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to the consideration of the true cases of Addison’s disease. They are comprised in the four tables, A, B, C, and D.
Bronzed skin without disease of the supra-renal capsules.- Table A. comprises ten cases in which there was bronzing of skin during life, but in which the supra-renal capsules were found to be healthy after death. One only of these (No. 5) presented any resemblance to the train of constitutional symptoms characteristic of Addison’s disease. It is remarkable in this case that the post-mortem appearances in other organs afford no sufficient explanation of the cause of death, and, moveover, the defective description leaves the real chracter of the discoloration of skin doubtful, so that no legitimate deduction can be drawn from the case as it stands. Of the other nine cases it may suffice to say, what a reference to the Table will shew, that not one presented the constitutional symptoms, without which the discoloration is of small value in diagnosis, and that the discoloration itself appears in no case to have presented the really characteristic features, whilst in several of the cases it was of a totally different character, and in some appears to have arisen from deposits of bile in the skin or from syphilitic eruptions. In one case, the discoloration obviously arose from uncleanliness and vermin, and strikingly resembled that seen in a living case exhibited by myself to the Pathological Society and recorded in the Transactions (Vol. xv., p. 226). The discoloration in this latter case was so deep and extensive that it might readily have been mistaken at first sight for that of Addison’s disease; but, from the absence of almost all of the constitutional symptoms, and of all the characteristic features of the discoloration, I was able at once to pronounce with certainty as to the case not being a true example of that disease, and, in fact, after a few months, the patient recovered almost entirely from her illness and her skin became much paler. The above being all the cases I have been able to find of bronzed-skin without disease of the supra-renal capsules, in which the discoloration was sufficiently analogous to that characteristic of Addison’s disease to have been quoted with reference to it, I think I am justified in concluding that such cases are extremely rare, and that, when they do occur, a careful investigation of their history and symptoms, and a close examination of the discoloration itself, would enable any physician, conversant with Addison’s disease, at once to discriminate such spurious cases from genuine cases of that disease.
Cancerous disease of the supra-renal capsules.- Table B. includes twenty-four cases reported as cancer of the supra-renal capsules; but,
E