OBESITY 41 



of the sugar metabolism is suggested by the low figure for blood sugar 

 reported by Umber. 



Vasomotor symptoms are very common. From time to time reddish 

 or bluish transient swellings of the skin arise over the affected parts, and 

 there is a marked tendency to hemorrhage from the nose, occasionally from 

 the stomach and uterus. Bruising of the subcutaneous tissues on slight 

 provocation is often noted. 



Adiposis dolorosa is chiefly confined to the female sex, women being 

 affected in the proportion of six to one, or more. The onset is usually at 

 middle age, often at the menopause. 



The etiology is obscure. A large proportion of the cases occur in 

 neuropathic subjects,, and insanity and epilepsy are often noted among 

 the relatives. Alcoholism plays a part in some cases, probably more as 

 an exciting factor than as a cause of the condition. Syphilis is emphasized 

 by some authors, as in all obscure diseases, but there is no good evidence 

 that it is of etiological importance, except in so far as it involves, one of 

 the endocrin glands. 



The pathology strongly indicates that the condition arises from disease 

 of the endocrin glands, which have been found more or less affected in al- 

 most every case. Thus Price states that the thyroid was found to be 

 diseased in seven out of eight autopsies, being sometimes small and fibrous, 

 sometimes enlarged and adenomatous, or the seat of calcareous deposits. 

 The pituitary was markedly involved in fifty per cent, showing either 

 tumor formation or inflammatory changes. Since then other cases have 

 been reported showing well-marked hypopituitarism. Gushing in one 

 case found the pituitary normal, but there was marked atrophy of the 

 cerebral convolutions. The gonads are less frequently involved, showing 

 atrophy and fibrosis. 



The justification for ascribing adiposis dolorosa to disease of the 

 endocrin glands is furnished not only by the symptomatology and the post- 

 mortem lesions, but also by the marked improvement shown in some cases 

 under thyroid therapy, and by the fact that the obesity is very resistant to 

 dietetic treatment. Thus Umber describes a case following oophorectomy, 

 in which the weight remained stationary over a prolonged period on a 

 diet containing only 900 calories. 



The fact that numerous incomplete forms and border-line cases are 

 met with by no means justifies, in the writer's opinion, the attempt to 

 deny that adiposis dolorosa is a definite entity, or at least a polyglandular 

 syndrome. In such cases it is to be expected that difficulty will be en- 

 countered in demonstrating endocrin disturbance, just as it is in "formes 

 frustes" of myxedema and hyperthyroidism. There is no doubt that many 

 cases have been reported as adiposis dolorosa which are instances of mis- 

 taken diagnosis, thus introducing more confusion into this difficult subject. 



The prognosis is not good. The condition usually resists therapeutic 



