large and bulky frame, and with a strongly-marked tendency to the formation of fat. It makes its approach in so slow and insidious a manner, that the patient can hardly fix a date to his earliest feeling of that languor, which is shortly to become so extreme. The countenance gets pale, the whites of the eyes become pearly, the general frame flabby rather than wasted; the pulse perhaps large, but remarkably soft and compressible, and occasionally with a slight jerk, especially under the slightest excitement; there is an increasing indisposition to exertion, with an uncomfortable feeling of faintness or breathlessness on attempting it; the heart is readily made to palpitate; the whole surface of the body presents a blanched, smooth and waxy appearance; the lips, gums and tongue seem bloodless; the flabbiness of the solids increases; the appetite fails; extreme languor and faintness supervene, breathlessness and palpitations being produced by the most trifling exertion or emotion; some slight dema is probably perceived about the ankles; the debility becomes extreme, the patient can no longer rise from his bed, the mind occasionally wanders, he falls into a prostrate and half-torpid state, and at length expires: nevertheless, to the very last, and after a sickness of perhaps several months duration, the bulkiness of the general frame and the amount of obesity often present a most striking contrast to the failure and exhaustion observable in every other respect.
With, perhaps, a single exception, the disease, in my own experience,
resisted all remedial efforts, and sooner or later terminated fatally.
On examining the bodies of such patients after death, I have failed to
discover any organic lesion that could properly or reasonably be assigned
as an adequate cause of such serious consequences; nevertheless,
from the disease having uniformly occurred in fat people, I was naturally
led to entertain a suspicion that some form of fatty degeneration might
have a share at least in its production; and I may observe, that in the
case last examined, the heart had undergone such a change, and that a
portion of the semilunar ganglion and solar plexus, on being subjected to
microscopic examination, was pronounced by