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of the skin. Whilst in the hospital, he had slight cough, raising a thick, dark, scanty mucus. His pulse remained feeble, and he still had pain in the left hypochondrium, but was better in both respects whilst in the recumbent posture. He left the hospital rather suddenly, in consequence of the shock he sustained from the death of the patients on either side of him on two successive days, but he has continued under treatment up to the present time. He is now decidedly stronger, and has been able to resume his occupation; but he still presents, though in a mitigated degree, the same constitutional symptoms, and the discoloration of skin is becoming gradually more general and its characteristic features more strongly marked.
These circumstances leave no doubt in my mind as to the existence of Addison’s disease of the supra-renal capsules; and, although the patient may, with great care and suitable treatment, be propped up for an indefinite time, he must always be considered as in imminent danger of breakdown under any powerful depressive influence. Even an unusually severe day’s work, or a slight attack of diarrhœa, might suffice to upset the balance and lead to a speedily fatal issue of the case. Nevertheless, he has unquestionably benefited much from the means used; for, when he came into the hospital, he was becoming so rapidly worse that it seemed probable that he would die in a few days, and he not only improved much before he went out, but continued to do so afterwards with rest and proper treatment at home, and has not yet relapsed.*
----------------------------------------* J. D. still remains under observation. He has varied greatly from time to time; having at times rallied so much as to be able to walk to the hospital, a distance of two miles, and even resume his work for a few days, though this latter attempt always brings on a return of depression. At other times he has been confined to bed for several days together, with retching, vomiting and profound exhaustion. Lately he has been in the country for a few weeks, and presented himself at the hospital on the 9th of October, very greatly improved in health by the change. The discoloration of the skin, however, which had to be sought for when I first saw him, has become very striking. The entire face is of a dusky greenish hue, more closely resembling real bronze colour than is usual in this disease. The hands, especially the knuckles, and the cicatrix on the left clavicle are much darker than formerly. The site of the blister on the epigastrium remains as dark as it was, but looks less so, in consequence of the deepening discoloration of the skin around it. The buccal mucous membrane is more extensively mottled, and there is now a patch of discoloration on the tongue. More of the little black specks, resembling freckles, are likewise observable on the face, neck, and hands. There is still some tenderness on pressure over the left hypochondrium, and distinct uneasiness, scarcely amounting to pain, is felt on percussion under the lower dorsal and upper lumbar vertebræ.