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peculiar morbid change in the capsules, but to the general tubular disease which is frequently associated with it. It is quite true that, in very chronic phthisis, there is occasionally a dusky hue of skin, and I have lately pointed out to many of you two such cases under my care; but this discoloration in phthisis is comparatively rare, and, when it does exist, is wanting in all the characteristic features of the discoloration peculiar to Addison’s disease. Moreover, the cases of Addison’s disease which are complicated with advanced phthisis are precisely those in which the discoloration of skin is most frequently absent; whereas, if the theory to which I have referred were correct, those are the very cases in which we ought to find it the most invariable and most strongly marked. The adhesion of the right capsule to the diaphragm and the thickening of the connective tissue round both capsules, in Dr. Thompson’s case, afford conclusive evidence of there having been inflammation in those parts, although the post-mortem examination has revealed no obvious cause for it, such as caries of the spine, which I feel assured will be found in the case of the patient now in Founder ward. Doubtless, some of the symptoms presented by Dr. Addison’s patient were due to the other diseases under which he was also labouring; but this in no way invalidates the correctness of the diagnosis as regards Addison’s disease, which was made on the day of the patient’s admission to the hospital, and was proved to be correct a month afterwards by post-mortem examination. A few days before death an unpleasant cadaverous odour was observed about this patient’s person. This peculiar symptom has been noticed before in Addison’s disease, both by myself and by other observers. In my experience, it is a sign of the approach of death, which has invariably taken place in the course of a few days after its appearance.
The discoloration is quite characteristic in both the cases I related, though it is most intense in Dr. Stewart’s case, which you can still see for yourselves. Sometimes, however, the discoloration of skin is slight, and insufficient to suggest the nature of the disease from which the patient is suffering. It has happened to me, on two occasions, to be led to diagnose Addison’s disease by the constitutional symptoms alone, aided by the circumstance that there was no other discernible disease to account for them; and I have then had to look closely for the slight discoloration of skin in order to confirm my diagnosis. This occurred, in fact, with regard to the case which I mentioned at the beginning of this lecture, as having been recently in the hospital under my own care; and, as it seems to show the at least temporary efficacy