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supra-renal capsules thickened, and the capsules themselves infiltrated with tubercular and scrofulous looking deposit. The time that has elapsed since the injury is indeed considerable, but by no means unparalleled, for, in a case of this disease under my own care some years ago, the illness appeared to have originated from a strain in the back received five years before the commencement of definite symptoms of Addison’s disease. That there is an intimate relation between the vertebral and supra-renal disease in our present case, I am well assured; and I believe the latter to have been caused by the extension of inflammation, from the cellular tissue in the vicinity of carious bone, to the envelopes of the capsules, and from them, secondarily, to the capsules themselves, which have thus become the seats of inflammatory deposit. My opinion concerning the origin of the supra-renal disease in this case is confirmed by a careful perusal of all the published cases I have been able to meet with; for not only has caries of the spine been found associated with Addison’s disease in more cases than any other lesion, excepting always tubercle in the lungs or any other organs, but in many other cases in which it was not discovered I am persuaded, by the symptoms recorded during life, that disease of the vertebræ might have been found, had it been sought for at the post-mortem examinations. Moreover, even when no disease of the spine exists, the capsules are often found adherent to adjoining organs and surrounded by thickened cellular tissue, showing that inflammation has probably been the primary link in the chain of local mischief.
The pulmonary affection in this case may possibly be of tubercular character; but, whether or not, it is assuredly much too slight to be of any moment in the illness, and far less could it account for the remarkable prostration and other symptoms under which the man is labouring. Seeing, however, that his occupation has been of a very dusty nature, that he has been subject to catarrh, and that there is certainly no marked difference of percussion-note in the two infraclavicular regions, I incline to believe that the slight pulmonary symptoms are due rather to continued mechanical irritation, arising from the inhalation of dust, than to actual tubercular disease. But on this point I can only speak with some doubt and reserve, for the physical signs are slight, and the patient’s condition is such as to preclude a thorough examination; and, it is certain, that, in many cases of Addison’s disease, tubercular disease of the lungs has been found in so quiescent a form as to have given rise to no prominent symptoms during life. Moreover, as I have myself explained, on many occasions, the pulmonary affection caused by