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In this case you will remark that the constitutional symptoms, although equally severe, if not more so, than is the case previously narrated, had set in suddenly only a very short time before death, instead of coming on gradually during some months. You will observe, moreover, that the discoloration, although strictly characteristic as far as it went, even to the single pin’s head-stain on the buccal mucous membrane, was so much less advanced than it was in W. R.’s case, or that it generally is in conjunction with the latest stage of the constitutional symptoms, that it failed to attract my attention until I sought for it in order to confirm the opinion I had already formed. Nevertheless the fact remains, which in the present state of our knowledge of the disease, I cannot pretend satisfactorily to explain, that, in spite of these discrepancies between the two cases during life, the supra-renal capsules were found after death in an almost identical state of degeneration.
In striking contrast to the case of the girl E. W., was that of a woman, Mrs. W., aged thirty-one, who came under my care several years ago as a patient at the Western General Dispensary. In her case the most obvious and striking feature was the intense and characteristic discoloration of skin, which led me at first sight to diagnose Addison’s disease, even before inquiring into the constitutional symptoms. She attributed her illness to a strain received in turning a mangle five years before, when she fancied that something gave way in her right side, and she was laid up in bed for some days with severe pain in the right iliac region. From that time she had never been robust; but began to droop more decidedly three years later; became worse in September, 1858, and presented herself at the dispensary in January 1859. She had suffered from occasional pain in the loins, sickness and vertigo. Her skin was cold and appetite bad. The pulse was under 80, and excessively feeble; the heart’s action weak, the lungs apparently healthy, but the respiration feeble. The catamenia had been irregular, and there
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with acetic acid) partly to fat-granules. These nuclei are
usually oval or round; but in some parts they are elongated,
in a definite direction, into spindle-shaped bodies or nuclear fibres.
The opaque portions exhibit no nuclear or cell structures,
either with or without acetic acid. They exhibit, in fact,
only albuminous, fatty granules, the latter being more abundant
in proportion to the advance of the softening process.
No structure having any resemblance to tubercle is to be found.
It is tolerably evident that the change consists
(1) in the development in the organ of firm tissue,
of which the structure is above described, viz.,
an albuminous exudation undergoing gradual transformation
into fibrous tissue, and (2) of the fatty degeneration of
this substance.”