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cases, including three of those recorded by myself, and it has been considered by some to be identical with the peculiar exhalation from the Negro-skin. As far, however, as my own observation goes, the fetid odour in these cases partakes rather of the cadaverous character, and may possibly be the result of commencing decomposition during the very slow death common in this disease. None of the three patients whom I watched survived its appearance many days. Death for the most part takes place slowly from gradual sinking, and in only eleven cases is it reported to have been at all sudden.
Influence of sex, age, and occupation, on the occurrence of Addison’s disease.- Males appear to suffer much more frequently than females from Addison’s disease; ninety-two of the true cases having belonged to the former, and only thirty-six to the latter sex. The disease seems not to occur in childhood, the earliest age at death having been eleven years in a boy (No. 105) and thirteen in a girl (No. 156), one of my own cases; and it appears to be equally rare in advanced life, only seven males and four females having died above the age of fifty, and of these only two males and one female were beyond the age of sixty years. But whilst among males the mortality is pretty evenly distributed over the hard-working years of life, among females the greater proportion of deaths takes place between the ages of fifteen and twenty-five, and, again, between those of thirty-five and fifty. The occurrence of Addison’s disease seems to be in a great measure limited to the classes engaged in active manual labour; only eight males and three females, so far as can be gathered from the reports, having belonged to the middle or higher classes of society. The facts thus brought out are, the almost exclusive occurrence of this disease among the classes most liable to local injuries from accidents or over-exertion; its much greater comparative prevalence among persons of that sex which is most exposed to these causes of injury; and the pretty equal distribution of the mortality caused by it over the active period of life, to which it is almost entirely confined. These facts appear, at least in some measure, confirmatory of the opinion I have already expressed, based on the history of individual cases, that the origin of Addison’s disease of the supra-renal capsules is due, in a hitherto quite unsuspected degree, to the extension of inflammation to those organs from diseased or injured parts in persons of a tubercular diathesis.