488 PATHOLOGICAL PIGMENTATION 



adrenals, 0.121; heart, 0.714; skin, 0.188; small intestine, 0.14. (Other 

 analytical results are given by Howard and Stevens.) 



Opie's conclusions concerning this disease are as follows: (1) 

 There is a distinct morbid entity, hemochromatosis, characterized 

 by widespread deposition of an iron-containing pigment in certain 

 cells, and an associated formation of iron-free pigments in a variety 

 of locahties in which pigment is found in moderate amount under 

 physiological conditions. (2) With the pigment accumulation there 

 occur degeneration and death of the containing cells and consequent 

 interstitial inflammation, notably of the liver and pancreas, which 

 become the seat of inflammatory changes accompanied by hyper- 

 trophy of the organ. (3) When chronic interstitial pancreatitis 

 has reached a certain grade of intensity, diabetes ensues and is the 

 terminal event in the disease. 



Diabetes occurs in the majority of the cases of generalized 

 hemochromatosis (50 of 63 collected by Sprunt) and was called by 

 Hanot, "bronzed diabetes," because of the coloration of the skin. 

 It has been suggested that the pigmentation is due to decomposition 

 of the blood-corpuscles in the diabetic blood, but the pigmentation 

 and sclerotic changes precede the diabetes, which is secondary to the 

 atrophic and sclerotic changes in the pancreas. It seems probable that 

 both the pigment formation and the tissue changes depend upon some 

 intoxication, the origin and nature of the toxic agent being entirely 

 unknown. In many cases it has seemed possible that alcohol might 

 have been the inciting cause. There is no evidence of abnormal boold 

 destruction which might account for the pigmentation, and ]\leltzer 

 and Parker have suggested that the difficulty lies in the inability of 

 the tissues to get rid of the iron set free in normal catabolism. INIetab- 

 olism studies have indicated that there is some retention of food iron 

 which may be interpreted as supporting but not proving this hypothe- 

 sis.^^ Rous and Oliver, -° finding that protracted hemolysis of foreign 

 corpuscles in rabbits produces a typical mild hemochromatosis, sug- 

 gest that the liver cirrhosis is primary and renders this organ unable 

 to deal adequately with the blood pigments, which therefore accumu- 

 late in the organs and cause diffuse fibrosis. 



ICTERUS^' 



Pigmentation of the tissues of tlie body in jaundice depends upon 

 the presence in them of bile-pigments, which usually have been formed 

 in the liver and reabsorbed either into the lymph or blood (or botii). 

 However, a pigment that seems to be chemically identical with bili- 

 rubin (hematoidin) may be formed from hemoglobin liberated on the 



" See Howard and Stevens {loc. cit.) and McCluro, Arch. Int. Med., 1918 (22), 

 610. 



2" Trans. Assoc. Anier. Phys., 1918 (3.3;, 132. 



2' Literature l)y Stadelinann, "Der Icterus," Stuttgart, 1891; Minkowski, 

 Ergebnisse der Pathol., 1S9.') (2), 079. 



