41

a proof sufficient that the supra-renal bodies are not, in the ordinary sense of the term, vital organs.

William M___, æt. 35, by trade a mason, of slight build and sallow complexion. He had always had good health until the close of the year 1857, when he first came under my notice. He then complained of considerable pain in the back, between the lower dorsal and upper lumbar vertebræ. This was accompanied by partial loss of power of the lower extremities. He was cupped and blistered, and Hyd. c. Cret., and Dover’s powder, was given every four hours. The mercury was not continued sufficiently long to affect the system, as the symptoms abated, and he was soon able to resume his usual work.

In March, 1858, he again applied to me, complaining of great debility, loss of appetite, and depression of spirits. It was at this time that the darkness of his complexion first attracted my notice, especially that of the forehead close to the hair, which part was completely protected from the sun by his cap. There was a sallowness over his whole body, but the parts more especially discoloured were the face, neck, and arms. This bronzing of the skin suggested that he was suffering from disease of the supra-renal capsules. He had, at intervals, pain in the epigastric region, which was very intense, attended with frequent vomiting. From the administration of steel, combined with tonics and opium, and the use of sinapisms, he derived some partial relief, so that he was enabled to resume his work for a short time ; but in consequence of excessive debility and languor, he soon became totally incapacitated. From this time he gradually succumbed to the disease, his face becoming of such a dark hue that he might well have been taken for a man of colour. In the epigastrium, where mustard plasters had been frequently applied, the skin was of a particularly dark colour. Three days before death took place he was able to walk out, but complained of intense pain at the pit of the stomach, which, however, was not constant. I saw him on the night previous to his decease ; he was then suffering very much, his pulse was weak and quick. I prescribed half a grain of acetate of morphia, to be repeated in three hours if he was not relieved. After the second dose he soon went to sleep, but died on the following morning, at half-past five.

Post-mortem examination, thirty-six hours after death.- Rigor mortis present. Body emaciated ; skin peculiarly dark. There was a fair amount of fat on the walls of the abdomen. The right supra-renal capsule was wasted, the left much enlarged. The remaining abdominal viscera were healthy, with the exception of slight enlargement of the mesenteric glands. The chest was not examined, as he had never had any symptoms of pulmonary disease.

For the following observations on the condition of the supra-renal capsules I am indebted to Dr. Wilks, to whom I sent them:- “Both capsules are affected in a manner almost peculiar to this organ. I can find no trace of healthy structure, but in its place a grayish, amorphous, lardaceous matter, of the consistence of wax, which exactly resembles numerous other specimens in the Guy’s museum.”

Case 12.- I would draw attention in the following case to the long duration of the disease and to the well-marked symptoms attending it, indicated by the discoloration of the skin and debility, and yet, at the same time, to the amount of