ADDISON S DISEASE 313 



ent of them. During the remissions, strength is in a 

 great degree recovered, appetite improved, sickness 

 abated; the discolouration becomes paler, and, above all, 

 the patient's whole aspect bespeaks that a heavy weight 

 has been lifted from his head. After each fresh exacerba- 

 tion, however, the patient remains upon a somewhat lower 

 level than during the previous remission. The recovery 

 of strength and the abatement of other symptoms is less 

 marked, and the skin, though paler than during the last 

 exacerbation is yet visibly darker than before it. Similar 

 alternations may occur several times before the onset of 

 the fatal paroxysm, but on each occasion the patient 

 takes at least one downward step that he never regains." 

 The duration of Addison's disease is dependent to a large 

 extent on the type of lesion present in the adrenals. The 

 expectancy of life in cases of adrenal atrophy is about three 

 times that of cases due to tuberculosis. 260 



It has been often noted that patients in whom the pigmen- 

 tation is an early symptom do better than those in whom the 

 pigmentation is not marked, or absent. Thus in the series of 

 566 cases analyzed by Guttman, 260 the average duration of the 

 disease was 43 months in patients in whom pigmentation was 

 the first symptom and asthenia developed subsequently. In 

 cases in which pigmentation and weakness developed simul- 

 taneously, the average duration of life was only 12 months, 

 while in the group of patients in whom weakness was the first 

 and predominant symptom and pigmentation of subsequent 

 onset, the average duration of the disease was only 8 months. 



PATHOLOGY 



In the earlier reports one finds cases described clinically as 

 Addison's disease which at autopsy failed to reveal lesions of 

 the adrenal glands. Thus in Lewin's 392 compilation of 639 

 cases, 12 per cent showed "normal" glands. It is most likely 

 that the clinical diagnosis in these cases was erroneous for the 



