572 OBESITY AND ADIPOSITAS DOLOROSA 



gated sufficiently. The most important element in the same is the appetite, 

 although at times we eat very much more than the appetite really craves 

 for, and then follows a period not of lessened appetite, but perhaps of in- 

 creased demand for movement, the cause of which is not known. May 

 not. perhaps on the occasion of too great demand on the assimilation, sub- 

 stances arise which give occasion to this desire for movement? If now the 

 diminution of the fundamental exchange increases the body weight, that is, 

 the need for food does not keep pace with the exchange, it seems to me that a 

 diminution of the fundamental exchange is less to blame for this increase in 

 body weight than a disturbance of the regulatory mechanism; and it is per- 

 haps not inconceivable that there are forms of endogenous obesity without 

 diminution in the fundamental exchange. In exogenous obesity, according to 

 this point of view, the regulatory mechanism is disturbed voluntarily or 

 on account of bad habits (v. Noorden) ; in endogenous obesity, involuntarily 

 through an alteration in the working together of the factors governing assimi- 

 lation. If now I investigate how far such factors depend on the function of 

 the ductless glands, it is known to me that I trespass into the territory of 

 speculation, yet I see no other way of bringing into association the few cer- 

 tain observations that we possess on this question. At first I must again call 

 to mind that the ductless glands exert an influence on both the endogenous 

 and the exogenous factors of the total exchange. Upon the endogenous 

 through diminution of the vegetative functions, for example; on the exogen- 

 ous by their influence on the temperament, the psyche, the desire for move- 

 ments, etc. 



i. Pancreatogenic Obesity 



We shall consider in the first place a form of obesity, whose genesis 

 has yet not been furnished to us. It is observations from the physiology 

 and pathology of metabolism that makes the supposition of such a form possi- 

 ble; if this supposition, however, suffices, many other forms of endogenous 

 obesity may be made the more readily intelligible from this standpoint. The 

 complete extirpation of the pancreas in the dog leads to an appreciable in- 

 crease in the gaseous exchange. High-grade insufficiency of the insular 

 apparatus in man is not, however, associated with an essential raising of the 

 heat-production. Therefore, if although up to the present there has not 

 been demonstrated by gaseous-exchange experiments concordant results as 

 to a quenching of the heat production through the function of the insular 

 apparatus, other considerations, however, seem to ascribe to the pancreas an 

 important role in the calofie economy. 



v. Noorden first adhered to such an opinion, in that he indicated the possi- 

 bility "that fixing of glycogen and sugar-production can be disturbed, while 

 fat formation from carbohydrate still functionates. The fat tissue then 

 takes up the excessively formed carbohydrate (as fat) ; there already exists a 



