THE PATHOGENESIS OP BRONZING; ADDISON'S DISEASE. /9 



review of each of these will prove interesting. In a case cred- 

 ited to Mattei 2 the skin of the face, neck, forearms, and hands 

 was bronze-like, while marked muscular debility was com- 

 plained of. The accompanying broncho-pulmonary congestion 

 with emphysema and valvular disorder did not account for the 

 bronzing. At the autopsy both adrenals were found hsemor- 

 rhagic. In Carrington's 3 case the bronzing was especially 

 marked over the mammary glands, the penis, and scrotum, and 

 the patient died of progressive asthenia. Both lungs were 

 found oedematous and dark, and both adrenals diseased and 

 probably cancerous. In Murray's 4 case the skin was described 

 as brown; there was dyspnoea, cough, and asthenia, but the 

 patient's illness only lasted four days. Both capsules were 

 hasmorrhagic. Less clearly defined is a case reported by 

 Northrup, 5 in which an "abnormal color" was associated with 

 haemorrhage into both capsules. In Leconte's case the dis- 

 coloration is termed "swarthy," with large sepia-like spots, 

 discovered after death. The case was one of pulmonary tuber- 

 culosis, but unusually cachectic. No tubercular foci were 

 found in the adrenals; one of these was atrophied and the 

 other was studded with hgemorrhagic puncta the size of a millet- 

 seed. In Eayner's 6 case a "marked olive hue" is referred to, 

 the patient suffering from bilateral bronchitis and pain in the 

 lumbar region. Death occurred suddenly and both adrenals 

 were found haemorrhagic. The interesting feature of these six 

 cases is that they are all associated with organic lesions of 

 both adrenals, while all cases (excepting two in which the dis- 

 coloration is obviously ascribable to other disorders) with only 

 one organ diseased show no discoloration. This does not mean, 

 however, that bilateral organic lesions always cause bronzing, 

 inasmuch as there were twenty-seven of such cases in which no 

 discoloration appeared, but it emphasizes the fact that, when 

 bronzing occurs, both adrenals are diseased or functionally insuffi- 

 cient. 



2 Mattel: Lo Sperimentale, p. 386, Case III, 1883. 



3 Carrington: Transactions of the Pathological Society of London, 1885. 



* Murray: Transactions of the Pathological Society of London, vol. xxi, p. 

 396, 1870. 



s Northrup: Proceedings of the New York Pathological Society, p. 161, 1889. 

 8 Rayner: Cited by Roger in 1'Experience, May 10, 1837. 



