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.

Dercum 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 Dercum 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. Dercum considers it a connective-tissue dystrophy--a
fatty metamorphosis of various stages, possibly a neuritis. The first
of Dercum'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, a