CHAPTER XIV 



THE DIFFERENT FORMS OF OBESITY AND ADIPOSITAS 



DOLOROSA 



We have already spoken of obesity in other chapters. It seems to me 

 appropriate, however, to describe the relations of the ductless glands to the 

 pathogenesis of obesity, even though I do not tell anything new. Further, 

 it would be appropriate to discuss the relations between obesity and lipomato- 

 sis, as also the origin of lipomatosis has been brought into relation with 

 disturbances of the ductless glandular system. 



A. THE DIFFERENT FORMS OF OBESITY 



Two. different principal types of obesity have been distinguished 

 (v. Noorden, Lor and], exogenous obesity and endogenous obesity. By exogen- 

 ous obesity, Lorand understands the obesity of big eaters that which later 

 becomes combined with diabetes; endogenous obesity he refers to a disease 

 of the ductless glandular system. Such individuals are for the most part 

 anemic, have an ''unhealthy fat," and the combination of the disease con- 

 dition with diabetes belongs to the great rarities. The separation and char- 

 acterization of both forms has been carried on exhaustively by v. Noorden 

 in his monograph on obesity. 



According to v. Noorden exogenous obesity is either an overfeeding obesity 

 or a laziness obesity, or the result of both overfeeding and laziness combined. 

 Exogenous obesity often occurs familially or hereditarily, although v. Noorden 

 points out that in many of these cases there has been much more the heredi- 

 tary transmission of a habit of living than that of a definite constitution. 

 Naturally, cases occur that must be regarded as transition forms between 

 exogenous and endogenous obesity. A further entrance into the subject of 

 exogenous obesity does not lie within the confines of my theme; I shall refer 

 to the exhaustive exposition of v. Noorden. 



In endogenous obesity much value has been laid on the demonstration of 

 a diminution of the fundamental exchange and great pains have been taken 

 in the demonstration. While such a diminution may be demonstrated in 

 myxedema with certainty and ease, the attempts to demonstrate it in en- 

 dogenous obesity have met with great difficulties. As the fat tissue only takes 

 part in internal respiration to a limited degree, the fundamental exchange 

 must fall very strongly in each fat individual if we wish to calculate it per 

 kilo of body weight. But we possess no method of estimating the fat con- 



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