HORMONES AND OVERGROWTH 343 



Dercum's disease (adiposis dolorosa). While these may be 

 nodular in type, more frequently the deposits while localized 

 are diffuse over the supraclavicular, inframammary, and lower 

 scapular regions. How regional is this distribution is frequently 

 noticeable in the extremities when, to quote Sir Dyce Duckworth, 

 " the hands appear to come out as from a cuff, and the foot from 

 a pantaloon." To the same order belongs the remarkable group 

 of perirenal, retroperitoneal, and mesenteric lipomas, so called. 

 These are one and all overgrowths of the fatty tissues normally 

 present in these regions. They are not, let me emphasize, 

 blastemas proper. They are diffuse hyperplasias which only 

 from their extreme extent give the impression of being distinct 

 tumours, but if carefully examined they are seen to respect the 

 boundaries of the normal tissue, and in fact to pass imperceptibly 

 into the normal fatty tissue around, without any sign of limiting 

 capsule. They cannot be regarded as autonomous, independent 

 developments ; they do not come within the accepted definitions 

 of tumours proper, or blastemas. They are conditions of hyper- 

 blastosis, that is to say, of the state of hyperplasia of an individual 

 tissue. 



As I say, these localized regional overgrowths of fatty tissue 

 constitute the type example of " Riesenwuchs," but what is of 

 particular interest for the development of my thesis is that as a 

 class they appear to be due, not to any local irritation, but to 

 internal secretory disturbances, to some lack of equilibrium 

 between the internal secretions, resulting, as in our previous group 

 of cases, not necessarily in a generalized but in a regional over- 

 growth of this particular tissue. Notably in the case of Dercum's 

 disease, almost every case which so far has come to autopsy has 

 been characterized by thyroid or pituitary changes or both, 

 while conversely, if I may so express it, we have the authority 

 of one whom I may term the leading authority on obese states 

 and their treatment Chune Fletcher that administration of 

 thyroid extract is the one method of treating Dercum's disease 

 that yields favourable results. 



Passing to the other members of this group it is true that so 

 far we possess no distinct evidence that they too are associated 

 with internal secretory or metabolic disturbances. Anatomically, 

 however, they present the same general characteristics, and this 

 in so striking a manner that we are forced to consider them as 



