A case of Addison's disease / by William Pepper.

  • Pepper William, 1843-1898.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: A case of Addison's disease / by William Pepper. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    [After the reading of the preceding paper:—] Dr. Frederick P. Henry remarked that this was undoubtedly a genuine case of Addison’s disease, and remarkably free from the fre- quent complications of that affection. The rarity of Addison’s disease in this country may be judged of by the fact that in the eleven volumes of the Transactions of the Pathological Society of Philadelphia, there are reports of only two cases, and these were made by Dr. Plenry, in whose practice they occurred. They are to be found in vols. v. and x. The specimens from one of the cases are now in the museum of the Episcopal Hospital. Dr. Hughes’s report upon the condition of the blood in this case is very interesting. Most writers upon Addison’s disease are accustomed to attribute the profound adynamia, so char- acteristic of the affection, to a high degree of general anaemia, in spite of the absence of any facts to support such a theory. This adynamia is due to an insufficient supply of blood, although of good quality, to the supra-diaphragmatic portion of the body, the result of an accumu- lation of blood in the abdominal bloodvessels caused by vaso-motor paralysis. Free pigment in the blood has only been once before ob- served, so far as the speaker is aware, by Van den Corput (Gaz. Hehdo- madaire, 24 Juillet, 1863). The changes observed in the sympathetic ganglia are of undoubted interest, but it must not be forgotten that typical cases of Addison’s disease have been observed without per- ceptible lesion of these ganglia. Eulenberg and Guttmann (Journal of Mental Science, January, 1879) have collected twenty cases in which changes were found in the nerves of the supra-renal plexus and the ganglia of the solar plexus, opposed to which they place twelve cases in which careful examination demonstrated no change whatever. The positive observations included fatty degeneration (found by Queckett in one of Addison’s original cases), swelling and redness of the nerves of the lesser splanchnic and ganglia of the solar plexus, atrophy, pig- mentation of the ganglionic cells, increase of connective tissue in the ganglia and in the neurilemma of the nerve-fibres, and caseation of the semilunar ganglia. Primary affection of the abdominal sympathetic has been appealed to as a cause of numerous other affections, notably of Bright’s disease, by Drs. Da Costa and Longstreth, on the basis of careful microscopic examination of the ganglia in nine cases (Am. Journ. Med. Sci., July,