584 OBESITY AND ADIPOSITAS DOLOROSA 



these authors of an alveolar carcinoma. In a case of Price's there were 

 found inflammatory alterations in the thyroid gland as well as in the hypo- 

 physis (alveolar or glandular carcinoma?) and interstitial neuritis. In a 

 second case there was found in the thyroid gland much interstitial tissue, 

 the acini were dilated, the hypophysis showed similar but not essential al- 

 terations. In the fat tissue no especial alterations were found. In a case of 

 Lbning and Fuss's the thyroid gland was dense, changed into a whitish-yellow 

 callous tissue; microscopically was found smallness of the gland cells and 

 round-cell infiltrate, the hypophysis was small, soft, unaltered. Finally, 

 in my case there were no essential alterations in the ductless glands. We 

 can hardly ascribe any especial significance to the colloid struma, there 

 were found perivascular infiltrates in the fat tissue, and cirrhosis of the 

 liver. 



Summing up the autopsy findings we find the following: Among eleven 

 cases, there were found nine times alterations of the thyroid gland, especially 

 of a chronic inflammatory nature. The hypophysis was examined micro- 

 scopically in seven cases. Among these were found alterations five times, 

 and these indeed of a very diverse nature (round-cell infiltration, sclerosis, 

 adenocarcinoma, glioma). Also in the sexual glands was sometimes found 

 sclerosis, in addition to which was found ovarian cysts, and once hypoplasia 

 of the testicles. Liver and spleen often show cirrhotic changes, the kidneys 

 sometimes interstitial changes. The microscopical examination of the 

 fat often showed, as well in the diffusely distributed fat as in the encapsu- 

 lated lipomata, abundant connective tissue; and in some cases newly formed 

 hemolymph nodules or perivascular inflammatory infiltration. In other 

 cases there were found no inflammatory alterations. Very frequently, there 

 was found interstitial neuritis (six times among seven cases investigated) , as 

 well in the fine nerve trunks in the fat tissue itself, as in the nerves of the 

 muscles. In one case there was degeneration of GolVs column. 



Pathogenesis. The views of the authors as to the pathogenesis of 

 adipositas dolorosa are very different. Dercum considered the cause of 

 the affection as a sort of dysthyroidia, through which came about a re- 

 duction of fat combustion and inflammatory alterations of the nerves. 

 Vitaut expresses himself similarly. Most of the authors assume a chronic 

 intoxication, the cause of which they see in a disturbance of the function of 

 the ductless glands (Price, Ballet, Miquet); but they are not agreed as to 

 which ductless gland is at fault. For example, Price believes that in addi- 

 tion to the thyroid, the hypophysis plays an especial part, Ballet regards 

 the involvement of the thyroid gland as unlikely and thinks of disturbances 

 of the other ductless glands, etc. Debove places the nervous system as 

 the central figure of the pathogenesis. Strubing and Thimm regard the 

 disease as a trophoneurosis, Haskovec as a central trophoneurosis. Sicard 

 and Roussky think of an involvement of the ovary, as they saw the disease 



