5
and weak, indisposed to either bodily or mental exertion; the appetite is impaired or entirely lost; the whites of the eyes become pearly; the pulse small and feeble, or perhaps somewhat large, but excessively soft and compressible; the body wastes, without, however, presenting the dry and shrivelled skin, and extreme emaciation, usually attendant on protracted malignant disease; slight pain or uneasiness is from time to time referred to the region of the stomach, and there is occasionally actual vomiting, which in one instance was both urgent and distressing; and it is by no means uncommon for the patient to manifest indications of disturbed cerebral circulation. Notwithstanding these unequivocal signs of feeble circulation, anæmia, and general prostration, neither the most diligent inquiry, nor the most careful physical examination, tends to throw the slightest gleam of light upon the precise nature of the patient’s malady; nor do we succeed in fixing upon any special lesion as the cause of this gradual and extraordinary constitutional change. We may indeed suspect some malignant or strumous disease; we may be led to inquire into the condition of the so-called blood-making organs; but we discover no proof of organic change anywhere,- no enlargement of spleen, thyroid, thymus or lymphatic glands,- no evidence of renal disease, of purpura, of previous exhausting diarrhœa, or ague, or any long-continued exposure to miasmatic influences: but with a more or less manifestation of the symptoms already enumerated, we discover a most remarkable, and, so far as I know, characteristic discoloration taking place in the skin,- sufficiently marked indeed as generally to have attracted the attention of the patient himself, or of the patient’s friends. This discoloration pervades the whole surface of the body, but is commonly most strongly manifested on the face, neck, superior extremities, penis and scrotum, and in the flexure of the axillæ and around the navel. It may be said to present a dingy or smoky appearance, or various tints or shades of deep amber or chestnut-brown; and in one instant the skin was so universally and so deeply darkened, that, but for his features, the patient might have been mistaken for a mulatto.