40 WILDER TILESTON 



licz syndrome, but differs from it in the involvement of the endocrin 

 glands, and in the fact that in Hammerli's case, the only one coming to 

 autopsy, a simple hyperplasia of the salivary glands was found. In ad- 

 dition to the salivary glands, the thyroid was involved in most of the cases, 

 and dysgenitalism was frequent. The hypophysis was occasionally af- 

 fected. Signs of status thymolymphaticus were frequently associated. 

 Syphilis was noted in several instances as an etiological factor. 



In no less than 11 of the 26 cases reported by Berthon, Mohr and 

 Nagel, obesity was present. It is probably ascribable to disease of the 

 thyroid. The association with dysgenitalism is interesting, in view of 

 the interrelationship between the salivary glands, and the gonads. The 

 question whether the salivary glands have an internal secretion is still 

 an open one. 



(6) Adiposis Dolorosa or Dercum's Disease. In 1888 Dercum de- 

 scribed a new condition, to which he gave the name adiposis dolorosa. It 

 is characterized clinically by four cardinal symptoms: (1) adiposity, 

 (2) tenderness and pains, (3) asthenia and (4) psychic changes. 



The adiposity in typical cases shows a characteristic distribution. Large 

 pendulous masses of fat, having a worm-like feel, develop especially in 

 the upper arms, the thighs, the inner aspect of the knees, and in apron- 

 like form on the lower abdomen. Deep furrows separate these masses from 

 the surrounding parts. Excellent photographs may be found in the second 

 article of Dercum and in that of Lyon. 



More rarely, as emphasized by ^ T itaut, the fat occurs in the form of 

 (a) nodular circumscribed lipomata, or (b) diffuse localized fat deposits, 

 the remaining parts being free from fat accumulation. Various combina- 

 tions of these three types may be met with. 



The fat deposits, both large and small, are exquisitely tender, and 

 are often the seat of spontaneous pains of a neuralgic character. Some- 

 times there is pain along the course of the larger nerve trunks. Paresthesia- 

 are common, and occasionally there are localized areas of anesthesia. 

 All of these signs, including the tenderness, are probably ascribable to a 

 neuritis affecting the nerve fibrils in the subcutaneous fat, which has been 

 demonstrated histologically by Dercum and others. 



The muscular weakness may be profound, resembling in pronounced 

 cases that seen in Addison's disease, and at once suggestive of disease of 

 the endocrin glands. It is incomparably greater than that seen in ordinary 

 obesity of a similar grade. 



The psychic changes are varied, consisting chiefly of irritability alter- 

 nating with depression. Failure of memory and apathy are often noted, 

 and occasionally there is dementia. The mental symptoms while very com- 

 mon are less constant than the other cardinal signs. 



Other symptoms suggestive of endocrin disturbance are the absence of 

 sweating, and the increased appetite, especially for sweets. Abnormality 



