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only from the time when it disables them from work; whereas Addison’s disease, being essentially a chronic complaint, is often so insidious in its advances, that patients are able to continue their ordinary occupations until some external depressing cause upsets the tottering balance, and they break down altogether only a few weeks, or even days, before death.
It has been supposed that a very considerable length of time is necessary for the development of the discoloration of skin, but the evidence I have collected does not confirm that assumption, although, for the reasons I have stated, it has not sufficient weight to negative it. The characteristic discoloration as well as the constitutional symptoms existed in thirteen cases, in which the illness is stated not to have lasted above four months. On the other hand, the discoloration was absent in two cases (Nos. 102, 148) in which the illness had lasted more than six and twelve months respectively. It is, however, undeniable that the discoloration seems to have been most intense and universal in very slow chronic cases which have been under observation for periods of from one to seven years. The progress of the disease is by no means always that of a steady advance. There have been remarkable remissions in some of the best-marked cases, during which the patient has been able temporarily to resume his ordinary occupations, and these have even occurred two or three times in the same case, and yet the patient has eventually died of the disease. Speaking from my own observation of several cases which I have carefully watched for considerable periods of time, the discoloration has seemed to me to become less deep during the intervals of improvement, but I have never seen it disappear after it had once been distinctly marked. Notwithstanding the extreme debility, breathlessness on exertion, feeble pulse and general exhaustion, neither emaciation nor anæmia, properly speaking, exists in simple cases of Addison’s disease. The blood in all the post-mortem examinations I have witnessed was dark-coloured and rather thick, and the muscles generally firm, well-nourished, and of a deep-red colour. Emaciation is, indeed, sometimes mentioned as existing during life, but, unless there was also wasting disease, such as phthisis or lumbar abscess, the post-mortem reports do not confirm this statement; on the contrary, in many cases, a large amount of yellow fat has been found under the integument, especially of the abdomen, and also in the omentum and around the heart and other organs.
The existence of an unpleasant odour about the person in the last stage of Addison’s disease has been observed in a certain number of