ADIPOSITAS DOLOROSA 575 



occasion to this are as yet not entirely clear. We must consider that eu- 

 nuchoids have another temperament than normal individuals; they are less 

 lively, have less energy, the muscular tonus is slighter; in hypophysial dys- 

 trophy there also happens that in the severer cases the vegetative functions 

 seem to course more slowly, and the fundamental exchange therefore is 

 established at a low level, as experimental investigations on animals have 

 shown. Also in these forms the function of the insular apparatus seems 

 to have a certain preponderance, at least, as has already been set forth in 

 detail, in almost all cases there is a strikingly high tolerance for carbohy- 

 drates. In the intimate pathological correlations between glandular hypo- 

 physis and thyroid, also a thyrogenic factor can, in many cases of hypo- 

 physial dystrophy, very well play a part. Ordinarily this does not seem the 

 case, at least the result of a thyroid treatment in such cases is not so excel- 

 lent as in the ordinary obese individuals, and the tolerance for the admin- 

 istration of thyroid gland is not essentially higher. There are numerous 

 statements in the literature that in such cases of hypophysial dystrophy 

 the peroral administration of hypophysis tablets or eventually a combina- 

 tion [of these] with sexual gland substance was followed by results. 



4. Epiphysial Obesity 



It is as yet doubtful whether we are justified in recognizing such a form. 

 At all events it is remarkable that commonly with the development of pineal 

 tumors in adults, obesity also develops. This may attain an excessive 

 degree. We may readily conceive that the obesity may be brought about 

 on account of limitation of function of the neighboring hypophysis. Actu- 

 ally, in the case of Raymond and Claude, the hypophysis was very much 

 flattened. One would then expect the other characteristic symptoms of 

 hypophysial dystrophy in all cases. From the cases in the literature, which, 

 however, have not been described very exactly, I have not succeeded in 

 eliciting a safe basis for this. 



B. ADIPOSITAS DOLOROSA 



In the years 1882 and 1892 respectively, Dercum described a disease 

 picture which is characterized by the peculiar form of fattening and by the 

 painfulness of the fat masses. Later Vitaut called attention to two additional 

 cardinal symptoms, namely the asthenia and certain psychical alterations. 

 Dercum considered the disease as due to an especial form of dysthroidia; since 

 that time numerous appropriate cases have been reported; most authors 

 adhere to the ductless glandular pathogenesis of this disease, although others, 

 especially French authors, oppose the setting up of this syndrome as a 

 disease sui generis, advocating the opinion that from this syndrome there 



