4

remarkable fact that, notwithstanding the great debility, which is the earliest and most constant symptom of the disease, there is, in uncomplicated cases, comparatively little or no emaciation. The skin also is soft and cool; the tongue usually clean and moist until the last days of life; the bowels seldom disordered, though sometimes confined; and the urine generally normal. It should be observed that the constitutional symptoms of this malady have been somewhat masked, or at least overlooked, in cases in which the patient has been contemporaneously suffering from some other serious wasting disease, such as pthisis or lumbar abscess; though, even in such cases, the languor and prostration are for the most part out of all proportion to the severity of the more obvious complaint: a circumstance well illustrated by a case I shall presently quote, which was under the care of Mr. Hulke some time since in this hospital, and in which - partly no doubt on account of the complication with psoas abscess, partly also from the absence of discoloration of skin - the disease of the capsules was not suspected during life.

II. The external signs of Addison’s disease are found in the discoloration of skin, which, when present in a fully developed form, is, I need scarcely say, its most striking feature. It is true that in a recent case in this hospital, in which the discoloration was slight, I ventured to diagnose the disease from the constitutional symptoms, and that diagnosis, as you well know, was verified by the post-mortem examination; but, as a rule, the external signs have been the main ground on which this disease has been hitherto diagnosed. The discoloration of skin in Addison’s disease is very peculiar, and gives rise to patients in whom it is well marked the appearance of belonging to one of the darker races of mankind. Most frequently it is of a dusky or yellowish-brown, but sometimes rather of an olive or greenish-brown colour. The shade is not uniform on all parts of the body, but is generally darker on the face, neck, and hands and in the axillæ and groins. The penis and scrotum and the nipples and areolæ are usually the darkest parts of the natural skin, and the discoloration of these last may be regarded as one of the diagnostic external signs of Addison’s disease. If the patient have been blistered, or have sustained any other superficial abrasion of the skin, the injured surfaces are always darker than the surrounding parts, but the cicatrices of deeper injuries usually remain pale. Very often, also, small well-defined specks or patches of darker colour, resembling moles, are found upon the face, neck, arms or trunk; but so far as I have observed, they only appear

[PREVIOUS] [NEXT]