146 ENDOCRINE GLANDS 



bringing it out when it is not very definite, by an arti- 

 ficial irritation of the skin, such as, a plaster or cupping. 



The character of Addison's disease pigmentation is very 

 peculiar. It is made up of brownish spots. They may 

 be uniform in color or contain darker pin head spots. 

 The skin in the neighborhood is dry and parchment like. 



At first the pigmentation may be very discreet, but 

 as the disease progresses, it becomes more generalized and 

 the skin takes on a darker and darker appearance, more 

 marked in the regions first affected. In some places loss 

 of pigment occurs, giving whitish spots resembling viti- 

 ligo. The pigmentation may involve the hairs, which 

 may change from blonde to black; the nails take on a 

 yellowish tint. The mucous membranes are nearly always 

 involved. On the buccal mucous membrane are seen 

 bluish like spots, as those sometimes seen in certain races 

 of dogs. This pigmentation may affect the lips, the gums, 

 even the conjunctiva. 



EVOLUTION. 



Addison's disease has a progressive evolution. The 

 patient becomes anemic early, the muscles atrophy 

 rapidly and this amyatrophism at the beginning, contrasts 

 with the conservation of the adipose tissue. Then these 

 patients become cachectic. They are extremely sensitive 

 to cold and their temperature is often subnormal. 



Sometimes, under the influence of organo therapy, the 

 evolution is interrupted by long periods of remission, then 

 the disease goes on so that the duration of the disease 

 rarely extends over a few years. Certain rare cases only 

 last a few months. The patient dies of cachexia, with 

 symptoms of cardiac collapse preceded by diarrhea. 



Addison's disease can also terminate suddenly. This 

 is usually brought about by excessive fatigue, an opera- 



