ADDISON'S DISEASE. 353 



skin of the head, especially that of the forehead, is a very dark brown, 

 resembling sunburn, this being less marked over the face and neck. The skin 

 of the trunk and abdomen is dirty yellowish in color. The dorsum of both 

 hands is deep brown in tint, as if sunburnt. Over both extremities and trunk 

 in front and behind are numerous symmetrically distributed lesions, all being 

 about 7 millimeters in diameter, round, macular, with a narrow, dark brown 

 pigmented rim, and a whitish, smooth central portion, not elevated above the 

 surface and not scaly. In a few of the maculae the central portions are slightly 

 depressed. The inner portions of the lips and mucous membranes of the mouth 

 show a few black pigmented areas. On the skin of the penis and glans are 

 several dark bluish pigmented areas of small size ( 2 or 3 millimeters ) . 



The hair of the scalp is of good gi'owth, brownish, lustrous. The beard and 

 moustache are scant. The axillary hair is scant, the individual hairs long. 

 There are a few long black hairs around the nipples, scant short hair on the trunk, 

 a few also on lineae of abdomen, and moderate pubse. The hair on the thighs 

 and lower legs is poorly developed. The anus and perineum have a good 

 growth of hair. There are no lesions around the anus. No mucous patches 

 are visible. 



There is no oedema of the subcutaneous tissues. 



The head is moderately round in type. The pubic hair is feminine in type. 

 The superficial lymph nodes are not palpable. 



On section there is a small amount of panniculus abdominis. The musculature 

 is everywhere well developed. The abdominal cavity is free from fluid and 

 adhesions. The liver reaches the costal margin. The diaphragm is at 4th rib 

 on the right and 4th space on the left. The costal cartilages are not ossified. 



Lungs. — The left lung is everywhere adherent; the right everywhere free. 

 Right pleura is filled with a clear straw-colored fluid. The left lung is every- 

 where well aerated and dry; it is slightly congested. The right lung, except 

 for apical thickening of the pleura, resembles the left. The bronchial lymph 

 nodes are small and anthraeotic. There are no signs of tuberculosis in the 

 nodes or in the lungs. The bronchi are congested, otherwise normal. 



Thymus. — Persistent. It is red and fleshy, and in places well developed. It 

 extends to the auricle over the pericardium where it is thin. It weighs 21.5 

 grams. 



Heart. — The pericardial sac is not distended; it contains 20 cubic centimeters 

 of clear fluid. The epicardial fat is moderate in amount, being excessive at the 

 apex. There is no distension of the cavities, which contain chicken-fat clot, es- 

 pecially on the right side. All the valves are normal except the mitral which 

 is thickened at the margins. The anterior papillary muscles of the mitral are 

 short and thick at the apex ; chordae tendinae are short. The apices of the 

 papillary muscles are pale and thickened. The aorta is normal as to thickness 

 and elasticity, the abdominal portion shows above the bifurcation a whitish, 

 raised patch. The iliacs normal. The aorta measures 75 millimeters above 

 the cusps, 45 millimeters at the coeliac axis, and 35 millimeters at its bifurcation. 



Spleen. — Normal in size and appearance. 



Adrenals. — The left adrenal measures 55 by 22 by 12 millimeters and weighs 

 (5.5 grams. It retains its original contour. On section it is seen to be apparently 

 completely replaced by a pale yellowish caseous mass, and there is no vestige 

 of glandula,r tissue visible. At the anterior extremity the vessels of the medulla 

 can be seen. The right measures 65 by 30 by 13 millimeters and weighs 12 

 grams. It also retains its contour and is replaced by a yellowish caseous 

 material, which extends to the capsule. At its lower and posterior extremity 



