148 ENDOCRINE GLANDS 



hand or the mucosa. The symptoms of Addison's disease 

 are attenuated. These patients are more anemic, weaker 

 and have a lower blood pressure than the ordinary cases 

 of tuberculosis. In other words, they have the mild type 

 of Addison's disease which has been described by Lafitte 

 Moncany and Bonnet under the name of Addisonism. 



DIAGNOSIS. 



The diagnosis of Addison's disease is made by the pig- 

 mentation. 



However, pigmentation of the skin or mucosa occurs in 

 a series of affections, foreign to a pathology of the adrenals, 

 but there are certain characteristics which allow us to 

 differentiate it from Addison's disease: 



1. In malaria the pigmentation is uniform, the color is 

 dirty gray and does not involve the mucosa. 



2. In pigmentary cirrhosis, the pigmentation has a 

 slate-like color, resembling mercury ointment. 



3. In arsenical intoxication (professional or medicated) 

 the pigmentation resembles very much the pigmentation 

 of Addison's disease. It is generalized but predominant on 

 the trunk and the roots of the limbs ; it does not involve the 

 uncovered extremities, the genital organs or the mucosa. 



4. In pityriasis, the pigmentation is more often on the 

 back of the neck, on the shoulders, at the level of the belt 

 and of the limbs. The skin is marked with liniary excori- 

 ations due to scratching and white lines,which are scars. 



Pityriasis of tramps sometimes causes a pigmentation 

 of the mucosa (Thibierge). The diagnosis may be in 

 doubt for several days, for these individuals may be so 

 tired that they appear asthenic. It, however, clears up 

 very rapidly with rest. 



5. In syphilis the pigmentation which is sometimes 

 found, at first starts in the region of the neck, then spreads 



