ADDISON'S DISEASE. 301 



the spinal column. It is possible that obstruction of the venous 

 and lymphatic trunks may produce the characteristic symptoms 

 in those cases where disease of the suprarenals is said to be absent. 

 Tuberculous peritonitis sometimes complicates Addison's disease, 

 and may in some instances spread direct from the capsules. A 

 part of the right suprarenal is in contact with the greater sac 

 and a part of the left with the lesser sac. Tuberculosis some- 

 times spreads directly, from the right capsule to that part of the 

 liver which is in direct contact with it. 



The small yellow fatty collections which normally occur in the 

 cortex of the suprarenal bodies must not be mistaken for tubercles. 



The cutaneous pigmentation of Addison's disease is due to 

 infiltration of the cells in the Malpighian layer. In the mucous 

 membranes the pigment is said to be more superficial. Those 

 mucous membranes which from their position are subject to 

 friction or irritation may be the site of the pigmentary deposits. 

 A bluish stain may be seen where the margins of the lips come 

 into contact. Brown smears occur on the inner sides of the 

 cheek and lips where these touch the teeth. The sides and tips 

 of the tongue may be pigmented for the same reason. Pigmen- 

 tation may sometimes occur in the mucous membrane of the vulva 

 and vagina. Pigmentation of the skin occurs chiefly in exposed 

 parts, such as the face and backs of the hands. It is also evident in 

 parts which are naturally pigmented and those which are exposed 

 to friction, pressure or irritation. The natural pigmentation of 

 the anterior axillary folds, areolse of the nipples, lower part of 

 the abdomen, groins, penis, scrotum and perineum may be 

 exaggerated. The friction of yokes, waistbands, garters and 

 corsets may determine deposits of pigment, and the same may 

 be seen in parts which have been irritated by blisters. Scars 

 as a rule escape. 



Accessory suprarenal bodies of small size are not uncommon. 

 Occasionally they are found embedded in the cortex of the kidney. 

 They have also been recognised in the broad ligaments and 

 spermatic cord, having been carried down from the neighbourhood 

 of the Wolfnan body by the descent of the ovary or testis. 



