ADDENDUM 587 



not subscribe to. Here too many things are thrown together. The sup- 

 position of the disturbance of correlation of the ductless glands as the cause 

 of a disease is, without corresponding pathologico-anatomical correlate a 

 vague idea, which only obstructs a deeper penetration into the pathogenesis 

 of such a disease. So that there remains only the supposition of a tropho- 

 neurosis, although I cannot conceal the fact that not much has been gained 

 by this assumption. 



There have been described still other trophic disturbances of the fat tissue 

 of which I shall here briefly refer to one only, although probably it has less 

 to do with the ductless glandular system than adipositas dolorosa. Pic and 

 Gardere first pointed out a trophic disturbance which Simons has lately desig- 

 nated lipodystrophia progressiva. It is concerned with disappearance of 

 the fat on the face and arms, simultaneously with a gradually increasing 

 adiposity in the region of the buttocks and on the thigh. Sensory and vaso- 

 motor disturbances are absent. The investigation of the fundamental ex- 

 change in Simon's case showed normal relations. 



In the differential diagnosis of adipositas dolorosa from myxedema we 

 should consider that in the latter the swellings are especially in the face; 

 from trophedema that this mostly sets in at an early age, that the edema 

 is mostly unilateral and that hands, feet, forearms and [lower] legs are 

 usually involved; from neurofibromatosis of Recklinghausen that the nodules 

 in this affection are much harder and also smaller, that they are more 

 confluent, that they do not avoid hands and feet, and that the psychic dis- 

 turbances are more pronounced, also that there are often marked pig- 

 mentations of the skin (Debove). The differential diagnosis from alcoholic 

 polyneuritis in the obese, concerning which diagnosis Umber and Schwenken- 

 becker have written, is often very difficult, if the characteristic distribution 

 of fat is absent. 



In the treatment of adipositas dolorosa a great role is played by thyroidin. 

 In many cases the results are indeed undoubted, but this does not furnish 

 evidence for the thyrogenic nature of the disease. It has been stated that 

 cases have been cured by thyroidin medication (Price). Also the psychic 

 disturbances have retrogressed, v. Noorden has seen good results from 

 systematic bath-treatments. X-ray irradiation and iodine have been 

 recommended. 



Addendum 



The type of obesity described by Anders under the name adiposis tuberosa 

 simplex is apparently nothing more than a transitional stage between simple 

 diffuse obesity and adipositas dolorosa. It is doubtful whether even the 

 latter will long maintain its position as a disease sui generis. It is probable 

 that many of the cases described under it could very well be classed under 



