On Addison's disease : clinical lectures on Addison's disease and a report on diseases of the supra-renal capsules / by Edward Headlam Greenhow.

Date:
1866
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Licence: Public Domain Mark

Credit: On Addison's disease : clinical lectures on Addison's disease and a report on diseases of the supra-renal capsules / by Edward Headlam Greenhow. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    are therefore only examples of one form of the ordinary tubercular affection. With the exception of a case reported by Dr. Duclos, a Prench physician, as one of cancer of the supra-renal capsules, but which, from the description and symptoms, I am inclined to regard as having been, in reality, a true example of Addison's disease,* no single case of cancer of those organs has to my knowledge been reported, in which either the constitutional or external symptoms of Addison's disease were present. JN'either, with the exception of the same case, has cancer of the supra-renal capsules, so far as I can discover, ever been reported, unassociated with, or probably otherwise than secondary to, cancer of other organs. Addison's disease is therefore due to a much more definite affection of the supra-renal capsules than its discoverer himself supposed; and, as we have seen, the manifestations of its existence during life are clearly divisible under two heads—viz.: 1, constitutional symptoms; and 2, external signs. Having had under my own care during the last few years at least five genuine cases of the disease, and having had the opportunity of seeing several of those which were under Dr. Addison's care, I shall now sum up the results of my own personal observation as to the constitutional symptoms and external signs of this singular malady. I. The constitutional symptoms are : gradually progressive asthenia, often originating without any apparent cause, and seldom dating from any definite period; great languor and indisposition for exertion, with, in advanced cases, breathlessness and palpitation, frequent sighing or yawning, and generally faintness on making any muscular effort, some- times even on being raised up in bed. There is almost invariably great weakness of the heart's action and remarkable feebleness of pulse; loss of appetite; irritability of stomach, with nausea; and, towards the close of the illness, at least occasional, often persistent, vomiting. The mind is generally clear to the last, but so great is the prostration in the latest stage of the disease that the patient often lies in a drowsy, ap- parently semi-comatose state, from which, however, he can be roused by questions, and to these he generally gives pertinent, though slow and reluctant, answers. The above I should class as the most charac- teristic symptoms of the disease : but there are in many cases pains in the loins, hypochondria, or epigastrium; and, more rarely, dimness of sight, vertigo, and, near death, a tendency to incoherence or delirium. Death takes place from asthenia, and often rather suddenly. It is a * See further remarks on this case, at p. 50.