articles, like Sugar of Lead and Iodine have a direct tendency to reduce the deposition of the tissue. B. ADIPOSIS.—Obesity.-Excessive deposition or hypertrophy of this tissue is common, and effects either the whole system or a part. Some persons reach the weight of 500 or 600 pounds. It is more common in childhood, and about the fortieth year, and among females or eunuchs. It is sometimes caused by excessive venereal indulgences in early life, with high living and indolence. It is accompanied by languid circulation, weak digestion, craving appetite, defective secretions and excretions, indisposition to perform mental or physical labor, and is often hereditary. The extent to which obesity may exist without being regarded as a disease varies in different constitutions. Ordinarily fat forms one twentieth part of the body. It is promoted greatly by a full diet containing fatty substances, as sugar, spirituous and malt liquors, used freely by persons whose vital energies are diminished, at the same time that the appetite remains unimpaired, or is excited by stimulating drinks; the formation of chyle into blood does not take place so rapidly nor so perfectly as in health; a large portion of the oily matter of the chyle is deposited in the adipose tissue, which thus becomes one of the emunctories of the frame; and a material which cannot readily be carried out of the circulation by any other organ is set apart for the purpose of future absorption and nutrition, as the wants of the system may require; thus preventing its hurtful accumulation in the circulating fluid. In many persons apparently healthy, the excessive accumulation of fat is often one of the earliest and most remarkable signs of diminution of the vital energies of the frame. Persons who become very fat have proportionately small arteries; they bear no losses of blood, breathe imperfectly, are dull and sleepy; and are highly susceptible to atmospheric influences. They sweat easily, take cold often, and are predisposed to gout, apoplexy and especially to dropsy. They are great sufferers from dyspepsia; and having little muscular power, they cannot take the necessary amount of exercise. As the adipose tissue enlarges still further it encroaches on every other structure. The blood is lessened in quantity and more and more diluted. The increased size of the body increases the demand for more blood to fill the distant enfeebled capillaries: and the deficient supply with the diminishing power of the circulation causes atrophy of important organs. In some cases there are dilatations, fatty deposits in the heart, or other degenerations of its structure. The heart, instead of becoming stronger by the large addition to the size of the body is really weakened in muscular power by the imperfect aëration of the blood; and yet it has the extra labor thrown upon it of propelling the diluted blood to the remotest extremities and surfaces of the corpulent body. The balance then between the systemic and pulmonary circulation must be destroyed, the lungs becoming also unequal to the task of excreting such an excessive quantity of carbon be yond their natural capacity. The blood then becomes continually more venous, more liable to form congestions, and to dilate the cavities of the heart by its retarded pace. TREATMENT.—The selection of a proper diet is the first thing to be considered. It is proposed to restrict the patient not only in quantity, even though it be admitted that this restriction alone is never effectual in diminishing the superabundant fat; but we may gain something by making such a selection of articles as may give the necessary amount of support, without a proportionate addition to the adipose tissue. Thus mutton is easily digested, and contains but a minute amount of fat, while beef is infiltrated with fat throughout the leanest parts. Other articles then best suited for corpulent persons are cod-fish, haddock, whiting among fish and the flesh of rabbits among animals. Acids.-Vinegar is said to have the property of removing fat or preventing its accumulation. It has been used in large draughts, and in some cases with success. Thus it is said that a Spanish general who was excessively corpulent diminished the amount of fat so rapidly by drinking large quantities of vinegar "that he could wrap the skin around him like a cloak." But this course has not succeeded with others. It is complained that the strong acid produces dyspepsia. For some persons the remedy is a good one, but it cannot in them be used with safety in quantity without being greatly reduced in strength. When used in quantity, in full strength, it inevitably causes a medicinal aggravation, or poisonous symptoms. It is only when it is taken to the extent of causing uneasiness, cramps, colic, and gradually destroying the texture of the stomach and its digestive functions that vinegar causes emaciation. Ammonium-muriaticum.-The following case is given in Frank's Magazine: A man aged 50 years, of middle stature, large head, broad neck, and a face increased in breadth by a large mass of fat hanging beneath the skin; and a fatty mass extended from one ear to the other. His small ears were pushed forward and outward by fatty enlargement. The eyes and face were sallow; cheeks lax, and hair thin. The bony frame was delicate; hands and feet small and thin; arms and legs scantily nourished. But on each arm was a large mass of fat, commencing at the deltoid muscles, passing over the shoulders to the nape, forwards upon the chest, and filling the arm-pits. The abdomen was flabby and protuberant; the nates extremely large. He was treated with Mur.-ammonia for six weeks, when the drug disease of the seven-day fever" was established, and continued to recur on every succeeding Thursday. After every paroxysm of the seven-day fever the diminution of the fatty swellings was too evident and remarkable to admit of doubt, while the improvement of his general health was equally striking and satisfactory. Hydriodate of Potassium is one of the best proved remedies in all hypertropic diseases. MALFORMATIONS.-The greatest evil of psora is that it reproduces itself and descends to posterity. The children of psoric parents are born with some of its manifestations. Thus:-Malformations, as tumors on the head, yellowish, sallow color of the skin; head too large; phthisical conformation; itch eruptions; they are liable to scald-head, &c. Towards the end of the 15th century psora culminated in syphilis, since the appearance of which lepra has nearly disappeared, though it still remains in a few countries. (See Lepra.) GENUS V.-PHYSICAL DEFORMITIES. CRETINISM. We have already spoken of this terrible infirmity of human nature in its relations to imperfect development of the mind; it is proper to refer to it here as a physical deformity. The cretin is a blighted specimen of humanity. His stature is not more than four or five feet, often less; the head is deformed in shape and is too large for the body; skin yellow, cadaverous, or of a mahogany color, wrinkled, pallid, or marked by eruptions; the flesh is soft and flabby; the tongue large and often hanging out of the mouth; the eye-lids thick; the eyes red, prominent, squinting; the countenance is void of all expression except that of idiotism; the nose is flat, the mouth large, gaping, and constantly permitting the saliva to flow over the elongated lower jaw. The abdomen is pendulous, the limbs crooked, short, and so distorted as to prevent any but a "waddling" progression. The external senses are often imperfect, many are deaf and dumb,—and the whole aspect presented is that of premature old age. Such is the disgusting physical exterior of the apparently wretched, but, perhaps, completely happy cretin. His moral picture is still more humiliating. The intellectual faculties are suspended, while the lower animal propensities are in a state of increased activity; the cretins are voracious eaters, and addicted to the lowest animal passions. Their chief pleasures are to eat and sleep; or, after eating, to bask in the sun, insensible to every stimulus that agitates the mind of savage or civilized man. "Goitre, on such a scale as we see it in the valleys of the Alps is bad enough, but cretinism is a cure for the pride of man, and may here be studied on a large scale and in its most frightful colors." (Johnson, on Change of Air. TUMOR.-A Tumor on the Face.-Case by Dr. Kenyon, of Buffalo.It began with a pimple in the middle of the forehead, where the skin had been broken by a scratch. It looked like a watery excrescence and bled when touched. The lady was of light complexion, nervous temperament, had never been sick much, no hereditary disease perceptible. She took Thuja 6° in the morning; Thuja 30° in the evening. Next evening Thuja 200°. And afterwards one dose Sacchar.-lact. each evening. In one week it ceased bleeding, and was diminished one-half its size. In two weeks all trace of it was gone, no spot left where it had been. Wens are considered endemical in certain regions, generally mountainous, as Switzerland, Bohemia, and the Pyrenees in Europe, and the Andes in America. Dr. Guyon publishes the history of the family of a Belgian consul, who went from Lima to Santiago, in Chili. When they had been there fifteen months, it was observed that the two daughters (aged 11 and 13) presented incipient wens growing upon their necks. The physicians of the country unanimously advised change of climate; and the mother embarked with the children for Europe. The voyage was protracted to 110 days, during which time they suffered much from sea-sickness and change of temperature in passing from the latitude of Cape Horn to the Equator. The children acquired the habit of passing their hands over their necks, and soon perceived that the tumors were visibly decreasing. When they reached Cherbourg they were half gone; and by the time they arrived at Brussels the last vestiges of the affection disappeared. It seemed to be a common prescription of the physicians of Santiago, as one known to be efficacious. Dr. Guyon says, a considerable number of Swiss emigrants, from the Valois, in 1853, settled in Algeria. Of these the most, especially the women, had wens. But they had not been a year in the country before they became aware of a considerable decrease in the size of the wens; and by the and of 1856 they had all disappeared. We suspect these wens were of a goitrous character. Tumor of the Face, caused by Aneurism of the Arteries.-Mr. Ferguson gives a case in the Lancet for 1842-3: A lad, aged 19, had a tumor about the size of a duck's egg, on his cheek, which the surgeon supposed to be a cyst. Mr. Fergussen, of King's College Hospital, proceeded to remove it, "but was greatly astonished to find that it was supplied with numerous large vessels, and that it had many of the characteristics of the formidable disease called aneurism by anas tomosis." He applied ligatures as speedily as possible, with the double object of arresting the bleeding and causing the tumor to slough away. (Practical Surgery, p. 147.) ORDER II.-DISEASES AFFECTING EXTERNAL SUR FACES. THE SKIN. DERMIS.-CUTIS. The skin, though apparently a simple membrane, is in reality composed of several different laminæ or layers, one within another. The outermost lamina is termed the scarf skin or cuticle; the second has the name among anatomists of rete mucosum. After these two are re moved, we come to the outer surface of the cutis or true skin. The application of a mild blister to the skin of a negro, for a few hours, raises the transparent gray cuticle from the layers beneath; and under it we find a clear serous fluid. On removing the scarf skin and the fluid, the surface beneath appears black. The black surface now consists of the rete-mucosum, a double membrane, the lower lamina of which is gray and transparent, and the appearance of a black web, resembling the pigmentum nigrum of the eye. The rete-mucosum gives the color to the skin; is black in the negro; white, brown, or yellowish in the European. It has been supposed that the design of Nature in giving the black skin to the negro has been to defend him against the tropical rays of the sun; and the purpose of a similar membrane behind the retina in the eye, appears to be not only that of absorbing the superfluous rays of light, but like the amalgam behind the looking-glass, it may enable the retina to reflect the rays, in order to perfect vision. In our own climate the skin becomes brown when exposed to the rays of the summer sun,-a process which seems also designed to defend the body against the access of too great external heat. Functions of the Skin.-Regarded as a protective covering, the skin possesses the united advantages of toughness, resistance, flexibility, and elasticity. The areolar frame-work of the cutis is the part chiefly conferring these properties, but they are also due in some measure to the epidermis. These structures are thickest on all the points in which the skin is liable to come with most force and frequency into contact with external objects; thus they are thickest on the palms of the hands and soles of the feet, on the back of the trunk, and on the outer surface of the limbs; thinner on the front of the body and on the inside of the limbs. The skin is employed in the two opposite functions of absorption and secretion. Absorption is performed by the net-work of lymphatics and the minute capillaries. Secretion is carried on at every point of the surface of the cutis; whilst the cuticle is merely a deciduous product which is constantly in course of separation from the cutis. But |