296 BENSON A. COHOE 



in this condition seem to be increasing in frequency in the literature. The 

 hypotension had heen commented upon by clinicians for many years be- 

 fore the first sphygmomanometer readings were made by Turner (1899). 

 In a small series of blood-pressure readings, collected from hospital rec- 

 ords by the writer, the average systolic pressure was found to be 105 mm , 

 and the diastolic T5 mm . Janeway has reported a systolic pressure of 

 140 mm , and Wolf and Thacher of 142-128 mm . All of these figures prob- 

 ably represent the maximum, rather than the average, for in the great 

 majority of cases, the pressure is known to fall much below these -read- 

 ings, especially in the advanced disease, where a systolic pressure of 60- 

 80 mm is commonly observed. In one case observed by the writer the 

 systolic pressure fell to 45 mm in the late stages. Other observers have 

 reported a systolic pressure as low as 30 mm . 



The temperature is almost always found subnormal. A hypothermia 

 is the rule in the early stages of the disease, but in advanced cases, es- 

 pecially in the presence of complications (tuberculosis), the disease may 

 run a febrile course. Hyperpyrexia at times occurs. 



The skin usually shows no important characteristic changes, apart from 

 the melanoderma. As a rule, it is soft and elastic, in contrast to the dry 

 and shrivelled skin of other chronic wasting diseases. Excessive sweating 

 sometimes occurs. A disagreeable fish-like odor of the skin has been 

 described (Neusser), and also (with extreme emaciation) a cadaveric 

 odor (Rolleston). 



The symptoms referable to the genitalia consist mainly in amenorrhea 

 and menstrual disorders in women and impotence in men. Falta(c) has 

 observed that atrophy of the gonads is almost always present. Not infre- 

 quently the genitalia may become invaded by the general tuberculous or 

 carcinomatous process. In women carcinoma of the uterus and ovaries, 

 and in men tuberculosis of the epididymis are commonly observed. 



There are frequent variations from the type of the disease, arising 

 from the absence, or the preponderance, of one or more of the cardinal 

 symptoms, or from the presence of a predominant complication. Such 

 atypical cases (formes frust.es) may render the diagnosis a matter of much 

 difficulty. The asthenia is rarely absent, but cases, quite frequently, 

 run their course with a complete absence of the melanoderma. In other 

 instances the gastrointestinal disturbances are wanting. Again, the se- 

 quence of the symptoms may show an unusually wide variation, and one 

 or more of the cardinal symptoms may become only imperfectly developed, 

 or appear late in the disease. The frequently occurring complications 

 (tuberculosis, carcinoma), when of a severe grade, may cause a marked 

 deviation from the type, and, at times, almost mask the Addisonian syn- 

 drome. The milder forms of tuberculous foci, commonly localized else- 

 where in the body, do not, ordinarily, modify greatly the cardinal symp- 

 toms, but the more severe lesions (pulmonary, intestinal, peritoneal, men- 



