52 DISEASES OF THE KIDNEY. 



monic of the affection. At all events, no mention is made of them 

 in any of the negative reports of bronzed skin without disease of 

 the capsules. 



Its more serious symptoms consist in an extreme debility, often 

 combined with deep depression of spirits. In some instances this 

 debility increases from time to time into profound and long-con- 

 tinued swoons. Sometimes the adynamic symptoms are so promi- 

 nent as to remind one of a severe attack of typhus, or of some other 

 acute affection, with so-called typhoid symptoms. Mistakes for 

 typhus, however, may always be avoided if all the elements of the 

 case be attentively considered, especially if the temperature be ob- 

 served. If, however, the case has not been long under observation, 

 and if the discoloration of the surface be not very distinct, it may 

 be impossible to make a positive diagnosis. The great lassitude and 

 insurmountable sense of weakness, unattended by any apparent 

 cause of exhaustion, would seem to proceed from a disorder of in- 

 nervation. The richness of the suprarenal capsules in nervous ele- 

 ments, and the numerous communications existing between them 

 and the various nervous plexus, especially the solar plexus, rather 

 confirm such a supposition. 



Pain in the back, and still more frequently pain in the epigas- 

 trium, is a very frequent but not a constant symptom. In one of' 

 my cases the pain was so violent that the patient for weeks was 

 treated with poultices. In a second, severe pain in the epigastric 

 region was one of the most conspicuous symptoms, while in the 

 third the patient never complained of pain at all. 



Dyspepsia and vomiting are reported as occurring in nearly 

 every case ; yet even these symptoms are sometimes absent. The 

 vomiting of Addison's disease may be regarded as a so-called sym- 

 pathetic vomiting ; since, in disease of other organs adjacent to 

 the stomach, and even in such as contain fewer nerves than the 

 suprarenal capsules, and whose nervous connection with the stomach 

 is much less obvious, such sympathetic vomiting occurs. 



Diarrhoea has been observed in many cases. In two of my three 

 cases the dirrahoea was very obstinate. It would be easy to account 

 for this diarrhoea, could it be proved post mortem that the cceliac 

 ganglion always was diseased ; since, according to the experiments 

 of JBudge, all the rabbits whose cceliac ganglia he removed suffered 

 from diarrhoea. But independently of this, there is nothing sur- 

 prising in the occurrence of diarrhoea in disease of the suprarenal 

 capsules, these organs being richly endowed with nerves, and stand- 

 ing in intimate relation with the nervous plexus of the abdominal 



