addison's disease 301 



CLINICAL COURSE 



The onset of the disease and the development of the cardi- 

 nal symptoms — asthenia, gastro-intestinal disturbances, and 

 pigmentation — are extremely insiduous in their development. 

 The patient begins to tire readily on slight exertion and be- 

 comes incapable of physical or mental effort. His complexion 

 gradually becomes darker. Gastric symptoms with loss of 

 appetite, nausea, and constipation alternating with diarrhea 

 occur with increasing frequency. 



The clinical course of the disease has been aptly described 

 by Addison 7 as follows: 



"The patient, in most of the cases I have seen, has been 

 observed gradually to fall off in general health; he be- 

 comes languid and weak, indisposed to either bodily or 

 mental exertion; the appetite is impaired or entirely lost; 

 the whites of the eyes become pearly; the pulse small and 

 feeble, or perhaps somewhat large, but excessively soft 

 and compressible ; the body wastes without, however, pre- 

 senting the dry and shrivelled skin and extreme emacia- 

 tion usually attendant on protracted malignant disease; 

 slight pain or uneasiness is from time to time referred to 

 the region of the stomach, and there is occasional actual 

 vomiting, which in one instance was both urgent and dis- 

 tressing; and it is by no means uncommon for the patient 

 to manifest indications of disturbed cerebral circulation." 

 . . . "We discover a most remarkable and, so far as I know, 

 characteristic discoloration taking place in the skin — suf- 

 ficiently marked, indeed, as generally to have attracted 

 the attention of the patient himself, or of the patient's 

 friends." 



"The disease develops in the third or fourth decade of 

 life, usually quite insidiously, with adynamia and apathy. 

 To these are added disturbances of the digestive tract 

 (constipation, often alternating with diarrhea), and pig- 



