Case of Addison's disease without pig mentation. At the necropsy each suprar enal body was found to be enlarged and adherent to the surrounding parts, and thickly studded with tubercles of the size of peas, some of which had softened in their centres and contained pus. There was no apparent implication of the solar plexus. J. B. Bradbury (Lancet, Oct. 3, '96).
Addison's disease with phthisis pul monalis and a typical pigmentation of the skin, consisting of melanoderma with symmetrical patches of leucoderma. C. 0. Hawthorne (Glasgow Med. Jour., Oct., '96).
In addition to marked disturbance of the functions of the respiratory, cardiac, and splanchnic nerve, as indicated by shortness of breath, irregular action of the heart, and frequent gastric disturb ances, a few cases have been recorded in which delirium, coma, or epileptoid con vulsions occurred near the fatal termina tion. Von Jaksch has attributed these symptoms to acetonuria.
Case of Addison's disease in a man, aged 57, who suffered for months from violent attacks of delirium, convulsions, and eventually coma and death. The urine was always free from albumin. Later attacks were followed by coma, and, though treated with bleeding and injection of (artificial) serum, he died. The necropsy showed (edema of the cere brat meninges, pericellular and perivas cular increase of leucocytes in the brain cortex, globules of myelin in the white substance, and disseminated sparse nerve degeneration in the posterior and lateral spinal-cord columns. A toxic agent re sulting from the Addison's disease looked upon as the cause of the encephalopathy. Klippel (Soc. de Neurol. de Paris, Dec. 7, '99).
Case in a man of 40 in which peri tonitis-like symptoms attended the final stage of addison's disease. The abdo men was flat and palpation was painful in the epigastrium, but it was tympanitic everywhere. He vomited frequently. The diagnosis had been in great doubt, but a malignant tumor along the gastro intestinal tract was suspected. Post mortem examination showed caseation of both suprarenal glands, with swelling of the lymph-glands and brown atrophy of the heart. No other changes of much importance were found. Some small, brownish spots were found on the left temple, on the under lip, and a few on the upper lip. There was no tuberculosis anywhere, excepting in the suprarenal gland. A diagnosis of Addison's disease
is justified with this peculiar peritonitis like symptom-complex if the conditions cannot otherwise be explained, even though all other symptoms of Addison's disease are absent. Zeudy (Zeit. f. klin. Med., B. 33, H. 4, 5, 6, 1900).
The temperature during the whole progress of the disease seldom rises above the natural, and in the advanced stage is often decidedly below. Roux men tions a ease in which the temperature was only 32.5° C. (90.5° F.) four hours before death. Again, in the advanced stage of many cases the hands and feet are uncomfortably cold, and the asthenia so profound that the patient cannot maintain the erect position without ver tigo, cardiac palpitation, or syncope. The disease usually runs its course and terminates in death in from one to three years. A few cases are on record that terminated in six months, and, per haps, a larger number that were pro tracted to eight and ten years. Those of longer duration have generally been characterized by repeated periods dur ing which they remained stationary for several months at a time.
[One such well-marked case came under my own observation. The patient, aged about 35 years, had been exposed to much hard service and confined air on board of one of the naval monitors in active service during the war, between 1861 and 1864. Some symptoms of the disease were manifested as early as in 1865, but they made slow progress, and appeared to have several periods of re maining stationary, and did not termi nate fatally until 1875: a period of ten years. During the last year he had been unable to walk more than a few steps without feelings of extreme exhaustion, and the final collapse resulted from pro tracted diarrhoea and vomiting. Large bronzed spots were on his forehead, temples, backs of his hands, and still more over the front part of his chest and abdomen. Like most eases of this dis ease, his emaciation was not extreme, though the hannoglobin was notably diminished. ti. S. Davis.] Addison's disease may terminate in sudden death. Case in which the patient was supposed to be suffering from ma larial cachexia and died in syncope. Autopsy revealed the true nature of the disease, Letulle (Bull. de la Soc. Anat., No. 6, '94).