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the symptoms and appearances he had observed in connection with one particular change, can be no matter of surprise, if we reflect that when he published his work, he had seen but five true cases of the disease which bears his name, and had had no opportunity of watching the cancerous cases during life, so as to ascertain, what much additional evidence renders patent to us, that some degree of very different discoloration of skin was all that they had in common with cases of the genuine disease.
Miscellaneous diseases of the supra-renal capsules.- In table C. are placed all the cases of reported disease of the supra-renal capsules, which are clearly neither cancer nor yet true Addison’s disease. These are but ten in number, and on reference to the Table it will be seen that only two (Nos. 35 and 39) presented any discoloration of skin, and that the very reverse of characteristic, whilst in a single case only (No. 38) did the symptoms at all resemble those of Addison’s disease, accompanied however by extreme pallor instead of by discoloration. I am, however, strongly of the opinion that in this latter case the capsules were really healthy - the appearances described in them strongly resemble those produced by post-mortem change - and the real cause of death was not discovered at the autopsy. I think it may fairly be inferred from the small number of cases I have been able to find referable to this Table and from the facts connected with them, that diseases of the supra-renal capsules which are neither cancerous nor yet true Addison’s disease are of very rare occurrence, and that none of the few recorded, which appear to be chiefly apoplexy, amyloid disease, or fatty degeneration, are found to be attended either by the constitutional symptoms or external signs of Addison’s disease.
Imperfectly described, or doubtful cases.- It was to be expected that among so large a number of cases, reported by observers of such various degrees of experience and with such different opportunities for observation, there would be some so imperfectly described, and others of so doubtful a character, as to render it impossible to determine their true places in such a classification as I have attempted. All such cases, twenty-four in number, I have thrown together in Table D. In several of these the characteristic nature either of the symptoms or of the discoloration of skin convinces me that they were really cases of Addison’s disease, and that the description of the morbid change in the supra-renal capsules alone was at fault; but I was, nevertheless, compelled to set them aside as unsatisfactory subjects for discussion and unsafe grounds on which to base any conclusions.
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