OBESITY AND ADIPOSITAS DOLOROSA 



are transitions to the different forms of lipomatosis and to the trophic edemas. 

 Lately Lyon is even of the opinion that also the different forms of obesity 

 and those of lipomatosis go over into each other without sharp boundaries. 

 Many authors assume a nervous trophic origin for this syndrome. Before 

 I enter into the description of the syndrome, I would like to report an appro- 

 priate case. 



Observation LXX. Fr. B., fifty-six years old. Entered the first medical clinic Sept. 3, 

 1912. The parents of the patient were both corpulent. Of five brothers three are very 

 corpulent, and of four sisters, two. According to the statement of the son the localization 



FIG. 96. Case of adipositas dolorosa (Observation LXX). 



of the fat in the corpulent relatives is not just the same as in the patient. The four chil- 

 dren are not adipose. There is no diabetes or gout in the family, so far as is known. As 

 a child and youth the patient was healthy. The obesity began to develop during his mili- 

 tary service, especially later, however, when the patient adopted a sedentary life; he was 

 landlord of an inn and ate and drank very much, consuming 4^ liters of wine daily and 

 smoking very much. The obesity was especially heavy from the thirty-fifth year of life 

 on. The fat developed in cushions on the shoulders, on the upper arm, on the thorax, and 

 on the pelvic girdle, while forearms and hands and [lower] legs and feet remained thin. 

 For about ten years there often occurred oppressions of respiration and vertigo, especially 

 on going up stairs and on long marches. Lately he can hardly walk on this account. The 

 appetite became slight, and he ingests practically only liquid nutrition. In the spring of 

 1912 he weighed as much as 140 kg. Since that time he lost about 30 kg. Foralongtime 

 there has existed pains in the hepatic region; during the last weeks he vomited several 

 times daily, independently of the ingestion of food, also belches. For the last year there 



