ADDISON'S DISEASE. 51 



secreting organs, and Addison's disease a result of over-production 

 of deleterious chemical matters in the blood (particularly tauro- 

 cholic acid), which partially dissolves the blood, thus causing the 

 anaemia, while a precipitation of the pigment of the blood occasions 

 the bronze color. In rarer cases, instead of this degeneration, we 

 have found carcinoma, extravasation of blood in the tissues of the 

 capsules, and sometimes simple atrophy ; hence it must be concluded 

 that the bronze color is not due to any special process. The imme- 

 diate cause of the brown skin is a deposit of pigment in the rete 

 Malpighii ; but pigment-cells are also to be found in the true skin, 

 and are to be distinguished from those in the rete Malpighii by their 

 containing iron. 



There are sometimes no lesions whatever of other important or- 

 gans ; but more frequently there will be found enlargement of the 

 spleen and of the intestinal follicles, cheesy degeneration of the mes- 

 enteric glands, and sometimes caries of the vertebrae.] 



SYMPTOMS AND COURSE. The darkening of the skin, whence the 

 malady derives one of its names, although it is by no means its most 

 important or most dangerous symptom, occurs gradually. If the 

 patient die before it has become very pronounced, it is apt to be 

 overlooked entirely. Such cases, however, do not disprove the con- 

 nection between disease of the suprarenal capsules and the deposit 

 of pigment in the rete Malpighii. It is only by degrees that the 

 discoloration of the linea alba and nipples in pregnancy acquires a 

 sufficient degree of intensity to become conspicuous, and indeed 

 there are many persons in whom it is never very marked even at 

 term ; and yet no one denies the existence of a connection between 

 pregnancy and such pigmentary deposit. 



In some instances the skin becomes so dark as to resemble that 

 of a mulatto or negro. One of my patients, a baker, from Heil- 



bronn, used to be generally known as " Black R ." The color 



sometimes is a pure gray, inclining to black, like plumbago. At 

 other times it has a brown or yellowish tinge. It generally com- 

 mences upon the exposed parts of the body, but, although more in- 

 tense upon those regions, is by no means confined to them, a cir- 

 cumstance which might save us from errors of diagnosis in dealing 

 with sailors, field laborers, and others whose hands and faces are 

 often of an exceedingly dark grayish-brown tinge. The roots of the 

 nails also remain white. The palms of the hands and soles of the 

 feet are spotted here and there, but are not uniformly discolored. 

 The sclerotica never participates in the discoloration, and its pearly 

 hue often forms a marked contrast with the dark color of the face. 

 Black spots upon the lips and mouth seem to me to be pathogno- 



