vienna on December 4, 1894, there was shown a girl of five and a half who weighed 250 pounds. She was just shedding her first teeth; owing to the excess of fat on her short limbs she toddled like an infant. There was no tendency to obesity in her family. Up to the eleventh month she was nursed by her mother, and subsequently fed on cabbage, milk, and vegetable soup. This child, who was of Russian descent, was said never to perspire.

Cameron describes a child who at birth weighed 14 pounds, at twelve months she weighed 69 pounds, and at seventeen months 98 pounds. She was not weaned until two years old and she then commenced to walk. The parents were not remarkably large. There is an instance of a boy of thirteen and a half who weighed 214 pounds. Kaestner speaks of a child of four who weighed 82 pounds, and Benzenberg noted a child of the same age who weighed 137. Hildman, quoted by Picat, speaks of an infant three years and ten months old who had a girth of 30 inches. Hillairet knew of a child of five which weighed 125 pounds. Botta cites several instances of preternaturally stout children. One child died at the age of three weighing 90 pounds, another at the age of five weighed 100 pounds, and a third at the age of two weighed 75 pounds.

Figure 170 represents Miss "Millie Josephine" of Chicago, a recent exhibitionist, who at the reputed age of thirteen was 5 feet 6 inches tall and weighed 422 pounds.

General Remarks.--It has been chiefly in Great Britain and in Holland that the most remarkable instances of obesity have been seen, especially in the former country colossal weights have been recorded.

In some countries corpulency has been considered an adornment of the female s.e.x. Hesse-Wartegg refers to the Jewesses of Tunis, who when scarcely ten years old are subjected to systematic treatment by confinement in narrow, dark rooms, where they are fed on farinaceous foods and the flesh of young puppies until they are almost a shapeless ma.s.s of fat. According to Ebstein, the Moorish women reach with astonishing rapidity the desired embonpoint on a diet of dates and a peculiar kind of meal.

In some nations and families obesity is hereditary, and generations come and go without a change in the ordinary conformation of the representatives. In other people slenderness is equally persistent, and efforts to overcome this peculiarity of nature are without avail.

Treatment of Obesity.--Many persons, the most famous of whom was Banting, have advanced theories to reduce corpulency and to improve slenderness; but they have been uniformly unreliable, and the whole subject of stature-development presents an almost unexplored field for investigation. Recently, Leichtenstein, observing in a case of myxedema treated with the thyroid gland that the subcutaneous fat disappeared with the continuance of the treatment, was led to adopt this treatment for obesity itself and reports striking results. The diet of the patient remained the same, and as the appet.i.te was not diminished by the treatment the loss of weight was evidently due to other causes than altered alimentation. He holds that the observations in myxedema, in obesity, and psoriasis warrant the belief that the thyroid gland eliminates a material having a regulating influence upon the const.i.tution of the panniculus adiposus and upon the nutrition of the skin in general. There were 25 patients in all; in 22 the effect was entirely satisfactory, the loss of weight amounting to as much as 9.5 kilos (21 pounds). Of the three cases in which the result was not satisfactory, one had nephritis with severe Graves' disease, and the third psoriasis. Charrin has used the injections of thyroid extract with decided benefit. So soon as the administration of the remedy was stopped the loss of weight ceased, but with the renewal of the remedy the loss of weight again ensued to a certain point, beyond which the extract seemed powerless to act. Ewald also reports good results from this treatment of obesity.

Remarkable Instances of Obesity.--From time immemorial fat men and women have been the object of curiosity and the number who have exhibited themselves is incalculable. Nearly every circus and dime museum has its example, and some of the most famous have in this way been able to acc.u.mulate fortunes.

Athenaeus has written quite a long discourse on persons of note who in the olden times were distinguished for their obesity. He quotes a description of Denys, the tyrant of Heraclea, who was so enormous that he was in constant danger of suffocation; most of the time he was in a stupor or asleep, a peculiarity of very fat people. His doctors had needles put in the back of his chairs to keep him from falling asleep when sitting up and thus incurring the danger of suffocation. In the same work Athenaeus speaks of several sovereigns noted for their obesity; among others he says that Ptolemy VII, son of Alexander, was so fat that, according to Posidonius, when he walked he had to be supported on both sides. Nevertheless, when he was excited at a repast, he would mount the highest couch and execute with agility his accustomed dance.

According to old chronicles the cavaliers at Rome who grew fat were condemned to lose their horses and were placed in retirement. During the Middle Ages, according to Guillaume in his "Vie de Suger," obesity was considered a grace of G.o.d.

Among the prominent people in the olden time noted for their embonpoint were Agesilas, the orator Licinius Calvus, who several times opposed Cicero, the actor Lucius, and others. Among men of more modern times we can mention William the Conqueror; Charles le Gros; Louis le Gros; Humbert II, Count of Maurienne; Henry I, King of Navarre; Henry III, Count of Champagne; Conan III, Duke of Brittany; Sancho I, King of Leon; Alphonse II, King of Portugal; the Italian poet Bruni, who died in 1635; Vivonne, a general under Louis XIV; the celebrated German botanist Dillenius; Haller; Frederick I, King of Wurtemberg, and Louis XVIII.

Probably the most famous of all the fat men was Daniel Lambert, born March 13, 1770, in the parish of Saint Margaret, Leicester. He did not differ from other youths until fourteen. He started to learn the trade of a die-sinker and engraver in Birmingham. At about nineteen he began to believe he would be very heavy and developed great strength. He could lift 500 pounds with ease and could kick seven feet high while standing on one leg. In 1793 he weighed 448 pounds; at this time he became sensitive as to his appearance. In June, 1809, he weighed 52 stone 11 pounds (739 pounds), and measured over 3 yards around the body and over 1 yard around the leg. He had many visitors, and it is said that once, when the dwarf Borwilaski came to see him, he asked the little man how much cloth he needed for a suit. When told about 3/4 of a yard, he replied that one of his sleeves would be ample. Another famous fat man was Edward Bright, sometimes called "the fat man of Ess.e.x." He weighed 616 pounds. In the same journal that records Bright's weight is an account of a man exhibited in Holland who weighed 503 pounds.

Wadd, a physician, himself an enormous man, wrote a treatise on obesity and used his own portrait for a frontispiece. He speaks of Doctor Beddoes, who was so uncomfortably fat that a lady of Clifton called him a "walking feather bed." He mentions Doctor Stafford, who was so enormous that this epitaph was ascribed to him:--

"Take heed, O good traveler! and do not tread hard, For here lies Dr.

Stafford, in all this churchyard."

Wadd has gathered some instances, a few of which will be cited. At Staunton, January 2, 1816, there died Samuel Sugars, Gent., who weighed with a single wood coffin 50 stone (700 pounds). Jacob Powell died in 1764, weighing 660 pounds. It took 16 men to carry him to his grave.

Mr. Baker of Worcester, supposed to be larger than Bright, was interred in a coffin that was larger than an ordinary hea.r.s.e. In 1797 there was buried Philip Hayes, a professor of music, who was as heavy as Bright (616 pounds).

Mr. Spooner, an eminent farmer of Warwickshire, who died in 1775, aged fifty-seven, weighed 569 pounds and measured over 4 feet across the shoulders. The two brothers Stoneclift of Halifax, Yorkshire, together weighed 980 pounds.

Keysler in his travels speaks of a corpulent Englishman who in pa.s.sing through Savoy had to use 12 chairmen; he says that the man weighed 550 pounds. It is recorded on the tombstone of James Parsons, a fat man of Teddington, who died March 7, 1743, that he had often eaten a whole shoulder of mutton and a peck of hasty pudding. Keysler mentions a young Englishman living in Lincoln who was accustomed to eat 18 pounds of meat daily. He died in 1724 at the age of twenty-eight, weighing 530 pounds. In 1815 there died in Trenaw, in Cornwall, a person known as "Giant Chillcot." He measured at the breast 6 feet 9 inches and weighed 460 pounds. One of his stockings held 6 gallons of wheat. In 1822 there was reported to be a Cambridge student who could not go out in the daytime without exciting astonishment. The fat of his legs overhung his shoes like the fat in the legs of Lambert and Bright. Dr. Short mentions a lady who died of corpulency in her twenty-fifth year weighing over 50 stone (700 pounds). Catesby speaks of a man who weighed 500 pounds, and Coe mentions another who weighed 584 pounds.

Fabricius and G.o.dart speak of obesity so excessive as to cause death.

There is a case reported from the French of a person who weighed 800 pounds. Smetius speaks of George Fredericus, an office-holder in Brandenburgh, who weighed 427 pounds.

Dupuytren gives the history of Marie Francoise-Clay, who attained such celebrity for her obesity. She was born in poverty, reached p.u.b.erty at thirteen, and married at twenty-five, at which age she was already the stoutest woman of her neighborhood notwithstanding her infirmity. She followed her husband, who was an old-clothes dealer, afoot from town to town. She bore six children, in whom nothing extraordinary was noticed.

The last one was born when she was thirty-five years old. Neither the births, her travels, nor her poverty, which sometimes forced her to beg at church doors, arrested the progress of the obesity. At the age of forty she was 5 feet 1 inch high and one inch greater about the waist.

Her head was small and her neck was entirely obliterated. Her b.r.e.a.s.t.s were over a yard in circ.u.mference and hung as low as the umbilicus. Her arms were elevated and kept from her body by the fat in her axillae.

Her belly was enormous and was augmented by six pregnancies. Her thighs and haunches were in proportion to her general contour. At forty she ceased to menstruate and soon became afflicted with organic heart diseases.

Fournier quotes an instance of a woman in Paris who at twenty-four, the time of her death, weighed 486 pounds. Not being able to mount any conveyance or carriage in the city, she walked from place to place, finding difficulty not in progression, but in keeping her equilibrium.

Roger Byrne, who lived in Rosenalis, Queen's County, Ireland, died of excessive fatness at the age of fifty-four, weighing 52 stone. Percy and Laurent speak of a young German of twenty who weighed 450 pounds.

At birth he weighed 13 pounds, at six months 42, and at four years 150 pounds. He was 5 feet 5 inches tall and the same in circ.u.mference.

William Campbell, the landlord of the Duke of Wellington in Newcastle-on-Tyne, was 6 feet 4 inches tall and weighed 728 pounds. He measured 96 inches around the shoulders, 85 inches around the waist, and 35 inches around the calf. He was born at Glasgow in 1856, and was not quite twenty-two when last measured. To ill.u.s.trate the rate of augmentation, he weighed 4 stone at nine months and at ten years 18 stone. He was one of a family of seven children. His appet.i.te was not more than the average, and he was moderate as regards the use of liquors, but a great smoker Notwithstanding his corpulency, he was intelligent and affable.

Miss Conley, a member of an American traveling circus, who weighed 479 pounds, was smothered in bed by rolling over on her face; she was unable to turn on her back without a.s.sistance.

There was a girl who died at Plaisance near Paris in 1890 who weighed 470 pounds or more. In 1889 an impresario undertook to exhibit her; but eight men could not move her from her room, and as she could not pa.s.s through the door the idea was abandoned.

There was a colored woman who died near Baltimore who weighed 850 pounds, exceeding the great Daniel Lambert by 120 pounds. The journal reporting this case quotes the Medical Record as saying that there was a man in North Carolina, who was born in 1798, who was 7 feet 8 inches tall and weighed over 1000 pounds, probably the largest man that ever lived. Hutchison says that he Saw in the Infirmary at Kensington, under Porter's care, a remarkable example of obesity. The woman was only just able to walk about and presented a close resemblance to Daniel Lambert.

Obesity forced her to leave her occupation. The acc.u.mulation of fat on the abdomen, back, and thighs was enormous.

According to a recent number of La Liberte, a young woman of Pennsylvania, although only sixteen years old, weighs 450 pounds. Her waist measures 61 inches in circ.u.mference and her neck 22 inches. The same paper says that on one of the quays of Paris may be seen a wine-shop keeper with whom this Pennsylvania girl could not compare. It is said that this curiosity of the Notre-Dame quarter uses three large chairs while sitting behind her specially constructed bar. There is another Paris report of a man living in Switzerland who weighs more than 40 stone (560 pounds) and eats five times as much as an ordinary person. When traveling he finds the greatest difficulty in entering an ordinary railway carriage, and as a rule contents himself in the luggage van. Figure 171 represents an extremely fat woman with a well-developed beard. To end this list of obese individuals, we mention an old gentleman living in San Francisco who, having previously been thin, gained 14 pounds in his seventieth year and 14 pounds each of seven succeeding years.

Simulation of Obesity.--General dropsy, elephantiasis, lipomata, myxedema, and various other affections in which there is a hypertrophic change of the connective tissues may be mistaken for general obesity; on the other hand, a fatty, pendulous abdomen may simulate the appearances of pregnancy or even of ovarian cyst.

Derc.u.m of Philadelphia has described a variety of obesity which he has called "adiposis dolorosa," in which there is an enormous growth of fat, sometimes limited, sometimes spread all over the body, this condition differing from that of general lipomatosis in its rarity, in the mental symptoms, in the headache, and the generally painful condition complained of. In some of the cases examined by Derc.u.m he found that the thyroid was indurated and infiltrated by calcareous deposits. The disease is not myxedema because there is no peculiar physiognomy, no spade-like hands nor infiltrated skin, no alteration of the speech, etc. Derc.u.m considers it a connective-tissue dystrophy--a fatty metamorphosis of various stages, possibly a neuritis. The first of Derc.u.m's cases was a widow of Irish birth, who died both alcoholic and syphilitic. When forty-eight or forty-nine her arms began to enlarge. In June, 1887, the enlargement affected the shoulders, arms, back, and sides of the chest. The parts affected were elastic, and there was no pitting. In some places the fat was lobulated, in others it appeared as though filled with bundles of worms. The skin was not thickened and the muscles were not involved. In the right arm there was unendurable pain to the touch, and this was present in a lesser degree in the left arm. Cutaneous sensibility was lessened. On June 13th a chill was followed by herpes over the left arm and chest, and later on the back and on the front of the chest. The temperature was normal.

The second case was a married Englishwoman of sixty-four. The enlarged tissue was very unevenly distributed, and sensibility was the same as in the previous case. At the woman's death she weighed 300 pounds, and the fat over the abdomen was three inches thick. The third case was a German woman in whom were seen soft, fat-like ma.s.ses in various situations over either biceps, over the outer and posterior aspect of either arm, and two large ma.s.ses over the belly; there was excessive prominence of the mons veneris. At the autopsy the heart weighed 8 1/2 ounces, and the fat below the umbilicus was seven inches thick.