CASE OF MELANOSIS OF APPARENT TRAUMATIC LOCAL ORIGIN. By ARTHUR MATHEWSON, M.D., Brooklyn. BY the courtesy of mny friend, Dr. Geo. K. Smith, of Brooklyn, I am permitted to present the following brief notes of a case lately seeni in consuiltation with him, which may prove of interest in connectioni with the other cases of kindred nature presented. . Williamn Rogers, set. 22, sewing-mnachine carrier, five vears ago received a blow from a hoop on the ternporal side of the right eye, from the effects of which he soon recovered, haviing suffered but little inconvenience. The precise nature of the wound I am unable to state. About a year after, lhe first noticed, at the seat of the injury, a small, dark-colored tumor, which gradually increased, and is now about the size and shape of the small field-bean split in two. This extends along the horizontal meridan of the eye, over the ciliary region and backward, and seems to be embedded in the sclera at that point. It has never caused pain. The vision is good, and the ophthalmoscope reveals nothiing abnormal in the interior of the eye. About a year and a half ago, he noticed a small ttumor on the right cheek near the angle of the jaw. This was followed by numerous other tumors of varying size, from that of a large pea to that of a very large horse-chestnut, andsappearing over an extensive surface-abdomen, thorax, back, limbs, and facesome of a deep bluish-black, the skin over thein having undergone melanotic degeneration, others still covered with normal skin, which is movable over them. They seenm to have their beginning in the subcutaneous tissue, and at first have no deep attachment. Some are now exfoliating from their external surface, but there is no proper ulceration.
194 The most prominent tumor unconcealed by the clothing was on the right temple, and was removed for cosmetic effect by Dr. Smith. Dr. Eno, who examined it, writes thus of the microscopic appearances:-" A small melanotic mass surrounded by connective tissue, and divided up by bands of the same. " The pigment of the melanotic mass is for the inost part disposed in the form of granules, large and small, infiltrating all the tissues of the mass, and not arranged in cells. In some places, however, there are irregular pigmental inasses, perhaps cells; also there are collections of large oval nuclei surrounded by delicate cell-substances of finely granular pigment-matter. These are to be found in the portions of the tumor where the pigment is least abundant. In the darker portions it is hardly possible to distinguish any struicture, only an indefinite mass of pigment. The specimen presents the characteristics of melanosis, mVid is similar to specimens taken from the subcutaneous cellular tissue of the case previously examined by me." There is no evidence as yet of the involveinent of any internal organ, except that dark pigment-granules have been found in the urine on repeated microscopic examiinations. Ilis general health is good, and lhe is robust and able to follow a laborious occuipation, whlich is the delivery of sewing machines, involving a good deal of heavy lifting. The points of special interest in this case, to me, are the apparenitly local and traumatic origin at a region in which piginent normally exists (-uveal tract), of a series of melanotic tumors scattered over the whole surface of the body; and also the question of the natuire of these tumors, whether simply masses of pigment (simple melanosis, if there be such a thing), and only dangerous as likely to occupy vital organs and destroy life by interference with their funietions, or having elemeints of malignacy, of a sarcomatous or carcinoinatous character. The man's good general condition shows that a marked melanotic diathesis with extensive deposit of pigment-matter in the tissues is not inconsistent with life and health for a considerable period of time.
194 The most prominent tumor unconcealed by the clothing was on the right temple, and was removed for cosmetic effect by Dr. Smith. Dr. Eno, who examined it, writes thus of the microscopic appearances:-" A small melanotic mass surrounded by connective tissue, and divided up by bands of the same. " The pigment of the melanotic mass is for the inost part disposed in the form of granules, large and small, infiltrating all the tissues of the mass, and not arranged in cells. In some places, however, there are irregular pigmental inasses, perhaps cells; also there are collections of large oval nuclei surrounded by delicate cell-substances of finely granular pigment-matter. These are to be found in the portions of the tumor where the pigment is least abundant. In the darker portions it is hardly possible to distinguish any struicture, only an indefinite mass of pigment. The specimen presents the characteristics of melanosis, mVid is similar to specimens taken from the subcutaneous cellular tissue of the case previously examined by me." There is no evidence as yet of the involveinent of any internal organ, except that dark pigment-granules have been found in the urine on repeated microscopic examiinations. Ilis general health is good, and lhe is robust and able to follow a laborious occuipation, whlich is the delivery of sewing machines, involving a good deal of heavy lifting. The points of special interest in this case, to me, are the apparenitly local and traumatic origin at a region in which piginent normally exists (-uveal tract), of a series of melanotic tumors scattered over the whole surface of the body; and also the question of the natuire of these tumors, whether simply masses of pigment (simple melanosis, if there be such a thing), and only dangerous as likely to occupy vital organs and destroy life by interference with their funietions, or having elemeints of malignacy, of a sarcomatous or carcinoinatous character. The man's good general condition shows that a marked melanotic diathesis with extensive deposit of pigment-matter in the tissues is not inconsistent with life and health for a considerable period of time.
