THYROGENIC OBESITY 573 



true diabetic disturbance of metabolism, but without glycosuria" (diabeto- 

 genic obesity). 



I would consider in the following consideration a further possibility: 

 It is known that carbohydrates have the ability to save protein to a much 

 larger extent than fat, and that an individual can hardly maintain his nutri- 

 tion on protein and fat alone. An abundant feeding, especially when there 

 is a simultaneous raising of the protein constituent, succeeds only when there 

 is abundant carbohydrate in the diet. Hence carbohydrate diminishes the 

 decomposition of the protein. As the specific dynamic energy of protein is 

 very much higher than that of fat and of carbohydrate the increase of the 

 calorie production associated with the more abundant ingestion of nutrition 

 is restricted. Now to-day there is not a particle of doubt that the ac- 

 cumulation of carbohydrates is under the governing power of the insular 

 apparatus. There must also accrue to the pancreas a direct influence on the 

 assimilation of fat, not only because on the ingestion of abundant carbo- 

 hydrates a portion of these is converted into fats, but because in severe dia- 

 betes the elimination of ketone bodies increases enormously on the adminis- 

 tration of abundant fat. For fattening, therefore, is necessary a functionally in- 

 tact pancreas. That we so often see diabetes supervene in fat people is per- 

 haps due to the fact that the long overstrained pancreas becomes insufficient, 

 apart from the circumstance that chronic overfeeding is often associated 

 with other factors deleterious to the pancreas (alcoholism, continual hypere- 

 mia of the abdominal organs, etc.). 



The considerations up to the present are concerned chiefly with exogenous 

 obesity. We can- conceive, however, that the origin of obesity may receive 

 an impetus through a primarily strengthened function of the insular apparatus, 

 in that the assimilation of larger amounts of food goes on abnormally easily, 

 and hence there does not occur the setting free of the reactions that in 

 normal individuals work against an ingestion of food which for a long time 

 supersedes the need. 



2. Thyrogenic Obesity 



The idea of thyrogenic obesity was first set forth by von Hertoghe, v. 

 Noorden, Lorand, Ewald, and others. Occasion for it was given by observations 

 of rather rapidly developing obesity with slight symptoms of hypothyrosis, 

 slight puffiness of the face, apathy, diminution of memory, insomnia, etc. 

 To it is often added a slight grade of anemia. Such individuals often bear 

 reducing treatment very badly, v. Noorden mentions especially that in such 

 cases reducing treatment often leads to conditions of cardiac weakness, while 

 a thyroid-gland treatment is often accompanied by rapid results, the manifold 

 oppressive symptoms disappear, the individuals become livelier, fresher, and, 

 although they eat with appetite and do not essentially restrict the intake of 

 food, they now gain in weight rapidly. There appear to be very different 



