In some cases this discoloration occurs in patches, or perhaps rather certain parts are so much darker than others, as to impart to the surface a mottled or somewhat checkered appearance; and in one instance there were, in the midst of this dark mottling, certain insular portions of the integument presenting a blanched or morbidly white appearance, either in consequence of these portions having remained altogether unaffected by the disease, and thereby contrasting strongly with the surrounding skin, or, as I believe, from an actual defect of colouring matter in these parts. Indeed, as will appear in the subsequent cases, this irregular distribution of pigment-cells is by no means limited to the integument, but is occasionally also made manifest on some of the internal structures. We have seen it in the form of small black spots, beneath the peritoneum of the mesentery and omentum- a form which in one instance presented itself on the skin of the abdomen.

This singular discoloration usually increases with the advance of the disease; the anæmia, languor, failure of appetite, and feebleness of the heart, become aggravated; a darkish streak usually appears upon the commissure of the lips; the body wastes, but without the extreme emaciation and dry harsh condition of the surface so commonly observed in ordinary malignant diseases; the pulse becomes smaller and weaker, and without any special complaint of pain or uneasiness, the patient at length gradually sinks and expires. In one case, which may be said to have been acute in its development as well as rapid in its course, and in which both capsules were found universally diseased after death, the mottled or checkered discoloration was very manifest, the anæmic condition strongly marked, and the sickness and vomiting urgent; but the pulse, instead of being small and feeble as usual, was large, soft, extremely compressible, and jerking on the slightest exertion or emotion, and the patient speedily died.