ADDISON'S DISEASE. 351 



amount of golden-yellow subcutaneous fat. The peritoneum is slightly thickened: 

 The great omentum is long and thin, with a small amount of fat and is adherent 

 to the dome of the bladder and to the anterior abdominal wall. The intestines 

 are collapsexi; the serosa is clear, pale, and glistening. The mesentery contains 

 a moderate amount of fat, with a few very pale lymph nodes about 1 centimeter 

 in diameter. The liver reaches the right costal margin and is firmly adherent 

 to the diaphragm. The diaphragm reaches 4th interspace on the right and 

 5th on tlie left. 



Lungs. — There is no fluid in the pleural sacs. The lungs are firmly adherent 

 to the parietes throughout, and each shows fibrocaseous areas near the apex, 

 the remaining lung substance being crepitant and soft, with a smooth surface. 

 The pleurae show a few punctate heemorrhages. Bronchi and vessels are in good 

 condition. The lymph nodes at the hilus are enlarged and anthracotic, and one 

 or two show fibrous foci. 



Thymus. — Not discovered owing to the method of section. 



Thyroid. — The thyroid is slightly enlarged, weighing 35 grams. On section 

 it is more pale than normal, but shows definite glandular structure, apparently 

 with a small amount of colloid. 



Heart. — The pericardium is firmly adhferent to the heart, which is small, 

 without hypertrophy of either ventricle. Endocardium is intact, except for 

 slight pallor and thickening of the mitral valve. The heart muscle is very brown 

 and rather soft. The coronary arteries are in good condition. The aorta shows 

 some fatty degeneration of the intima, especially about the isthmus. 



Spleen. — The spleen is of about normal size, weighing 150 grams. It is of 

 good consistence and the capsule is thin and smooth. The cut surface is smooth 

 and dark red. The Malpighian bodies are easily visible. 



Adrenals. — ^The left adrenal is small and very firm, and on section none of the 

 normal markings of the gland can be distinguished, the gland substance being 

 completely replaced by large, white, partly caseous, masses. 



The right adrenal is considerably enlarged, its surface being pale and nodular. 

 On section there are seen few of the markings of the gland, the cortex being 

 represented by faint yellowish streaks. At the lower pole is a large caseous 

 focus, and surroimding the entire cortex, for a width greater than that of the 

 normal gland, is a pale, firm tissue containing a few caseous foci. 



Kidneys. — The kidneys are of normal size with thin capsules which strip easily 

 from smooth pale surfaces. The two kidneys together weigh 275 grams. On 

 section the consistence is diminished, the cortex is broad and pale, with somewhat 

 injected Malpighian bodies. The pyramids are of a deep blue color. The pelves, 

 ureters, and urinary bladder are free. Uterus. — ^The uterus is small, firm and 

 pale. The endometrium is intact. A mucous plug extrudes from external os. 

 The VaginOL — Is normal. The Fallopia^i tubes. — Both are considerably distorted, 

 folded on themselves and adherent, the left being adherent to the anterior wall 

 of the uterus. They are also adherent to the ovaries, which are small, firm, 

 pale, and sclerotic, with a few small cysts. Hanging on the broad ligament at 

 the fimbriated extremity on each side are small unilocular cysts containing a 

 dark fluid. 



Stomach and intestines. — Contain a considerable amount of pea-green, fluid 

 material, but no formed faeces. Duodenum and stomach show, on their mucous 

 surfaces, numerous rather closely packed but still discrete small pale elevations. 



Liver and gall bladder. — The liver weighs 1,500 grams and is slightly diminished 

 in size. The capsule is somewhat thickened where adherent to the diaphragm. 

 On section the consistence is somewhat diminished, and the cut surface is dark 

 brown in color, showing the lobules but indistinctly. Bile ducts. Normal, 



