Back mice have been also named “lumbar cellulite” by the French authors. That’s why I keep studying all the works that deal with “cellulite” (they related cellulite to the painful circumscribed serous edema or hyperplasic reaction of the cellular tissue or fibro-fatty tissue, sometimes it presents as painful hard nodules).
This is an interesting thesis from one of the doctors of the group of French authors that focused on trying to prove that the presence of subcutaneous painful hard nodules was related to what they called “arthritisme”. At the beginning of the century, the French doctors seemed very influenced by the Swedish massaeurs that apparently were the first to talk about the painful syndromes related to the “cellulite nodules”. The Swedish used the term “celullit”.
In the first pages, Hanriot already makes it clear that the term “cellulite” or “cellulitis” is inappropriate since there is a serous edema or fibrous hyperplasia but not an INFLAMMATION as the termination “-ite” or “-itis” would suggest. (Personal note: Giving “mice” a wrong name continuously has been such a drama in its history. Somehow it seems that the termination “-itis” has been very commonly misused. Maybe they used it as an equivalent of “ something swollen and pain”. Some of the names they used to name the “mice” were: Fibrositis, swollen and pain in the fibrous tissue. Cellulitis, swollen and pain in the cellular tissue. Myositis, swollen and pain in the muscular tissue; these three names have been commonly used to describe the “mice”. Despite these doctors used the wrong termination particle “-itis” in English or “-ite” in French, they were completely aware that there was NOT a real INFLAMMATORY REACTION neither in the fibrositis, cellulitis or myositis).
Curiously, currently the term cellulite or cellulitis is used to explain an esthetic appearance of the skin, but at the beginning of the century, it had a different meaning.
Hanriot mentions that the aim of this thesis is to expose, in a general view, the concept of what they named “cellulite” and its relation to what they called “arthritisme” and its various manifestations. Arthritisme is an “obsolete term” that was used by some authors to designate a general entity that presented people that suffer certain specific chronic pathologies such as: “rheumatisme chronique, gout, eczéma, migraine, diabète, cauculus biliaires ou rénaux”. Hanriot insists that “cellulite” must be prevented especially on those individuals that he calls “arthritic subjects” which have nutrition and circulation problems.
Personal note: On page 26, he describes that the tissues are impregnated with lymph, and that there are lacunae. Could this be a description of what they have lately called INTERSTITIUM?
It is noticeable again that the French authors did know very well that the SEROUS EDEMA or fibrous hyperplasia of the cellular tissue could cause painful syndromes (mainly rheumatic pain or neuralgias), but the only way they managed to treat this entity or the painful syndromes it may create was mainly by MASSAGE, diet and exercise, and that usually took weeks.
It is not surprising that this way of treatment did not succeed in the medical community at the end. It seems that maybe massaging is “not a proper work for a doctor”. They do not mention the punctures of local anesthetic or the acupuncture technique at all.
In many parts of this thesis they mention the abdomino-pelvic cellulite, since it seems it was the most studied entity by then and the starting point of many subsequent studies that place the cellulite as a pain creator in the abdomino-pelvis and elsewhere.
In the introduction, Hanriot mentions that the “cellulite” is not just an affliction of cellular tissue, but it also affects the arteries, veins, articulations and muscles. He says that the tissue is altered by the “déchets des albuminoïdes” or their products. (Personal note: I found this comment very interesting but he does not go deeper about it or give any reference).
Notes on the Thesis:
Contribution à l’Étude d’’’une des manifestations de l’Arthritisme “La cellulite”.
Armand Hanriot. Paris.
Hanriot starts mentioning that of all the manifestations of what he calls “arthritisme” there is one manifestation that is commonly overlooked and misdiagnosed as “névralgies, arthrites, and phlébites”… he means “the cellulite”. That’s why he decided to do the thesis about it.
He was convinced by Dr. BOULOUMIÉ during a journey to Vittel. That doctor told him that it was worthy to study the entity that they named “cellulite”, since he was surprised of the high prevalence they saw of these cases. They related it to the artério-sclérose and the obesity, and to all the diseases that they relate to the “ralentissement de la nutrition” (and to the “arthritisme”).
He mentions that the “cellulite” is not just an affliction of cellular tissue, but it also affects the arteries, veins, articulations and muscles. They are altered by the “déchets des albuminoïdes” or their products.
Etude Générale de la Cellulite
He starts mentioning the studies that focused in the “cellulite profonde des femmes” localized in the cellular tissue péri-oophorite, péri-métrite, péri-salpingite.
About the term “cellulite”:
Etymologically, “cellulite” means inflammation of the cellular tissue, BUT IN REALITY “cellulite” is used to describe the lesion that is caused by
“l’infiltration ou le dépot des produits de décomposition des albuminoïdes, dans le tissue cellulaire connectif”
[The lesion that is caused by infiltration or deposit of albuminaid decomposition products in the connective cellular tissue]
Hanriot makes it also clear that despite “cellulite” is the term used, there is not in any way any sing of antimicrobial inflammatory reaction. It is not related to fever or suppuration.
He also has to clarify that, despite the termination “-ite” means somehow an acute illness, the “cellulite” was considered a chronic affliction. (Again admitting that the term “cellulite” was somehow totally inadequate).
Cellulite is an affection of the connective cellular tissue, and it can present at any part of the body: “cellulite sous-cutanée”, “cellulite urétrale”, and “cellulite abdomino-génitale”.
Hanriot quotes STAPFER’s definition of “cellulite”.
Notes about the chapter: “historique” from cellulite
Hanriot explains that the first ones that put attention to the existence of the “cellulite” were the “masseurs suédois”, the Swedish masseuse. They were the first ones to report the treatment of
“noyaux durs et douloureux, dans les diverses régions du tissue adipeux et des muscles du corps”
[hard and painful cores inside adipose tissue and muscle tissue of several regions of the body].
Before that, certain physicians studied the alterations of the cellular tissue just related to certain abdominal organs, and attributed it to certain localized peritoneal inflammation.
Hanriot mentions that the Swedish doctors were the first that gave importance to the cellulite and used the term “cellulit” especially for the troubles of the connective tissue of the skin.
In 1888, Dr. NORSTROOM, Swedish, explained the relief of rebel headache by massaging the cervico-dorsal muscles that were indurated and painful (Personal note: Norström or Norstroom used the term MYOSITIS, and insisted that he could treat many rheumatic kinds of pain just with massage, he often mentioned indurated points that FRORIEP described as rheumastiche schweile).
He then mentions other doctors that studied the “abdominal or pelvic cellulite”: JOSEPHEON (1891), WIDERSTRÖM.
But HANRIOT especially mentions the contribution of STAPFER who, in 1893, especially talked about the cellulite in France. And he especially mentions that the cellulite would be understood as “oedèmes douloureux” [painful edemas] in many locations.
He mentions RICHAR HOGNER’s publication in 1896 about the “cellulite ou panniculite adipeuse et le myitis, complication habituelle des maladies des femmes”.
IN 1897, STAPFER presents the hypothesis that the “cellulite” could be a kind of “présclérose”.
Hanriot then mentions WATTERWALD and his theories related to the alteration of the nutrition.
He mentions many authors such as KRIKORTZ, DELASSUS, BRALANT, and LUTIKOFF.
Notes about the chapter: histology of the celullitic lesions
Hanriot states that since cellulite is a “benign” entity (in the sense that it does not cause the death of the patients), it is difficult that it is studied in the hospital.
GEOFFROY ST-HILAIRE mentions a kind of “empatments cellulaires” in certain abdomino-pelvic tumours that were operated. These authors differentiate 2 types of edemas:
- les oedémes séreux simples
- les oedémes “fibro plastiques”
Hanriot mentions that the oedéme séreux is nothing more that what occurs normally in the tissues. He mentions that the lymph impregnates the tissue and that it is produced by transudations from the blood. Any imbalance in this equilibrium could lead to what he calls oedeme séreux [serous edema].
This edema is just a symptom that indicates that the circulation has not been normal.
The “serous edema” differed from the “fibro-plastic edema”:
- The serous edema is circumscribed, well limited, forming tumors of variable size, like a “noix” or bigger (Personal note: Like the simple back mice could be).
- It can change volume from one day to another. The seat where it presents is variable. And Hanriot related it to the “perturbation nutritive des eléments cellulaires”.
- He mentions that the exudate interstitial is the base of the fibro-plastic edema. He mentions several phenomena: vascular dilatation, accelerations, slowing down of blood, decrease of pressure, leukocytes at the margin, diapedesis, and exudation.
GEOFFROY SINT-HILAIRE also mentions that cellulite from the Swedish is a term that has led to confusion since there is NOT A SUPPURATION. Geoffroy Saint-Hilaire focused on the abdomino-pelvic lesions and performed detailed histological findings of what he saw.
Hanriot then mentions that DERCUM also published a work related to symptoms of “adipose douloureuse”.
He also mentions the works of FÉRÉOL (nodosités éphémères), TROISIER (nodosités sous cutanées rhumatismales, VERNEUIL, and POTAIN (lipomes et pesudolipomes).
He mentions that STAPFER relates the lesions to an “obstruction des vois lymphatiques”.
Hanriot mentions that the chronic congestion of the cellulite may lead to the presence of the peripheral neuropathies. And then a kind of vicious circle could start.
Notes about the chapter: etiology
- At the beginning, it seems that the “cellulite abdominopalviane” was related to the local genital infections. Also to circulation troubles or nutrition ones.
- He also mentions a certain predisposition of the women to suffer “congestions physiologiques répétées”.
- It has also been related to the certain physical works or external traumatism.
- It could also be a result of “choc nerveux”. It would be for an acute alteration of the blood tension.
- It is also related to the atmospheric or temperature changes.
- To professional intoxications or alcoholism. Tobacco use.
- Also to infections such as: syphilis, tuberculosis, grippe.
Hanriot mentions that, in 1893, Hanot relates the vulnerability of the connective tissue in patients that were affected of arthritisme. He mentions a tendency to the hyperplasia and tendency to the hyperplasia and fibrous retraction.
The connective tissue is the intermediary between the blood and the lymph.
“Le milieu intérieur n’est pas le sang comme le prétendait CLAUDE BERNARD, c’est le tissu conjuctif, dit le professeur RENAULT”.
Hanriot mentions KRIKORTZ’s thesis about rheumatisme musculaire and the study of TESTELIN oedemes dans la diathèse arthritique, and they related it to certain vasomotor alteration.
In 1883, LANCEREAUX talked about “hydropisied névropathiques” that consisted in edematous painful tumefactions.
Other authors that talked about edema: QUINCKE, 1883.
Other authors related the cellulite with certain degree of uremia (gout, diabetes, migraines, asthma, obesity, dyspepsia).
Notes about the Chapter: Symptoms
The main symptoms are: “les nodosités, la douleur, l’oedème, resultant de l’infiltration”.
A more complex manifestation is what VETTERWALD related to a manifestation “diathèse neuro-arthitique”.
Hanriot mentions 6 types of manifestations: “sensitif, sensoriel, moteur, vaso-moteur, sécrétoire, trophique”.
The principal symptom of the “cellulite” is the edema: it is a HARD and painful edema. It is different from the “oedema ordinaire” in the way that the finger does not get marked. This edema comes progressively, and many patients do not notice it.
–This cellulitic edema can cause spontaneous violent pains and neuropathic pains.
–On palpation, it can be felt in different ways: as crackling of the tissue, and the pain is low. Later the nodules may be felt as balls rolling under the fingers in the “tissue empate”. The nodules can then compress nerve filaments. At later stages, it can be more difficult to palpate the nodules since they may be harder and more painful on palpation.
-In fatty patients the disease can present as what they called DERCUMS’S disease.
-Sometimes the cellulite is explained by a decrease of sensation.
-The most frequent symptom is what has been called RHEUMATIC PAINS. They usually present on the shoulders, the nape, the lumbar region, the knees or to what has been named NEURALGIAS (sciatica, trigeminal, intercostal nerves). One of the most famous one is the one in the leg, 1/3 inferior that sometimes is confused with periphlebitis, the internal face of the knee, the posterior side of the thigh, the greater trochanter, the buttocks, dorsal region, and the epigastric region. All these sides correlate with the orifices were the cutaneous nerves become superficial.
-The shoulders are related with terminal branches of the cervical plexus, like the circumflex.
-Usually those affections do not cause paralysis, but they do provoke partial functional impotence and asthenia.
Another strange symptom is the “troubles secrétoires”: decrease, increasing or suppression.
Notes on the formes cliniques and diagnosis
Hanriot insists that the neuralgies intercostales, or sciatica is one of the common presentations of the cellulite.
He mentions that the cellulite of the paret abdominale around the MacBurney point can be confused with appendicitis.
The lumbosacral localization may present as lumbago.
Notes on the chapter: What is the treatment of the cellulite?
There is a preventive and a curative treatment. And there is a local and a general treatment.
The preventive measures are: the diet, the gymnastics, the open-air activities, baths, and friction.
The local treatment is the KINÉSITHÉRAPIE. Massage.
Notes on the Chapter: OBSERVATIONS
Hanriot presents XVII observations with patients with several symptoms related to “arthritisme and cellulite” to prove his points.
Published in May 2019 by Marta Cañis Parera
Thèse pour Le Doctorat en Medicine. Contribution à l’Étude d’’’une des manifestations de l’Arthritisme “La cellulite”. Armand Hanriot. Paris.