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in detecting many cases, which, in the present state of our knowledge, may be entirely overlooked or misunderstood; and, I think, I may with confidence affirm, that although partial disease of the capsules may give rise to symptoms, and to a condition of the general system, extremely equivocal and inconclusive, yet that a more extensive lesion will be found to produce a state, which may not only create a suspicion, but be pronounced with some confidence to arise from the lesion in question. When the lesion is acute and rapid, I believe the anæmia, prostration, and peculiar condition of the skin will present a corresponding character, and that whether acute or chronic, provided the lesion involve the entire structure of both organs, death will inevitably be the consequence.
If this statement is correct, and I quite believe it to be so, the chief difficulty that remains to be surmounted by further experience in this, I fear, irremediable disease, is a correct and certain diagnosis;- how we may at the earliest possible period detect the existence of this form of anæmia, and how it is to be distinguished from other forms of anæmic disorder. As I have already observed, the great distinctive mark of this form of anæmia is the singular dingy or dark discoloration of the skin; nevertheless at a very early period of the disorder, and when the capsules are less extensively diseased, the discoloration may, doubtless, be so slight and equivocal as to render the source of the anæmic condition uncertain. Our doubts, in such cases, will have reference chiefly to the sallow anæmic conditions resulting from miasmatic poisoning or malignant visceral disease; but a searching inquiry into the history of the case, and a careful examination of the several parts or organs usually involved in anæmic disease, will furnish a considerable amount of at least negative evidence; and when we fail to discover any of the other well-known sources of that condition, when the attendant symptoms resemble those enumerated as accompanying disease of the capsules, and when to all of this is superadded a dark, dingy or smoky-looking discoloration of the integument, we shall be justified at least in entertaining a strong suspicion in some instances,- a suspicion almost amounting to certainty in others. It must, however,