On disease of the supra-renal capsules, or morbus Addisonii / by Samuel Wilks.

  • Wilks, Samuel, Sir, 1824-1911.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: On disease of the supra-renal capsules, or morbus Addisonii / by Samuel Wilks. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    43/68 (page 39)
    Case 9.—The following case occurred earl}' in Uie history of the discovery of the disease, and one of the first in Guy's Hospital after the publication of the original cases. The pa- tient, it -will be seen, was followed home from the hospital, and although on his death no general examination of the body was permitted, yet the supra-renal bodies being extracted, were found diseased in the usual way. That a small opening could be made in the body, the hand placed within it, and the precise seat of the disease fixed upon, needs no comment of mine in proof of the accuracy of the diagnosis. I give the case as already published in the ' Medical Times and Gazette.^^ Charles W—, set. 24, was admitted into Guy's Hospital, under the care of Dr. Barlow, July 24th, 1855. A well-formed man, of temperate habits, employed as a carpenter at the Crystal Palace. He had always robust health until five months ago, since which time he has been ailing with debility, breathlessness on exertion, nausea, and what he terms biliousness, with a gradual darkening of the complexion. He attributed the onset of his symptoms to over-exertion in running to catch a train. He continued to work until within a fortnight of his admission into the hospital, but was under medical treatment for what was considered to be dyspepsia. On admis- sion, his principal symptoms were great debility, emaciation, irritability of stomach, and a tawny colour of the complexion. Tlie pulse was regular, but very soft and feeble, 70. Tongue clean; entire loss of appetite. The vomiting continued un- checked ; the lint of the skin rapidly became of a deeper biown. On the day before his death the following notes were made of his condition :—Great malaise and ex- ):austion ; no cerebral disturbance. Constant nausea, and freqtient vomiting; tongue rather dry and injected; abdomen retracted to the spine; sharp aortic pulsation; radial pulse very feeble, 120. No tenderness in loins; skin of a sallow olive-brown. Inside of lips mottled with black pigmentary deposit, and surface of lips dark, so as to give to a superficial observer the appearance of sordes. The dark colour of the skin is most marked in the lower extremities, about the knees. Hair dark-brown; irides blue; nails pearly white. Blood drawn from a puncture of a bright and full colour, but rich in white corpuscles. Urine of a pale-straw colour, free from albu- men. He suddenly sank a few hours after these notes were taken. The body was removed to Hatfield without examination ; but as the case appeared to be a striking instance of disease of the supra-renal capsules. Dr. Gull determined with Dr. Bealey to follow it. After much opposition from the friends, they suc- ceeded so far as to be allowed to make a small incision in the abdomen, with a promise to do no more than remove the capsules. Both were found diseased. The left one was much atrophied, and in tlie |)lace of the original structure were several cysts, one as large as a hazel nut, containing rather tuibid, colourless fluid. The right capsule was also much wasted, and in its substance were many round, indurated masses, varying from the size of a small pea downwards; they were firm, opaque, and fibroid in structure. ' Jan. 19th, 1856.