586 OBESITY AND ADIPOSITAS DOLOROSA 



of puberty and attained their full development at maturity. They were 

 associated with rheumatoid pains, dysmenorrhea, and psychic impairment. 

 According to Lyon there may be also found in such lipomata lymph nodules 

 similar to those which are found in adipositas dolorosa. That in adipositas 

 dolorosa the distribution of fat may be rigidly symmetrical is shown by the 

 case quoted in detail above. A quite similar distribution of fat was found in 

 a case of Dercum and McCarthy's. In my case, there were, in addition, lipo- 

 mata up to the size of a goose egg, with a rigidly symmetrical distribution. 

 This type of fat distribution was also present in a case of Bock-rock's. 



I will not venture to pass judgment on the question whether there are 

 also transitions between lipomatosis and trophedema. I shall only register 

 some important findings. In a case of trophedema, Strubing found on 

 microscopical examination, no edema at' all, but only fat with strikingly 

 large fat cells. Haskovec describes a case in which there set in at the meno- 

 pause pains in the back and in the limbs, attacks of weakness, and then 

 edema, which, recurring constantly, closed with attacks of violent pains. 

 At the site of the edema there then gradually developed a painful hyperplasia 

 of the subcutaneous fat tissue. Haskovec regards this case as a transition of 

 a vasomotor neurosis or an acute edema to a trophoneurosis. We must 

 remember, however, that the acute edema usually shows quite another 

 localization from that of the symmetrical lipomata. Also combination of 

 adiposis dolorosa with other diseases that are regarded as trophoneuroses, 

 for example, xanthelasma, are known. Debove has described such a case. 



Finally, as far as the ductless glands are concerned in the pathogenesis 

 of adiposis dolorosa, this seems to me very doubtful. The pathologico- 

 anatomical alterations in the ductless glands are very diverse. As we have 

 previously seen, there have been found rather frequently degenerative 

 changes and especially chronic inflammatory changes in some of the ductless 

 glands, especially in the thyroid gland and in the hypophysis. (The findings 

 of adenocarcinoma or glioma of the hypophysis might very well be an acci- 

 dental coincidence). 



These chronic inflammatory alterations seem to me throughout not re- 

 markable, as in this disease we find them otherwise in many organs. Cir- 

 rhotic alterations in the liver and spleen, chronic inflammations in the nerves, 

 etc., belong to the commonest findings, and may in part be explained by the 

 alcoholism that is present. Thyrogenic obesity, a mild form of myxedema, 

 is widely distinguished in its clinical behavior from the picture of adiposis 

 dolorosa. Simultaneous sclerosis of the thyroid gland and of the hypophysis 

 leads to a combination of myxedema and cachexia, a disease picture that 

 has nothing to do with adipositas dolorosa. There does not appear to me 

 to be any grounds for assuming the involvement of any of the other ductless 

 glands. The assumption of Lyon that all forms of obesity and of lipomatosis 

 have their origin in a disturbance of correlation of the ductless glands, I can- 



