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again discharged at the end of a few weeks, in a greatly improved condition. Soon after leaving the hospital, she married, and continued tolerably well for some months, but is now once more under my care as an out-patient, suffering, though in a less intense degree, from her former symptoms, and the discoloration of her skin having certainly become deeper during the interval. Her hair, originally of a dark brown colour, has also gradually changed to black and become very coarse.*
It seems to be unquestionable, from the history especially of this last case, that Addison’s disease, although incapable of cure, is yet in some degree amenable to treatment in respect of delaying its progress, until the illness have already arrived at its later stages. Owing, no doubt, greatly to our still imperfect knowledge of the nature and causes of the disease, the means of treatment at out disposal are as yet, unfortunately, very scanty. The remarkable asthenia, however, by which the disease is characterised, and the distressing retching and vomiting which usually accompany it, clearly demand the use of therapeutic agents calculated to mitigate the exhausting symptoms, and of such tonic treatment and nutritive diet as may invigorate the general health. On the other hand, the strong evidence as to the frequent origin of the disease of the supra-renal capsules in neighbouring local irritation, and the constant tendency of the patient to succumb under any external depressing influence, imperatively indicate the necessity for abstinence from over-fatigue, or, indeed, from much bodily exertion or mental strain of any kind. Prolonged rest in bed, I have found an essential part of the treatment in the several cases which have improved for a time under my observation. The use of drastic purgatives
----------------------------------------* E. B. continues under observation up to the present time. The discoloration of skin has become deeper since the lecture was delivered, especially on the neck, on the cicatrices inside the right elbow, and round the surface on the right hip which ulcerated after cupping. The discoloration in this last situation is the more striking, because of the contrast between the dark parts of the cicatrices and the white spots where the ulceration was deep enough to involve the cutis. The general surface of the abdomen is as dark as that of a mulatto, and the colour in this region is more intense than on the face. At this date (October 20th) the patient is in her best state, but she has had, since March, several attacks of extreme depression, attended by retching and vomiting, and, during the autumn, two attacks of diarrhœa, each of which has exhausted her so much as to leave, at the time, little apparent chance of her rallying again. At her best she is very languid, breathless on exertion, incapable of doing any work, and has an indescribably weary, depressed look. Her pulse is generally about 72, exceedingly small and feeble, and her skin cold.