reliable mode of completing the diag nosis of such cases during the life of the patient.
Direct relation between diseases of the adrenals and bronzing of the skin de nied. Case where one suprarenal body was intact, the bronzing nevertheless ap pearing. Two cases in which extensive tuberculosis of both adrenals was present without a trace of dermal discoloration. Where there is discoloration there is ex tensive disease of the nerves and ganglia of the abdominal sympathetics. Lancer eaux (Arch. Gen. de Med., Jan., '90).
A similar view-. Nothnagel (Med.
Press and Circular, Jan. 12, 19, '90).
Discovery of a pigmented body, the size of the head of a large black pin, and presenting the complete histology of a suprarenal capsule in contact with the semilunar ganglion. Pilliet (Bull. de la Soc. Anat., No. 10, '91).
The true origin of the bronzing may still be said to be unknown, although several plausible theories have been ad vanced. In the cutis there are chroma tophorous cells, which, as is the case in the frog and chamelion, are under direct nervous control, and they yield an ex cess of pigment of the Malpighian layer under certain conditions of nervous dis order. Raymond (Lancet, July 2, '92).
Examination of the skin in one case. Coloring composed of pigmented clas matocytes, which, after penetrating by migration, fix themselves upon the sup porting elements of the derma. Ch. Audry (Le Midi Medical, July 29, '94).
Masses of medullary cells and even buds of the substance of the suprarenal capsules in the interior of veins, more frequently in the medullary than in the cortical substance found in man. The same peculiarities were noted in the horse, ox, pig, and sheep. The medullary tubes, the central portion of which is filled with brown, hyaline masses se creted by the double row of cells seen on their interior, project into the lumen of the veins, at this point deprived of their endothelia] covering. Conclusion that the brown, hyaline masses are secreted by the suprarenal capsules, and that they are carried into the circulatory stream after penetrating into the interior of the veins. P. Manasse (Revue des Sciences Med., July 15, '94).
The melanodermia of Addison's disease is to be observed whenever the periphery of the organ, the cortex, the nerve-fila ments, or the ganglia of the region are .involved. On the other hand, it is diffi cult to distinguish which phenomena are due to toxmmia. Bedford Fenwick,
Greenhow, Jtirgens, Kalindero, Babes (Brit. Med. Jour., Mar. 30, Apr. 6, '95).
Etiology. — Well-marked cases of me lasma suprarenale are of comparatively rare occurrence in this country. Of the cases on record, much the larger number were in persons between the ages of 20 and 40 years; and more than 60 per cent. were in the male sex. Greenhow collected 183 cases, of which 119 were males and 64 females. Belaieff has recorded one congenital case, the child living eight weeks after birth, the skin presenting a yellowish-gray color, and an autopsy showed the suprarenal capsules enlarged and filled with cysts. Another case has been reported in a child only 8 days old. Its skin was "mottled and yellowish brown." An autopsy revealed enlargement and congestion of the mid dle third of the right suprarenal capsule, and haemorrhage with caseous degenera tion in the left.
Records collected of 48 cases of Addi son's disease occurring during childhood. Youngest child was 7 days, eldest 14 'A years. The affection, almost invariably due to tuberculosis, is usually first mani fested by vague symptoms, such as weak ness, anemia, loss of weight, gastro intestinal symptoms, nausea, vomiting, and diarrhoea. Pain and pigmentation are quite uncommon in children. Con vulsions are usual, intermissions fre quently occur, and the disease pursues a more rapid course than in adults. Dezirot (Jour. de Med., Aug. 28, '98).
Addison's disease in a 3-year-old child. It was taken quite suddenly with diar rhoea, gastric disturbance, and prostra tion. At the end of three days asthenia was marked, and there were complaints of pain in the upper part of the abdomen and lumbar region. The vomiting, elevated temperature, and the character of the pulse pointed to a peritonitis. A slight pigmentation of the abdomen was all that suggested Addison's disease, but the previous history of the patient did not support such a diagnosis. At the autopsy an ancient tuberculosis of the suprarenal capsules was found. Pet'er's patches were swollen, but not ulcerated. The spleen, which was enlarged, fur nished a pure streptococcic culture. The case is interesting from what appears an acute Addison's disease, the more pro nounced symptoms of which developed coincidently with a general streptococcic infection. Netter and Nattan-Larrier (La Presse Med., May 2, 1900).