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of treatment in this disease, I shall devote a few minutes to giving you some particulars of it.
J. D., aged 43, park-keeper, became an out-patient under my care on the 17th of last November. He had had ague some years before, but had been otherwise healthy until about five months before coming under observation. He had suffered much during that time from pain in the loins, especially on the right side, and from pain and sense of tightness in the epigastrium, for the relief of which he had applied a small blister to the part three months before his admission. He had also suffered from vertigo, and latterly from nausea, retching, and vomiting. On admission, he had a languid, exhausted aspect; his pulse was extremely feeble; he was short of breath, and manifestly very ill; but there was no emaciation, nor any obvious evidence of local or constitutional disease. He had a troublesome catarrhal cough, but without any physical sign of pulmonary disease; his tongue was clean, his bowels were confined, and the urine was perfectly normal.
From the absence of any apparent cause for his peculiar symptoms, I was at once led to suspect the existence of Addison’s disease and to seek for discoloration of skin in corroboration of my suspicion. I then observed that the face and the back of the neck were slightly dusky, as were also the hands and arms as high as the elbows. The part of the epigastrium where the blister had been applied, three months before, was deeply discoloured; and on the left clavicle there was a yellowish-brown stain, about an inch in length, evidently corresponding to the cicatrix of some slight wound. These last features of the discoloration decided me in the opinion that the case was one of Addison’s disease. With these exceptions, however, the skin was still fair, and free from pigmentary deposits. The buccal mucous membrane presented several brown stains, in places which had apparently been irritated by teeth, but the margins of the lips were unaffected.
J. D., continued an out-patient until December 29th, when he was admitted into Hertford ward. His cough had abated, and he had lost the sickness for some time; but on December the 20th he had been attacked with severe pain in the epigastrium, together with loss of appetite, nausea, and breathlessness. These all continued at the time of his admission. His hands were cold; his pulse threadyanor compressible; respiration hurried; and he had a constant inclination to yawn and stretch. His face, hands and nipples were manifestly darker; and several black specks, of the size of freckles, had appeared since he was first examined, but all on the previously discoloured parts
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