ADDISON'S DISEASE.
Definition. — A disease characterized by progressive asthenia, blood-impover ishment, frequent disorder of the gastric and intestinal functions, cardiac weak ness, and irregular pigmentation of the surface in the form of bronze-colored spots, and, when not interfered with, uniformly tending toward a fatal result. It was first investigated and described as a distinct form of disease under the name of "Bronzed Skin Disease" by Dr. Thomas Addison, of London, in 1855. Since that time it has very generally been called "Addison's disease," and as sociated with disease of the suprarenal capsules.
Symptoms. — Perhaps the earliest symptoms to attract attention in this disease are those of asthenia, or lack of energy and endurance, with a variable condition of the digestive organs, and slight anemic appearance. of the surface. As the disease progresses the asthenia is manifested by shortness of breath, hur ried and irregular action of the heart, and great sense of weariness from very moderate exercise. Sometimes there are present vertigo, tinnitus aurium, and syncope. The appetite is variable, but generally impaired, with occasional at tacks of pain in the epigastrium and left side of the chest, increased by attempts to exercise. Moderate constipation exists in most cases, but is interrupted by in creasingly frequent attacks of diarrhoea, and sometimes vomiting.
The foregoing symptoms are so much like those of pernicious anemia that Addison's disease might not be suspected until the characteristic pigmentation be comes noticeable on some part of the surface. In most cases the pigmented, or dark-brown, spots appear first on the face and backs of the hands, varying much in size and in color. The latter is generally at first a light-brown or olive hue, but grows darker and the spots larger as the disease progresses. Spots also appear around the nipple, in the axilla, on the genital organs, and where ever the surface is exposed to much fric tion from the clothing, and in some cases they spread until they occupy nearly the whole cutaneous surface, imparting to the patient much the same color as the mulatto or half-bred negro. (See colored Plate I.)
The palms of the hands and soles of the feet generally remain white. Brown or pigmented spots in many cases appear on the tongue and other parts of the mouth and in the vagina. Spots have been described on the serous membranes in a very few cases. (See colored Plate II.) In a majority of cases the patients have complained of asthenia for a con siderable time prior to the appearance of noticeable pigmentation on the sur face. In a few instances the bronzed spots have been the first symptoms to attract attention. Cases in which bronz ing does not accompany the other symp toms are not infrequent.
Case of subacute suprarenal cachexia without pigmentation. The patient had shown only two symptoms: (1) an un interrupted rise of temperature during a month and a half, and (2) a progressive cachexia marked by loss of flesh and in ability to undergo any muscular strain. Death followed about two months after the beginning of the affection. On post mortem examination only the adrenals were found diseased; they showed a caseous suppurative degeneration of tubercular origin. The mucous mem branes did not show the smallest sign of pigmentation. R. Marie (La Presse Medicale, July 24, '95).
Cases in which there existed patholog ical changes in the adrenals without the existence of pigmentary deposits in the skin or mucous membranes: Lejars (Bull. de la Soc. Anat.. Mar.) ; Perry i (Brit. Med. Jour., June 7) ; Pilliet (Bull. de la Soc. Anat., No. 26) : Bradshaw (Liverpool Medico-Chirurgical Journal, July); Davidson (Liverpool Medico-Chi. Jour., Jan.); Blackburn (Jour. Amer. Med. Assoc., Mar. 31, '88). Cases of marked involvement of adrenals failing in the symptoms or bronzing: Virchow (Berliner klin. Woeh., Apr. 29); La marque (Jour. de Med. de Bourdeaux, May 5); West (Brit. Med. Jour., Nov. 9); Perry (Brit. Med. Jour., Oct. 21); Griffiths (Brit. Med. Jour., Feb. 2, '89). Girode (Bull. de la Soc. Anat., Apr.) ; Barth (London Medical Recorder, May 20) ; Counsel' (Lancet, May 3) ; Vaughan (Brit. Med. Jour., Nov. 15) ; Cagliati (Eiforma Medica, No. 6); Jacquemard (La Loire Medicale, Aug. 15) ; Ritchie (Edinburgh Med. Jour., July, '90), and others.