ADDISON S DISEASE 337 



lowered (Munzer). Dyspnea ensues on slight physical exertion. Edema is 

 almost never observed, even later. Arteriosclerosis is extremely rare; when 

 it is present, the rise in blood-pressure does not occur. 



The blood picture always shows changes. The count of erythrocytes 

 and the hemoglobin contents are almost always reduced, the leucocyte count 

 is mostly normal. Lymphocytosis was first observed by v. Neusser. In 

 the cases from the literature in which the leucocytic formula is given, espe- 

 cially in the cases of Bittorf and Munzer and in those described by myself, 

 lymphocytosis was always present. Hypereosinophilia is not constant. 

 Moreover the number of large mononuclear cells is often increased, and the 

 number of neutrophilic cells relatively and absolutely much diminished, some- 

 times to 40 per cent. Commonly there are found in additionsigns of a status 

 lymphaticus; swelling of the glands, the tonsils, the papillae at the base of the 

 tongue, etc. Also hyperplasia of the thymus was observed in some cases 

 (Weisel, Kahn, Hedinger). 



Of alterations of the metabolism should be mentioned especially the 

 falling off in weight. . In very rare cases only is observed corpulency lasting 

 until death (Bittorf). Investigations as to the fundamental exchange are 

 not known to me. The gastrointestinal disturbances may very well cause 

 the emaciation. The few investigations as to the protein metabolism are 

 too short as to time. Wolf and Thacher found the endogeneous uric-acid 

 elimination very low. In three cases of Addison's disease, Eppinger, Rudin- 

 ger, and / found very high tolerance for grape-sugar and absence of glycosuria 

 after injection of adrenalin. Also in a case of Pollack's there was no sugar 

 after 2 mg. adrenalin. Later O. Forges found pronounced hypoglycemia (up 

 to 0.033 P er cent.) while in other cachexias the blood-sugar picture lay nor- 

 mally high. The finding of Forges that was corroborated by Bernstein in 

 several cases, has therefore come to have a diagnostic value attached to it. 

 The body temperature is often reduced, but when the manifestations become 

 violent there may be found sudden increases in temperature, even to hyper- 

 pyretic values. 



The making use of the diet is, so far as there are no diarrheas, normal; 

 frequently there is indicanuria. In the later stages are found very frequently 

 disturbances of the genital function, deficiency or absence of menstruation, 

 in men diminution or loss of sexual power. 



The pigmentations that are so important from a diagnostic point of view 

 mostly begin on the uncovered parts of the body, or on parts where the 

 clothing presses, or on parts on which certain irritants, for instance plaster, 

 have exerted their action. Sites of especial predilection are the borders of 

 the lids, the areoke of the nipples, the linea alba, the genitalia, the anal folds, 

 the folds of the palm; otherwise the palms, the soles and the nail beds usually 

 remain free. In many cases too the hairs become darker. The pigmented 

 places are light brown to dark brown, and in many cases the entire body may 



