588 OBESITY AND ADIPOSITAS DOLOROSA 



the other varieties of obesity. In adipositas dolorosa we have the additional 

 factor of pain, which may very well be explained as a neuritis of the small 

 nerve filaments. In many of the histories there is quite enough to account 

 for the existence of such a neuritis and also the mental changes; nor is the 

 asthenia of sufficient importance to delimit this condition as a pathogenic 

 entity, although for clinical purposes adiposis dolorosa does constitute one 

 of the recognizable types of obesity. 



This being the case, the question as to which ductless glands are at fault 

 in adiposis dolorosa seems to me entirely misplaced. We may very well con- 

 ceive that certain of the cases might (just as ordinary obesity) show no changes 

 in the ductless glands at all, and that others might show changes in individual 

 glands or in several, as in the varying types of obesity in general. In no case, 

 or perhaps only very rarely, is the condition to be regarded as pluriglandular 

 in the author's conception of the term, but rather as a result of a patho- 

 logical or a physiological correlation. 



Price has recently contributed a case that suggests to him the possibility 

 that, in addition to the thyroid condition, there were some disturbances in 

 function of the parathyroids the woman showed alternating, long periods 

 of apparent hypothyroidism and hyperthyroidism (without exophthal- 

 mus) and in 'addition, during or just before the periods of hyperthyroidism 

 flexor cramps of the extremities, especially of the hands and the feet. 

 Whether in this case these cramps would be considered a sign of hyperexcita- 

 bility of the nerves such as would presage tetany, or constitute an attack of 

 tetany, cannot be decided from the case report alone. 



McCarthy and Karsner have recently reported a case of adenocarcinoma 

 of the thyroid, with metastases to the cervical glands and pituitary, which 

 they regard as linking together three of the groups of pathological fat 

 adiposis cerebralis, symmetrical adenolipomatosis (a predominence cervicale) 

 of Launois and Bensaude, and adiposis dolorosa. McCarthy regards another 

 case reported by him with Dercum as an intermediate type between adipo- 

 sis dolorosa and adenolipomatose symmetrique a predominance cervicale. 

 A third case mentioned by McCarthy in the report was evidently a case of 

 eunuchoidism. 



In the treatment mention should be made of the various "degrassators" 

 that bring about a reduction of the fat by electrical means, also of hot steam 

 or electrical light baths. It is needless to state that these measures should 

 be employed in those weakened and debilitated individuals affected with 

 adiposis dolorosa only with extreme caution, if at all. 



REFERENCES 



Anders (H. S.). Adiposis tuberosa simplex. Am. J. M. Sc., 1908, CXXXV, 325-333. 

 Price (G. .). Clinical types of adiposis and lipomatosis. Report of a case of adiposis 



