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.