356 CROWELL. 



adrenal tuberculosis witliout other tuberculous foci except those long 

 healed, parathyroid fibrosis, and status lymphaticus. It is worthy of 

 note that adrenal tuberculosis may occur without other active or recogniz- 

 able tuberculous foci. It is also true that severe loss of Aveight may occur 

 on account of adrenal tuberculosis without other widespread tuberculous 

 lesions. This patient lost 35 pounds in 3 months. This case, like the 

 lirst, showed a status lymphaticus and destruction of another endose- 

 cretory gland. 



The two cases of tuberculosis of the adrenals which the writer has 

 had the opportunity of studying in Manila were accidental autopsy find- 

 ings in which the clinical diagnosis was generalized tuberculosis. Both 

 of these occurred in Filipinos, thus raising the question as to the pos- 

 sibility of making the clinical diagnosis of Addison's disease in dark races. 

 Bittorf and ^N'eusser state that melanoderma is not a necessary integi'al 

 part of Addison's disease, but agree that it is of very great diagnostic 

 importance. In these cases no excessive pigmentation of the mucous 

 membranes or of the skin could be observed on very close examination 

 on the autopsy table, aside from two isolated dark spots on the tip 

 of the tongue of the second case. It was considered at the time that 

 these might have occurred from extraneous sources, such as the teeth, 

 and microscopical examination was of little assistance, since the pigment 

 involved not only the epithelium but the corium as well, and might have 

 reached the part from either direction. 



The first case, number 1350, was a male Filipino, 26 years of age, who had been 

 imprisoned for 7 years and had been in the tuberculosis ward of the hospital for 

 3 years. From May, 1906, until April 15, 1908, when he was transferred to 

 the tuberculosis ward, various diagnoses were made at different times and these 

 diagnoses constitute the only available record during that period. These were, 

 acute dyspepsia, acute articular rheumatism, malaise, acute bronchitis, neurosis 

 (anaesthesia of the right arm), intestinal colic and conjunctivitis. In 1907 amoe- 

 bic and ova of Trichuris trichiura were found in his fseces, but disappeared after 

 treatment. T}ie urine was negative. Tubercle bacilli were found in the sputum 

 for the first time in April, 1908. At autopsy he was foimd to be a mucli emaciated 

 Filipino who showed no excessive pigmentation of his mucous membranes. 

 The skin being normally of a uniform, dark color, no pathological bronzing could 

 be determined. Tlie anatomical diagnosis made at the autopsy was: Chronic 

 ulcerative pulmonary tuberculosis (veiy extensive) ; chronic adhesive pleurisy, 

 tuberculous; chronic bronchitis; tuberculous colitis; congestion and parenchy- 

 matous degeneration of the liver; parenchymatous degeneration of the heart and 

 kidneys; tuberculous lymphadenitis of the bronchial and cervical nodes; tuber- 

 culosis of adrenals. 



The pulmonary tuberculosis was very extensive, practically all lung tissue 

 being destroyed. 



The left adrenal weighed 5 grams and it showed on the surface smaller and 

 larger foci, the largest measuring as much as 1 centimeter in diameter. On 

 section these foci were firm, pale, circumscribed, and occurred mostly in the cortex 

 of the gland, although some extended through the cortex to the medulla ; otherwise 

 the adrenal tissue had a normal appearance. The right adrenal weighed 4.5 



