130 THE DUCTLESS GLANDS 



all the symptoms of Addison's disease. The patient suffers 

 from an almost complete indisposition for any exertion. He 

 is very easily tired, and is never able to get properly rested. 

 There is no corresponding emaciation or neuritis. 



Asthenia is almost always the earliest sign of the disease. 

 Long before one notices any change in the skin the patient 

 complains of extreme lassitude. He can perhaps make a 

 short series of movements with some energy, but he is almost 

 immediately fatigued. Langlois lays great stress on this feature, 

 and recommends the use of Mosso's ergograph as an instrument 

 of diagnosis. He states that what characterizes the patient 

 with Addison's disease is not so much the loss of ability to 

 perform a single muscular feat, as a more or less complete 

 disappearance of resistance to fatigue. If one submits under 

 the same conditions a patient with Addison's disease, and 

 another patient in a comparable condition (both, for example, 

 tubercular to the same extent), to the ergographic test, we 

 find that the fatigue curve is quite different in the two cases. 

 We find that the simple tubercular patient can carry out a 

 sustained labour (lift a weight of 1 kilogramme every two 

 seconds) for a certain time ; but the patient with Addison's 

 disease, who at first will lift the same weight to the same height, 

 soon becomes exhausted ; his curve shows a rapid fall. 



3. Other Symptoms. The majority of authors report that in 

 Addison's disease the blood-pressure is remarkably low. The 

 heart is feeble in action ; there is a small, soft, almost impercept- 

 ible pulse. From the evidence before us we are not justified 

 in stating that a low blood-pressure is constant. 



The temperature is usually subnormal. 



In regard to the condition of the blood, some authors state 

 that anaemia is not characteristic, though the patients present 

 an anaemic appearance. Others affirm that the blood always 

 shows changes, in the directions of diminution in number of 

 the red corpuscles and lowered haemoglobin content. The 

 number of leucocytes is in most cases normal. It has been 

 stated also that the eosinophilous cells and the large mono- 

 nuclear cells are increased in number. Status lymphaticus 

 is not rare, and hyperplasia of the thymus has been observed. 

 It U stated that there is no very marked emaciation in the 

 majority of cases. 



Vomiting is very common, and there is frequently hiccup 



