5 8o 



OBESITY AND ADIPOSITAS DOLOROSA 



vascular infiltration consisting especially of mononuclear. and partially of polynuclear 

 cells. Especially distinct is this infiltration in the interstitial connective tissue between 

 the individual fat lobules, although the smallest perivascular infiltrations are found also 

 around the capillaries between the fat cells themselves. 



The patient went down very rapidly, soon he was not oriented any more as to time and 

 space; there occurred hallucinations of faces, he spoke confusedly, believed himself to be 

 on a journey, whistled and made a noise, especially at night. Apparently there was diplo- 

 pia on looking toward the left. Slight paresis of the left abducens. The ingestion of 

 food became always slighter; nutritive enemas were not retained. At times vomiting. 

 The pulse accelerated, small, soft cardiac remedies were without effect. At the close there 

 developed an ulcerous pharyngitis, later bronchitic murmurs; death occurred with in- 

 creased cardiac weakness. 



Autopsy (Assistant Dr. Schopper). Hypertrophic cirrhosis of the liver with moderate 

 enlargement of the organ and uniformly granulated superficial and cut surface. Marked 



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FIG. 100. Anterior lobe of hypophysis in a case of adipositas dolorosa (Observation LXX). 



fat infiltration of the heart in the form of nodular fat lobules with penetration of the fat 

 until up to the endocardium. Concretio cardio cum pericardio. Increase of the fat also 

 in the pericardium, hypostasis- of the lungs, etc. Chronic internal hydrocephalus with 

 granular thickening of the ependyma. Slight fatty degeneration of the kidneys and of 

 the myocardium. Acute splenic tumor. Ulcerative pharyngitis. Marked atheromatosis 

 of the aorta. Slight sclerosis of the peripheral arteries. 



The distribution of fat corresponds to the clinical description. The fat is of a yellow- 

 ish gray color, firm consistence with individual stripes and spots of white-gray color that 

 are appreciable even macroscopically. 



The hypophysis is rather small, otherwise macroscopically normal. 



The thyroid gland is macroscopically for greatest part quite normal, in the left lobe is 

 found a goose-egg-sized strumous nodule. 



