Melanuria in Mental Disease.

Abstract

In an examination of microscopic sections of the large intestine, removed by Dr. J. W. Draper from about 170 patients suffering from various types of functional neurosis at the New Jersey State Hospital under the direction of Dr. Henry Cotton, marked pigmentation has been noted as a striking feature in many of the specimens. The pigment in these cases contains no iron, and belongs in the group of melanins. It is sometimes present throughout the entire large bowel, but is usually most marked in the caecum, diminishing toward the sigmoid. On section, the pigment is found as a rule to be confined to the mucosal layer, where it is seen as large polyhedral cells with a yellowish brown stippling. It does not stain by the Prussian Blue method. Pigmentation of this type is generally regarded as a sign of intestinal deterioration, and is not infrequently seen in the bowels of those who have suffered from long continued intestinal stasis and intoxication.

Sometimes the epithelial cells themselves are the site of this pigmented deterioration. But more often the yellowish brown polyhedral cells lie in columns in the lympho-reticular tissue, frequently in close proximity to the minute blood vessels. In one instance a pigment cell has been observed lying within the lumen of a small vessel which perforated the muscularis mucosae and terminated in the reticular substance of the mucosal layer. These observations suggested the possibility that the pigment in the type of case under consideration might reach the circulation, and should therefore be sought in the urine.