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should be scrupulously avoided in these cases. Constipation is more common than otherwise in Addison’s disease; but unless it be very extreme, I think it better to abstain from interference than to risk the dangerous depression which often follows the administration of aperient medicines. Many of you will recollect the case of E. W., a young girl who died in Murray ward under my care, of Addison’s disease, somewhat more than a year ago, and whose fatal seizure appeared to have been brought on by a dose of calomel and jalap given by her mother. As regards diet, the only plan is to give nourishing food of whatever kind the patient’s stomach can best bear, and this will probably vary more or less in every case; substituting milk, eggs, jellies, oysters, and the like, for the stronger diet of meat or soups, when the stomach cannot tolerate these latter. For the relief of the nausea and vomiting, ice, soda-water and brandy, chloroform or creosote, bismuth, and effervescing medicines with citrate of iron, have each in turn proved useful in my hands; and again, each at times has failed to effect any good result. After the sickness has abated, decided benefit sometimes attends the administration of chalybeates and of cod-liver oil or glycerine. In the last two cases I have related to you, cod-liver oil disagreed with the patients; but glycerine, in doses of two drachms, combined with fifteen or twenty minims each of spirit of chloroform and of the tincture of sesquichloride of iron, of the London Pharmacopœia, has been of great service. I speak positively on this point, because in each case the patients on several occasions have discontinued the medicine as soon as they felt better, have then lost ground again, and, on applying to me and resuming its use, have in a week of ten days once more begun to improve, without any other simultaneous change in their circumstances.
Little as this is, it is yet all that I can tell you from my own practical experience on the subject of treatment; and I shall now only detain you for one concluding remark. You may be surprised that I have chosen to base my lecture on four cases of Addison’s disease, of which only one has passed the crucial test of a post-mortem examination; but I have done so purposely, because I have little doubt, that, in one at least of the other three cases, we shall soon have the opportunity of verifying the diagnosis, and of thereby demonstrating the reality of the relationship between the symptoms I have described and Addison’s disease of the supra-renal capsules - a relation of which I am myself as firmly convinced as I am of the relation between the physical signs of a cavity in the lungs, or of incompetency of the mitral valve, and the diseases which they respectively indicate.