14

during the last few days. The patient stated that he had first begun to feel languid and unwell two days before his admission; but the feeling increased so rapidly that he was unable to move about when brought to the hospital. Previously to this attack he had always enjoyed good health, had been of sober habits, and well fed. On admission, his skin and conjunctivæ were of a peculiar dark, dirty-brown colour; the skin was covered with a cold clammy sweat, and his pulse was barely perceptible. He was restless, and answered questions with difficulty, though perfectly conscious. He stated that the only pain he had was deep-seated, and in the region of the liver. The cold sweat continued, and he died the following morning.

At the post-mortem examination, the body was extremely muscular and well-formed, the entire surface was of a uniform and peculiar brown colour; there was slight lividity of the lips and back. The pericardium was firmly adherent, and the whole of the solitary glands of the small intestine were enlarged, forming dense solid tumours, nearly half the size of their respective kidneys but retaining their characteristic form. On section, they were seen to be composed of an opaque yellow substance, of the consistence of soft cheese. Portions of this substance appeared to be tubercle, as it is seen in the brain; whilst other portions were soft and broken down, like the matter of a scrofulous abscess. In one or two places portions of the natural structure of the supra-renal capsules could be detected.

You will find this case published at greater length in the Medical Gazette* by Mr. Sibley, about the time when the announcement of Dr. Addison’s discovery had excited great interest on the subject amongst the profession; and I quote it with the more pleasure because it is an example of the great value of accurate clinical observation. To the details of the case no peculiar significance of importance was attached at the time, for the connexion between the symptoms observed during life and the local disease found after death was then altogether unsuspected; and yet both the appearance and condition of the patient and the state of the supra-renal capsules were so accurately recorded, as to afford strong and impartial corroborative testimony to the existence of that connexion, when discovered. The apparent cause of the fatal seizure in the above case is not stated; but it seems, so far as I can judge, that in

----------------------------------------

* Medical Gazette, Vol. xxxiii. p. 188.

[PREVIOUS] [NEXT]