found to contain the peculiar corpuscles of melanotic matter, in addition to the usual constituents of medullary cancer.

In the lungs, the melanotic cancerous tubercles and stains are not unfrequently met with in connexion with the presence of the disease in other parts of the body, but care must be taken to distinguish between these and the black pigment, so constantly met with in the lungs and bronchial glands of adults generally; and especially in those of persons engaged in the working of coal mines; and between, also, that chronic black induration of the lungs—the Phthisie avec Melanose of Bayle.*

As observed in these organs, the black tubercles, of varying sizes, are found located generally beneath the costal and pulmonary pleuræ, lying in the sub-serous tissue; also, in the pulmonary texture itself, inserted in the same manner as in the hepatic. They have been seen likewise as clusters, attached by a slight pedicle to the pleura; or this membrane has presented the characteristic streaking of the disease. In the cellular membrane of the mediastina, the masses have been recognised in large quantities, as well as in the intercostal spaces.

Many writers were in the habit of describing all black discolourations, from whatever source arising, under the general designation of melanosis. This was manifestly calculated to lead to erroneous views, regarding the nature of true or malignant melanosis, as it confounded with its secondary deposit the appearances so frequently observed in the lungs from the introduction of carbonaceous matter, or from the stagnation of the blood in the capillaries. These forms were most properly classed under the head of "Spurious Melanosis," by Dr. Carswell. The universality of the colour, in the first instance, and the absence of a globular arrangement, in the character of the deposit, together with the general hardness of the lung tissue-immediately adjacent to it, in the second, suffice to distinguish either from the isolated rounded tubercle of melanotic cancer. In addition, these spurious forms are never observed to form pedicled or grape-like masses.‡

The heart has repeatedly exhibited melanotic cancer. Thus its surface may be seen sprinkled with a series of black spots, situated beneath its investing membrane (plate iii).

In a case of Mr. Lawrence's, § there were numerous black tumours upon the outer and inner surface; and in the muscular substance of the heart, two of considerable size projected into the cavity of the left ventricle.

Andral || mentions having observed a patch of a deep black colour as

*Recherches sur la Phthisie Pulmonaire. Paris, 1810; p. 28.

Op. Cit.-Melanoma.

For an elaborate essay On the Deposition of Black Matter in the Lungs, by W. Thompson, M.D., see Med. Chir. Trans.; vol. xx, p. 230; also vol. xxi, p. 340.

§ Op. cit.; p. 963.

Op. Cit., p. 563.

large as a two-franc piece, on the external aspect of the heart, which, on dissection, he found situated between the fleshy substance and the pericardium—that is, in the sub-serous cellular tissue.

*

Cruveilhier's illustration of the deposit of melanotic tubercles in the heart is most complete. Not only were they observed superficially on the external surface, beneath the pericardium, on both ventricular and auricular divisions, but also within; upraising the lining membrane of the cavities, and being protuberant between and upon the muscular columns, like black currants. Some few were in the muscular substance of the organ itself.

Comparatively rarely is the brain affected by melanotic deposit. The best recorded instance that I am aware of is mentioned by Dr. Carswell. An old man, between seventy and eighty, was brought to the Hotel Dieu, in Paris, in a state of incomplete paralysis. He died soon after admission. On examination, deep brown or black tumours were found in various organs. In the brain, in either hemisphere, was found a deep brown tumour, as large as a hen's egg. These, though partly melanotic, were also composed of erectile tissue-the blood vessels of the pia mater passing into them, and constituting the greater. part of their bulk. "The cortical substance of the brain," however, "contained three or four melanotic tumours, rather larger than hempseed."

More frequently the small vessels of the brain are found to contain the dark melanotic matter. This was found to be the case in the examination of the veins traversing the semi-melanotic tumours above referred to.

He says,

Sir A. Halliday, also, notices a somewhat similar fact. “The substance of the brain was natural; but several minute studs of dark matter were deposited in the course of the ramifications of the small vessels on the membranes covering the base of the brain and the choroid plexus."

Dr. Hooper, § in his description of certain tubercles of the brain, speaks of the "black tubercle "-i. e., melanotic cancerous tubercle. This, he states, "is as dark as soot, very soft and pulpy: it is found in the cortical and medullary substance, and of various sizes, but mostly as small as a lentil."

He further adds a most valuable illustration of this form of tubercle in plate xii, fig. 2, where a portion of the posterior part of the right hemisphere of the brain is represented; the whole of which is studded with black tubercles. One of these tubercles was of the size of a hazel nut, whilst others were smaller.

*Pathol. Anat.; liv. xix.

+ Illustrations of the Elementary Forms of Disease-Melanoma.

Op. Cit.; p. 203.

§ The Morbid Anatomy of the Human Brain. R. Hooper, M.D. London, 1826; p. 29.

"This species of tubercle," he remarks, "appears, at first sight, as if it were merely a coagulum of very dark venous blood. It is, however, an organised mass, of a pulpy or gelatinous consistence, which can be easily broken down, when it looks like the pigmentum nigrum of the eye, or soft Indian ink. It is surrounded by a very thin delicate membrane. Its structure is cellular; and it can easily be turned out of the brain, to which it adheres loosely, except at one point, where the vessels enter by which it is formed and nourished."

In a foot note, Dr. Hooper states, that the subject from which the illustration above described was taken, had melanotic cancer in almost every part of the body both externally and internally. It was found in the liver, lungs, heart, kidneys, breasts, and axillary glands.

Mr. Wardrop has recorded a remarkable instance of what he terms Fungus Melanodes" of the brain.

The patient, a farmer, had undergone extirpation of the right eye three years previously. The operation involved the removal of a vast growth, of nearly ten years' duration, from the right orbit. The tumour consisted of a dark brown or blackish substance, rather firmer than brain, but in some parts so soft, as readily to be washed away with

water.

Before death, for some months, the patient became paralysed. The following appearances in the brain were recorded: "On cutting into the left hemisphere, on a plane with the corpus callosum, a large dark sanguineous coloured mass presented itself, which at first had the appearance of coagulated blood; but on examining it minutely, it was found to be of a firm consistence, having numerous small vessels passing through its substance. This mass seemed to have no connexion with the surrounding brain, which was quite natural, and formed a sort of bed for it. By immersion in water a quantity of blood was extracted, and the mass, which remained, was of a dark brown colour, consisting of very loose cellular tissue. In the substance of the right hemisphere there were also several dark-coloured masses, of the size of a pigeon's egg, very similar in texture to that found on the left side. The ventricles contained a small quantity of serum, and the choroid plexus was of an unusually pale colour. The cerebellum appeared natural. The optic nerve on the right side, from its bifurcation to the orbit, was much wasted, having no medullary matter, and seemed to consist only of neurilemma. At the extremity of the nerve, where it had been divided during the extirpation of the eye, there was a hard tumour, of the size of a small nut, of a black granular appearance."

In a patient under the care of Dr. Alderson, in St. Mary's Hospital,† January 8th, 1855, in addition to numerous other illustrations of secondary melanotic deposits, "the left lobe of the cerebellum was displaced by

an encysted mass larger than a walnut, and was perfectly separable from the cerebral tissue, which presented in its neighbourhood its natural appearance and consistence."

On the other hand, in a man, ætat 50, who died of apoplexy, Lobstein* found the cerebral substance in the optic thalamus of the left side converted into black matter, which penetrated inwards for two lines.

Andral'st experience led him to state that melanosis had never been observed in the brain.

In regard to the nervous system generally, it does not appear that the nerve structure has ever been found penetrated with melanotic cancer. Branches of nerves may be seen passing so as to be surrounded by the disease; but none of their filaments can be traced into the contiguous tubercles, nor have they been found altered either in colour or texture.

The only exception I am aware of is perhaps in the orbit, where not unfrequently, when the disease is situated in the eye, the optic nerve will become converted into a mass of melanotic appearance, and will expand within the skull into a far larger growth, so as to prop up the under surface of the brain. This fact has been observed by Lawrence and others.

It is very common to observe the cut end of the optic nerve of a black colour in the post mortem examination of patients who have died after operations for the extirpation of melanosis of the eye.

Melanotic cancer is very frequently found deposited in the cellular and adipose tissue around the breasts. I am not aware of its having been noticed in the mammary gland as a primary affection.

Velpeau‡ says, "In the mamma, I have seen but two cases of melanosis; and the two females who were thus affected had the disease at the same time in different other regions of the body. In one of these it was the right breast which was thus affected, and the tumour, the size of a five-franc piece, was situate almost exclusively in the skin, was only two-fifths of an inch in thickness, was ulcerated at two points, and discharged a blackish ichor tolerably abundantly: in the other, the cancer, the size of a hazel nut, situated on the outside of the left nipple, was at the same time lobulated, and moreover everywhere solid. Both these patients died without operation, with a multitude of small melanotic tumours in the skin, in the glands of the neck, and in the viscera, all of which presented the same anatomical characters, and had the homogeneous section and black colour of the best marked melanotic

cancer.

Even in this, the secondary affection of the mamma by melanotic cancer, it is questionable whether the disease is not deposited in the meshes of * Traité d'Anatomie Pathologique; t. i, p. 460.

p. 366.

Op. Cit.; p. 573.

Velpeau: Treatise on Diseases of the Breast, translated by Mitchell Henry: Syd. Soc., 1856;

the cellular membrane, binding the component parts of the gland together rather than in the gland itself.

The arteries between their middle and interior coats, have presented instances of the deposit of melanotic masses. Similar instances have not been observed in regard to the veins.

Breschet* has, however, described the presence of a melanotic fluid in the small vessels of the mucous and serous membranes affected by melanosis, of the same character as that observed by Sir A. Halliday in the small vessels of the pia mater, previously alluded to.

In the thyroid gland, M. Alibert† has observed this disease; M. Laennec, also, found it affected by melanotic tumours.

The lymphatic glands generally are very prone to melanotic degeneration. The inguinal and lumbar glands, and the mesenteric, are very frequently found implicated from neighbouring growths. The lumbar glands will sometimes compress the vena cava, so as to cause anasarca of the extremities, in the later stages of the disease. Sometimes, a number of these glands, when diseased and enlarged, coalesce, and form a considerable tumour, possessing all the characters of melanosis.

It does not appear, however, that where the disease affects the eye, it is found to propagate itself in the adjacent gland, as when located in other places.

Melanotic tumours in the muscles are not really met with. In the instances in which they have been said to be so situated, there is little doubt but that they occupied the intermuscular spaces, or the cellular intervals between the muscular fibres.

In the fibrous tissues, though very rarely, melanotic deposits have been observed. This was Breschet's§ experience, who states that it was especially observed in the fibrous tissue covering the muscles.

Dr. Norris || observed melanotic tubera, from the size of a pin's head to that of a pea, in the the fascia, covering the temporal muscles. The dura mater was also studded with them.

I have myself witnessed the dura mater stained apparently from contact with the contiguous deposit on the internal surface of the cranium, and the same condition was observed by Sir A. Halliday; but it did not appear to me that the membrane derived its deposit from any other source than from the adjacent bone, as it was easily removed by scraping and washing, and no alteration of its structure was perceptible.

Cruveilhier¶ records a case in which a single melanotic tumour was

*Op. Cit., p. 12.

+ Nosologie Naturelle; tom. 1.

Treatise on Diseases of the Chest. London, 1829; p. 396.

$ Op. Cit., p. 11.

Op. Cit.; p. 565.

Op. Cit., liv. xix, p. 3.