52
These four Tables comprise, as I have said, the sixty-eight cases which, upon a careful analysis of the whole number collected, I was obliged to exclude from the category of genuine and reliable cases of Addison’s disease.
ADDISON’S DISEASE OF THE SUPRA-RENAL CAPSULES.- I now proceed to the consideration of the one hundred and twenty-eight cases in which there appears to be no doubt, from the description of the condition of the supra-renal capsules, that those organs had undergone the peculiar morbid change characteristic of Addison’s disease, and in almost all of which the characteristic constitutional symptoms and external signs were also more or less fully developed. In a very considerable number of these cases the disease in the supra-renal capsules is said to have been entirely, or almost entirely, uncomplicated, and in a few cases undoubtedly of genuine character, the other organs had not been examined. In a large majority of the remaining cases, the disease in the capsules was found to be complicated only with tubercle in the lungs or other organs, in a considerable number with vertebral or lumbar disease, frequently associated also with tubercle, and, in a small residue of cases, with non-tubercular diseases of a serious nature. These circumstances have afforded data for corresponding subdivisions of the genuine cases, each of which I have formed into a separate Table.
Uncomplicated cases.- Table E. comprising twenty-four cases in which the only disease found on post-mortem examination was that of the supra-renal capsules, the other organs being reported all healthy. In twenty of these cases the constitutional symptoms and discoloration of skin characteristic of Addison’s disease coexisted in a well-marked form; in one case (No. 72) the constitutional symptoms were well-marked, but there was no discoloration, and in three cases (Nos. 70, 86, 91,) there were some of the constitutional symptoms and more or less discoloration of skin, but neither apparently fully developed.
Almost uncomplicated cases.- Table F. contains seventeen cases in which the lesions found in other organs were of a trifling nature. In four the mucous membrane of the stomach was congested or otherwise altered, in seven the glands of the small intestine were enlarged and prominent, and in six the mesenteric glands were enlarged, or contained cheesy deposits. In eleven of these cases the constitutional symptoms and the characteristic discoloration of skin coexisted, in three cases (Nos. 96, 98, 101,) the constitutional symptoms existed together with more or less discoloration of skin, and in one case (no.