ADDISON'S DISEASE, an affection manifesting itself in an exaggeration of the normal pigment of the skin, asthenia, irri tability of the gastro-intestinal tract, and weakness and irregularity of the heart's action : these symptoms being due to loss of function of the suprarenal glands. It is important to note, however, that Addison's disease may occur without pigmentation, and pigmenta tion without Addison's disease. The condition was first recognized by Dr. Thomas Addison of Guy's Hospital, London, in 1855. But it remained for Schafer and Oliver of University college, London, to demonstrate that the suprarenal glands contain a very power ful extract which produces toxic effects when administered to animals, and that an active principle "adrenalin" can be separated, which excites contraction of the small blood vessels and thus raises blood pressure. The latest views of this disease thus stand : that it is entirely dependent on suprarenal disease, being the result of a diminution or absence of their internal secretion, or else of a perversion of their secretion; or (2) that it is of nervous origin, being the result of changes in or irritation of the large sympathetic plexuses in the abdomen; or else (3) that it is a combination of glandular inadequacy and sympathetic irritation.
The morbid anatomy shows (I) that in over 8o% of the cases the changes in the suprarenals are tuberculous, usually beginning in the medulla and resulting in caseation; and that this lesion is bilateral and usually secondary to tuberculous disease elsewhere, especially of the spinal column. In the remaining cases (2) simple atrophy has been noted, or (3) chronic interstitial inflammation leading to atrophy; and finally (4) an apparently normal condition of the glands, but the neighbouring sympathetic ganglia diseased or involved in a mass of fibrous tissue.
The onset of the disease is insidious and consists in a slow but increasing condition of weakness. There is a feeble and irregular action of the heart, resulting in attacks of syncope which may prove fatal. Blood pressure is low and anaemia may be great. From time to time there may be severe attacks of nausea, vomiting or diarrhoea. The best known, though a late, symptom is a grad ually increasing pigmentation of the skin, ranging from a bronzy yellow to brown or even occasionally black. This pigmentation shows itself (I) over exposed parts, as face and hands ; wher ever pigment appears normally, as in the axillae and round the nipples; (3) wherever pressure is applied, as round the waist; and (4) occasionally on mucous membranes, as in the mouth.
The patient's temperature is usually sub-normal. The disease is commoner in males than in females, and among the lower classes than the upper. But this latter fact may be due to poor nourish ment and bad hygienic conditions rendering the poorer classes more susceptible to tuberculosis.
The diagnosis is by no means easy. Pigmentation of the skin occurs in many conditions, but the presence of a low blood pres sure with weakness and irritability of the heart and some of the preceding symptoms render the diagnosis fairly certain. The latest researches on the subject tend to indicate a more certain diagnosis in the effect on the blood pressure of administering suprarenal extract, the blood pressure of the normal subject being unaffected thereby, that of the man suffering from suprarenal inadequacy being markedly raised. The disease is treated by promoting the general health in every possible way : by diet; by tonics, especially arsenic and strychnine; by attention to the hygienic conditions; and always by the administration of one of the many preparations of the suprarenal gland extract.