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of the small intestines were slightly roughened by the presence of small, perfectly transparent granular bodies, closely aggregated upon the serous surface. There were some patches of congestion upon the mucous surface of the cardiac end of the stomach, which was otherwise healthy. Both supra-renal capsules were converted into hard yellowish masses. On section, the left capsule was found to consist entirely of yellow cheesy matter, apparently tuberculous; the right capsule was in a similar state, but softened at the centre, from which oozed a few drops of thick creamy fluid when the capsule was divided. There remained no appearance either of cortical or medullary substance.*
The three cases I have now related not only well illustrate, respectively, though in different degrees of intensity, the constitutional symptoms and external signs of Addison’s disease, but also show that on the one hand these symptoms may run through a slow, chronic and progressive course, extending over several months, or even years, and that on the other hand the disease may remain latent until near the close of life. I say “latent,” because it would be contrary to all analogy to suppose that any important change could have taken place in the condition of the supra-renal capsules within the last ten days of life, during which only in the case of E. W., any definite symptoms of the disease were visible. It is in these latent cases, especially, that the discoloration of the skin sometimes affords the earliest indication of the impending danger. The records of this hospital contain the notes of a case which illustrates, even more strikingly than that of E. W., the occasional latency of Addison’s disease until almost the eve of its fatal termination, and also the occasional appearance of the discoloration of skin some time before the accession of any of the constitutional symptoms. In the case of E. W. some slight indisposition had apparently existed during three or four weeks, and the characteristic symptoms supervened ten days before death; whereas, in the case I am about to relate, the history would appear to show that the patient had continued to feel perfectly well until within four days of death, although his friends had observed the discoloration of skin for several weeks previously.
W. P., aged twenty, was admitted into the Middlesex Hospital
on the 11th of July, 1854, under the care of
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*This case is reported in the Transactions of the Pathological
Society, Vol. x., p. 269. The fact of the strain in the back
so long after the patient’s last illness is not, however,
mentioned in that report, for at that time experience had not
led me to attach the importance I now do to such local injuries,
with reference to the causation of the disease.