ADIPOSITAS DOLOROSA 583 



described above, the muscular weakness was so great that the patient could 

 scarcely walk. 



Psychical alterations are indeed very common, but not constant. The 

 case of L'dning and Fuss, a sixty-six-year-old woman in whom the disease had 

 existed for about twelve years was mentally entirely normal and active. The 

 psychical alterations are very various. In many cases hallucinations and 

 conditions of excitement are observed, in others, as for instance Ballet's case, 

 depressive melancholic conditions. Also the accessory symptoms are very 

 diverse and not constant. On the part of the motor nerves are observed 

 tremor (alcoholism), slowing of the speech, alterations of the reflexes, es- 

 pecially reduction. On the part of the sensory nerves there are hyper- 

 esthesias and paresthesias, disturbances of the sensibility, etc., on the part 

 of the vegetative nerves often vasomotor symptoms such as dermographism, 

 tachycardia, dyspnea, anidrosis, and hyperidrosis. There occurs in addition, 

 trophic disturbances, such as premature turning gray of the hair, and on the 

 part of the vascular system hemorrhages, inclination to nose-bleed, purpura, 

 etc. As may be seen, very diverse symptoms are collected together in this 

 group. As we are mostly dealing with elderly people with fatty heart and 

 severe alcoholism, many of these symptoms are readily intelligible without 

 anything further. 



Investigations as to the metabolism are as yet very sparse. Schwenck- 

 enbecher observed two cases in which the body weight only began to fall 

 when the administration of calories was as low as 19 calories per kilogram. 

 In many cases polydipsia is asserted, in others reduction of the body 

 temperature. 



Pathological Anatomy. There are already a series of autopsies, into a 

 consideration of which I shall enter somewhat exactly, as it is necessary for 

 the discussion of the pathogenesis. 



Dercum described two cases, in which were found macroscopically en- 

 largement and calcareous infiltration of the thyroid gland. In a case of 

 Dercum '5 was found uniform atrophy of the thyroid gland, and widespread 

 interstitial neuritis of the peripheral nerves in the depositions of fat. In a 

 case of Burr's was found degenerative alterations in many lobules of the thy- 

 roid gland, also a glioma of the hypophysis, and in addition interstitial 

 neuritis, sclerosis of the liver, and atrophy of the ovaries. In a case of Dercum 

 and McCarthy's the thyroid gland was normal, there was found an adeno- 

 carcinoma of the hypophysis, enlargement of the right suprarenal, hemo- 

 lymph glands in the fat tissue, interstitial neuritis, hypoplasia of the 

 testicles, and acute parenchymatous nephritis. In a case of Guillain and 

 Alquier's the thyroid gland was found to be enlarged and the connective tissue 

 in it increased. The hypophysis was likewise enlarged, the connective tissue 

 in the glandular portion was increased, in association with which the eosino- 

 philic and basophilic cells were increased, alterations that reminded both 



