THE SYMPATHETIC SYSTEM 147 



tion, chloroform anesthesia, or even a slight infection. 

 The glandular deficiency is such that the glands cannot 

 neutralize the slightest excess of toxins circulating in the 

 organism. Death occurs in a few hours or a few days. 



Sudden death is always possible at any time during 

 Addison's disease. 



CLINICAL FORMS. 



Many writers describe as abortive cases of Addison's 

 disease some characterized by an absence of melanodermia. 

 These cases studied by Dieulafoy and Bressy really 

 belong to simple adrenal insufficiency and for this reason 

 should not be included under Addison's disease. They 

 refer to cases having active or latent tuberculous lesions 

 of the adrenals, who, due to some slight accident, die 

 suddenly or give the appearance of acute poisoning 

 or peritonitis. 



In certain cases, such as, the gastro intestinal, painful 

 or asthenic type, the melanodermia develops late in the 

 disease. Inversely, there is a melanodermic form charac- 

 terized by the fact that the pigmentation is the first to 

 appear. 



The symptoms of adrenal insufficiency, particularly 

 asthenia, only appear secondarily and for quite a while 

 are only very mild. These cases usually have minor 

 lesions, nearly always limited to the peripheral layers of 

 the adrenals. Addison's disease can be associated with 

 other glandular lesions, in particular, to thyroid syn- 

 dromes: Basedow's disease or myxedema. 



In some cases of tuberculosis a slight pigmentation is 

 sometimes observed. It is made up of small disseminate 

 spots, light brown in color, located on the lateral part of 

 the neck around the nipples and in the region of the del- 

 toids. The pigmentation does not invade the face, the 



