The Clinical Symptoms and Treatment of Chronic Subcutaneous Fibrosis

With the exception of a short article bearing the title De la Panniculite, by ?. Kjellberg,1 of Stockholm, which appeared in the Journal dee praticiens for 1900, and in which reference is made to a previous description by Professor Salin, also of Stockholm, I have been unable to find any sys tematic account of this con dition. Cases illustrating one clinical aspect of it have often been reported as symmetri cal diffuse lipoma, sym metrical fatty tumours, or diffuse fibro-fatty tumours ; and Dercum,2 in 1892, in an article entitled, Three cases of a hitherto unclassified affection resembling in its grosser aspects obesity, bat associated with special ner vous symptom s?Adiposis dolorosa, described a fatty condition, more generalized than these, which he regarded as a speoial and previously unnoticed disease. The cases ? on which he based his descrip tion all occurred in women past middle life, who had gradually developed masses of fat in the subcutaneous areolar tissue, these masses being irregular in their posi tion and distribution, and very painful on pressure. Spontaneous pain of a constan or sharp and stabbing, was ] swellings. Occasionally very pain occurred, and these were ci swelling and hardening of the not evenly deposited, but felt ] bundles of worms. Certain ner described as characteristic, these being chiefly diminu tion of cutaneons sensibility in patches, motor weakness, a tendency to herpetic erup tions, and anidrosis. He dis tinguished the condition from ordinary obesity in that (1) the fat occurs in masses and is first deposited at one part, other parts being in volved gradually ; (2) the fatty masses are extremely painful on pressure, and (3) well marked nervous symptoms are present. On these last he lays great stress. Subse quently Deronm8 published an account of the post-mortem examination of bis first case. She weighed 3001b., and there was an excessive deposit of fat in the subcutaneous tissue of the arms, shoulders, and back, rather less in the abdomen and thighs. The fat is described as normal, but containing numerous independent enoapsnled lipomata. The peripheral nerves lying in it showed interstitial neuritis with proliferation of the connective tissue and diminution in the number of nerve fibres. Burr,4 in another case, desoribes the fat as peculiarly fibrous and firm, with its peripheral nerves in a condition of interstitial neuritis, while Price8 gives a practically similar description of the morbid anatomy, and expresses the opinion that the condition is due to ohanges in the pituitary body. Dercum, on the other hand, had attributed its causation to an alteration in the function of the thyroid, and seemed to regard it as allied to myxoedema. A description of adiposis dolorosa (Dercam's disease) is now included in most of the recent textbooks? where it is variously classified under nervous diseases, constitutional diseases, obesity, and so forth. I am very doubtful, however, if it can be rightly ranked as a special disease. The condition was well known to me clinically for some years before ? became acquainted with Dercum's original description of it, and I had come to conclusions dur?rent from his