350 CROWELL. 



slight hyperplasia has been shown by Pappenheimer.(36) This delayed resolution 

 brings the weight of the thymus above that of the normal, which latter, within 

 the last few years, has been shown to differ from all previous conceptions. 

 Hammar,(37) Norris,(38) and Pappenheimer(36) have shown that the weight of 

 the thymus increases up to the 15th year and then the gland undergoes involution. 

 Delayed involution occurs from several causes. 



Disease of other glands of internal secretion is not infrequeutlj' associated 

 with status lymphatieus, the most noteworthy instance being Basedow's disease. 

 In fact a hypoplasia of the genital organs is claimed by some as an almost 

 constant feature of status lymphatieus. 



The insufficiency of our knowledge of Addison's disease is very ap- 

 parent from a consideration of the conflicting theories just discussed. 

 Hence, the following cases are reported with the idea of furnishing data 

 which may be of value in arriving at its corr.ect interpretation. 



REPORT OF CASES. 



The present writer had the opportunity of studying two cases of 

 Addison's disease during his service in the Pathological Laboratory of 

 Bellevue Hospital, and has recently encountered two instances of adrenal 

 tuberculosis in Filipinos in Manila. 



The first case, number 2142, was that of an Italian married woman, 39 years 

 of age, a shopworker, who was under observation only 48 hours before death. 

 The history was that of good health until 3 months previous to adrnission to the 

 hospital. She then had severe pain in the abdomen and back, which for a time 

 became less severe, and was accompanied by insomnia and loss of appetite and 

 strength. After 2 months her weakness became so marked as to confine her to 

 bed, and she suffered from abdominal pain, vomiting, hiccough, insomnia, con- 

 stipation, and headache. During the last 3 months of her life she lost 30 pounds 

 in weight and her face and hands grew darker during the last month. 



While under observation the essential clinical features were pigmentation 

 (described below), marked asthenia, weak pulse (84 millimeters of mercury), 

 and signs of apical tuberculosis. There occurred an ante-mortem rise of tem-' 

 perature to 104°. 2 F. (40°.l C. ) and an attack of pulmonary oedema ended fatally. 



Tlie autopsy, which was performed 13 hours after death, was limited to an 

 abdominal incision, through which, however, it was possible to remove the thoracic 

 viscera. 



PKOTOCOL 2142. 



The body is that of a well-formed, fairly well-nourished white female of short 

 stature, 39 years of age. Rigor mortis is marked, and there is considerable 

 post-mortem suggillation over the dependent parts. There is no oedema of the 

 skin. The face and back of the hands, the lips, and the gums show brownish . 

 pigmentation. The chest is well developed and well formed. The nipples and 

 areolae are extremely small and black. The waist is narrow. The thighs are 

 well arched laterally, the arching starting from the waist line; anterior arching 

 is not marked. Thighs and legs have a few long hairs. The pubic hair is well 

 developed. Tliere is abundant lanugo over the abdomen. There are hairs over the 

 upper arms, moderate in amount. The hair of the head is abimdant and dark. 

 The eyebrows are well developed. Tliere is hair on the nose between the eyebrows, 

 a fairly well developed moustache and long hairs on the chin. There is a moderate 



