ADIPOSITAS DOLOROSA 585 



develop after ovariotomy in two relatively youthful cases. Schwenken- 

 becher believes in an endogenous obesity, with a pressure of the fat growth 

 on the small vessels and nerves, causing circumscribed circulatory disturb- 

 ances and paresthesias. We thus see that the views as to the pathogenesis 

 of this disease diverge greatly. 



Before I discuss the significance of the ductless glandular system for this 

 disease, I would like to say a few words concerning the relationship of these 

 to lipomatosis. The view has been adopted by French and German authors 

 that adiposis dolorosa is no disease sui generis, but only a syndrome that 

 belongs to the great group of lipomatoses and of trophedema. To my 

 knowledge, Kottnitz was the first to point out that in the symmetrical lipo- 

 mata there frequently occur constitutional symptoms, such as nervous 

 symptoms, rheumatoid pains, etc. He describes a case, in which the meno- 

 pause set in prematurely, and at the time of the failing menses, symmetrical 

 lipomata several times developed, the eruption of which was attended with 

 pain in the part of the body in question. Kottnitz regards adipositas 

 dolorosa as a trophoneurosis and believes that all transitions to the painful 

 symmetrical lipomata occur. Also Cheinisse and Fulconis maintain the iden- 

 tity of the two diseases.. After Potain and Mathieu had assumed transitions 

 from neuropathic edemas to pseudolipomata and even to true lipomata, 

 especially Strubing, and after him Thimm, advocated the view that neuro- 

 pathic edema (oedeme blanc and bleu), multiple lipomatoses, symmetrical 

 diffuse lipomata, and finally the painful lipomata all belonged to a great 

 group of diseases that "had at their foundation the same basic process." 

 Also Miguel sought to establish in detail that the oedeme neuropathique of 

 Mathieu, the oedeme segmentaire of Debove, the chronic trophedema of 

 Meige and the pseudooedeme catatonique of Dide formed with adipositas 

 dolorosa a great group, the cause of which was to be sought in alterations of 

 the nervous system and of the ductless glands. Lately Lyon after a careful 

 compilation of the literature and the addition of new material, has advo- 

 cated a similar view. 



The view that fleeting transitions exist between painful symmetrical 

 lipomata and adiposis dolorosa has received much support from the works 

 of the last years. Among the circumscribed lipomata that are often dis- 

 tributed in great number over the entire body are those, as Launois and 

 Bensaude point out, that are painful to pressure and are associated with 

 spontaneous neuralgiform pains. In the symmetrical lipomata the consti- 

 tutional factor mostly comes still more strongly into the foreground. Here 

 are frequently found manifestations of asthenia, also vasomotor disturb- 

 ances, especially bluish-red coloration of the skin over the nodes, paresthesias, 

 even psychic disturbances. Also in such cases the hereditary and familial 

 element is often well pronounced. As an example I cite a case of Lyon's 

 (case 2). In two sisters painful symmetrical lipomata set in at the time 



