DOI: 10.7925/drs1.ucdlib_280823
title: Melanosis

description: Watercolour medical illustration depicting melanosis. It has the alternative reference number 2048, P9 and 99a on the front. There is no Richmond Hospital Museum reference. The artist's name is in the bottom right corner 'J. Connolly Del.t'. The handwritten and typescript notes on the back begin 'Melanosis'.
description: Scope and content: The full handwritten and typescript notes on the back read 'Melanosis …man entered the hospital for the first time, the eye appeared natural. On opening the thorax, several depositions of melanotic matter were seen upon the heart; and when the organ was opened, melanotic tubercles were also seen in the ventricles and auricles beneath their lining membrane, but in much greater number in the right than in the left cavities of the organ. The lungs were filled with small round tumours, surrounded by a cyst, and filled with melanotic matter. Every organ, in fact, was diseased, with the exception of the brain; there was atrophy of the right optic tract, but the brain itself was free from disease. The lungs, heart, liver, spleen, mesenteric glands, peritoneum, and the absorbent glands along the course of the great vessels, all presented specimens of melanotic degeneration. The liver presented a very singular appearance; during life it extended down as far as the umbilicus, in the mesial line, while a projection from it descended as low as the iliac fossa on the right side. This had given rise to a mistake in diagnosis during life, the disease in this situation being supposed to be developed in the mesentery. Two prominent tubercles could also be distinguished on the anterior surface of the liver through the abdominal parietes. On making a section through the liver, a large quantity of melanotic matter was brought into view; and on attentive examination of the tumours, it appeared that the melanotic matter had been diffused through the substance of tubera circumscripta previously developed. There were several of these masses in which a process of change was going on similar to that in the case recorded by Cruveilhier, and in which also the disease commenced originally in the globe of the eye. In many of these tumours a small quantity of melanotic matter was diffused through the encephaloid tubercle; while in others the whole of the tumour appeared consist of melanotic matter; the latter were in general small. In the spleen a small quantity of the same black substance was found between the capsule and the substance of the organ. The pancreas also exhibited a number of these tubercles; there were several small ones under the mucous membrane of the stomach, and the peritoneum was studded in various places with them. The appendices epiploicae, and the whole of the mesentery, presented a very curious appearance, being mottled over with minute glossy spots. The melanotic tubercles, properly so called, were of a small size, varying from a minute speck to the size of a hazel nut. On the under surface of the diaphragm, the melanotic matter formed a kind of lamina or plate, being extensively effused between the peritoneum and muscular substance, so as to form a thin continuous layer. The glands, which accompany the large blood-vessels, were loaded with it. It was also scattered over the supra-renal capsules, and between the substance and fibrous capsule of the kidney. There were two points connected with the case which seemed of importance. One of these referred to the caution necessary to be used in proposing an operation, in cases of malignant disease. Dr MacDonnell said he felt quite convinced, that at the time the operation had been proposed in this case, the seeds of the disease had already developed in the internal organs. One of the most prevalent ideas with respect to melanosis is, that it is the result of an effusion of blood altered in its vital qualities, and containing a large quantity of colouring matter. Dr MacDonnell did not think that this opinion was borne out by the circumstances of the case under consideration. In the first place, there was a total absence of melanotic deposition in the brain; and where it occurs in the parenchymatous tissue of organs, as for instance in the lung, it does not present any of the distinctive characters of effused blood. In addition to this, it might be urged, that it was not found loose in cavities, as so frequently occurs in other haemorrhagic effusions. And, if the preparations laid before the Society were minutely examined, even the very smallest of the tumours, and those which were most recently deposited, would be found to exhibit, in an exquisite degree, all the characters of melanotic matter; and in none of them could be discovered anything like a state of transition from blood to melanosis. (Museum, Richmond Hospital).'
description: Numbering/sequence: Original reference number: 2048.
description: Date details: This illustration is undated, approximate dates are given based on dates for the entire collection.