DYSTROPHIA ADIPOSOGENITALIS 



919 



there was a perceptible increase of subcutaneous fat over the chest, 

 shoulders, neck and face. The patient completely recovered, and her 

 health and figure were normal four years after treatment was discon- 

 tinued. 



For the purpose gf ascertaining the nature and extent of fat redistribu- 

 tion in dystrophia adiposogenitalis a system of measurements combined 

 with the weight of the patient has been employed in the series of cases 

 studied and tabulated in Groups A and B. The circumference measure- 

 ments are indicated in Figure 25. The most important are the axillary, 

 waist, hip and thigh measurements. The axillary circumference is taken 

 at the level of the axillary folds, and the thighs at the juncture of the 

 groins. The waist and hip are taken without regard to any fixed level or 

 anatomical landmarks. The former represents the minimum circumfer- 

 ence of the upper abdomen and the latter the maximum at any point below 

 the umbilicus ; a point which fluctuates as much as three or four inches, de- 

 pending upon the degree of girdle adiposity. The maximum hip circum- 

 ference occurs at a much lower level in well marked cases of girdle obesity 

 than it does in the milder forms, but during the process of fat redistribu- 

 tion this level is gradually raised. 



Out of a series of 46 cases 28 have been studied with reference to the 

 effect of organotherapy upon fat redistribution, combining both mensura- 

 tion and weight as criteria in determining the results. 



The cases have been divided into two groups. Group A (16 cases) 

 represents those in which the results have been designated as typical fat 

 redistribution, i. e., the upper circumference measurements increased 

 and the lower diminished. In group B (12 cases) appear the atypical 

 cases, including those with irregular redistribution as well as those unin- 

 fluenced by treatment. Those which failed to respond to treatment did not 

 present a well defined clinical picture of dystrophia adiposogenitalis. In 

 some of them the predominant symptoms could be attributed to other endo- 

 crin glands (e. g., cases 5, 7, 9, 10 of Group B). It would thus appear 

 that anterior pituitary and thyroid feeding could be used advantageously 

 as a therapeutic test for diagnostic purpose. In true cases of dystrophia 

 adiposogenitalis the effect of thyroid and anterior pituitary substance upon 

 fat dystrophy can be disclosed by mensuration usually within a period of 

 two weeks. With the improvement of the obesity a coincident improve- 

 ment of the general condition of the patient was almost invariably observed, 

 (Fig. 26.) The nervous and mental symptoms subsided; fatigability 

 diminished ; metabolic processes increased ; and the sexual functions were 

 often restored to normal results which are not infrequently permanent. 

 This, of course, does not apply to progressive lesions in the nature of 

 tumors, involving the pituitary gland. 



In these two groups of cases diet and physical therapeutics, with a 

 few exceptions, were purposely eliminated so that whatever results were 



