574 OBESITY AND ADIPOSITAS DOLOROSA 



etiological factors that lead to such a slight functional disturbance of the 

 thyroid gland. In many cases there had been numerous parturitions fol- 

 lowing each other at short intervals. In others the obesity develops imme- 

 diately at the close of a protracted infectious disease, v. Noorden mentions 

 for instance cases in which the obesity developed progressively after an 

 abdominal typhoid, and refers to similar examples from the French literature. 

 The diagnosis of this form of obesity is often difficult, because the symp- 

 toms of hypothyrosis are only suggested. The justification for one's regard- 

 ing the hypothyroidism as the cause of the obesity can, however, in many 

 such cases, indeed not be doubted. It is found in the entire course of the dis- 

 ease and in the excellent action of the thyroid treatment, which we may re- 

 gard as a sort of functional test. Of course thyroid gland acts as an agent 

 that reduces weight also in the cases of ordinary exogenous obesity. The 

 essential point lies, however, as v. Noorden mentions, in the difference between 

 the complete action of the thyroid cure and the intolerance against much 

 withdrawal of food, and, as I would attach especial value to, in the high 

 tolerance for thyroid-gland preparations. From the theoretical standpoint 

 the assumption of such a thyrogenic obesity is well founded. We can con- 

 ceive that just in such slight degrees of thyroid-gland insufficiency, the bal- 

 ance between thyroid-gland function and the function of the pancreas is dis- 

 turbed in favor of the latter, and that thus is furnished the impulse for the 

 origin of an obesity, while with a severe disturbance of the function of the 

 thyroid often all vegetative functions are highly diminished, and therewith 

 the ingestion of food and the appetite are restricted. The very general 

 observation that in such cases of thyrogenic obesity the assimilation limits 

 for carbohydrates lie abnormally high, indicates with the greatest probability 

 a preponderance of the pancreatic function. 



3. Dystrophia Adiposo-genitalis 



In this form, whether it be of primary genital or hypophysial origin, there 

 is found a characteristic distribution of fat such as has been described in detail 

 in the corresponding chapters. It depends on the withdrawal or the weaken- 

 ing of the protective influence of the interstitial glands on body formation. 

 The distribution of fat has per se nothing to do with obesity, as it is re- 

 tained in such individuals when they otherwise become very thin on any 

 other basis, and for the reason that sure cases of hypophysial dystrophy and 

 also many eunuchoids do npt come to the development of a pronounced obes- 

 ity, while the abnormal distribution of fat is always present. Also a certain 

 degree of fatty infiltration of the muscles may be peculiar to this dystrophy, 

 independently of obesity, as well as a weak, velvety texture of the skin, and 

 the behavior of the hair. The fact is, however, that in both forms, obesity 

 develops very commonly, even to excessive degree. The factors that give 



