THE ADRENAL BODIES 129 



2. Symptoms 



1. Pigmentation. The pigmentation is very variable both 

 as to its period of onset and as to its intensity. Usually it 

 first occurs at a later period of the disease than the general 

 symptoms, such as the muscular prostration. It sometimes 

 occurs only shortly before death, and in some cases it never 

 occurs at all. Occasionally, however, the pigmentation has 

 been stated to precede the general symptoms. 



As for the degree or intensity of pigmentation, it may vary 

 from the dark hue of the negro to a faint sunburn brown. It 

 is very interesting to note that the pigmentation is an exaggera- 

 tion of the normal, and occurs most markedly in those parts 

 which are normally pigmented, such as the dorsal surface of 

 the forearm, the axillary folds, the areola around the nipples, 

 the genitals, and the groins. The pigmented regions have 

 no sharp margins. Friction or pressure induces especially the 

 increased pigmentation ; thus we find dark patches or streaks 

 brought about by corset, belt, garters, braces, or collar-stud. 



Pigmentation is usually first noticed on the face, neck, and 

 backs of the hands and fingers, especially over the joints. The 

 lips may sometimes become pigmented and the tongue occa- 

 sionally presents stains near the free border. There are also 

 to be seen in some cases small, well-defined specks, like small 

 moles, but occasionally of inky blackness. Pigmentation of 

 the peritoneum and pia mater has been recorded. The hair 

 may become darker, but the skin of the hairy scalp and other 

 regions covered by hair does not appreciably change in colour. 

 The linea alba may become a dark line. Rolleston says that 

 the palms of the hands and the soles of the feet are very rarely 

 pigmented, but he has twice seen pigmentation of the palms 

 with intensification along the various lines. 



Microscopically the pigment is found in the cells of the stratum 

 Malpighii, and the dermis shows a few pigmented. cells 

 "carrier cells " which, it is thought, convey the pigment 

 from the bloodvessels of the dermis to the stratum Malpighii. 



The pigment is iron-free. In some few cases a combination 

 of Addison's disease with hsemochromatosis has been reported. 

 Pigmentation occurs in about 75 per cent, of all cases. 



2. Asthenia. Many authors regard the asthenia or muscu- 

 lar weakness as the most constant and the most significant of 



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