CASE II.

James Jackson, æt. 35. The subject of this case was admitted into the Clinical ward, under my own care, November 11, 1851, and died December 7, 1851. For the particulars of its history and result, I am indebted to my former pupil and present distinguished colleague, Dr. Gull, who was the first to suspect the true nature of the malady during the life of the patient.

A married man, residing at Gravesend, and occupied as a tide-waiter in the Customs. Of a bilious temperament, dark hair and sallow complexion, which since his illness has much deepened, so that now it is of a dark olive-brown. His wife says, “The obvious change in his complexion has been from the beginning of the illness, and gradually came on at that time.”

There can be no doubt as to this change in the complexion depending upon increase of pigment, for if the lips be turned down, the mucous membrane is seen to be mottled by a deposit of pigment, and a closer examination shows that the dark colour of the lips, which at first had the appearance of sordes, is dependent upon the presence of a black pigment, which is not moveable by moistening or washing the lips. There is an expression of anxiety in the face, and the brow is contracted. He gives the following history of himself:-