ADIPOSITAS DOLOROSA 577 



has been entire impotence and failure of libido which for a long time has been developed 

 only very moderately. 



The patient now weighs 105 kg. and by Nov. 9 had lost 3 kg. more. The body length is 

 170 cm., the span width, 169 cm., the greatest circumference of the abdomen, 124 cm. 

 There are enormous accumulations of fat on the upper arms and on the outer sides of the 

 shoulders, also on the inner side of the upper arm, also a thick cushion of fat over the verte- 

 bra prominens (a true fat neck), also on the outer sides of the buttocks and of the thighs; 

 the thin forearms and [lower] legs stand in characteristic contrast to the heavy fat accu- 

 mulations on the shoulder and pelvic girdle. In consequence of these the patient presents 

 the appearance of an athlete. On closer examination, however, it is noted that the body 

 build is slender, and that thorax and pelvic girdle are not abnormally broad. The cir- 

 cumference about the shoulders is, in consequence of the enormous cushions of fat, 128 cm. 



FIG. 97. Inflammatory alteration of the feet-tissue in a case of adipositas dolorosa 



(Observation LXX). 



The circumference of the abdomen a hand's breadth under the xiphoid process is 122 cm., 

 the greatest circumference of the thorax, 123 cm., the greatest circumference of the upper 

 arm on both sides, 40 cm. On the inner side of the forearm may be felt on both sides sev- 

 eral symmetrical fat nodules, the size of a nut; the fat has accumulated more abundantly 

 on the upper part of the thorax, in the vicinity of the nipples, so that it drapes forward 

 in two enormous folds, directed obliquely outward and downward, and drapes backward 

 in several oblique and horizontal folds. From the waist on the fat again begins to be 

 enormous, so that it hangs below like an apron over the symphysis and half conceals the 

 genitalia. 



Also laterally over both iliac bones are enormous fat nodules that are bounded below 



37 



