Two cases of Pagets disease of the nipple / by Louis A. Duhring.

  • Duhring, Louis A., 1845-1913.
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of Pagets disease of the nipple / by Louis A. Duhring. Source: Wellcome Collection.

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    years over the central portion of the breast, the disease being apparently superficial, and of a chronic inflammatory nature, but little different in its general character from eczema of this region. It has been accompanied by a variable amount of oozing, excoriation and crusting, and with almost constant itching, which of late has been excessive. The itching was comparatively slight during the first five years, but for the last two or three years it has been severe and constant. Within the last two years, moreover, the region of the nipple has become sunken, puckered, and ulcerated, while the whole breast has enlarged and has become fuller and firmer. At times it has felt tender and sore. No lumps or nodules, however, have at any time been felt. The lymphatic glands have never been affected. The treatment had, at intervals during the ten years, been vigorously pushed on the part of several physicians, the remedies used having been numerous and varied, including tar, chloral, carbolic acidy and iodoform ; internally, arsenic was repeatedly prescribed, but the sys¬ tem never tolerated its use. There is no history of any similar disease,, nor of cancer, in the family. The following notes were recorded at the first examination : The dis¬ ease occupies the central portion of the breast, and consists of an irregu¬ larly shaped, somewhat circular, sharply defined, chronically-inflamed patch, about two and a half inches in diameter, somewhat excoriated, slightly crusted, and scaly. The colour is a bright crimson red, and is much more vivid than that usually met with in eczema. In the central part of the lesion it is intense. It is less marked as the periphery is ap¬ proached. The nipple has disappeared, its site being sunken and the seat of an irregularly rounded ulcer a half inch in diameter and a quarter inch in depth, with a granular, violaceous red base. The secretion is scanty. The areola, too, has gone. The patch is smooth and firm, and is con¬ siderably thickened, the border being well defined and slightly elevated. The amount of discharge from the lesion is slight. The subjective symp¬ toms consist of pain and itching. At times (more frequently during the last year) slight darting pains through the breast are experienced. Itching is constantly present, and is very annoying. In the opinion of the patient, this is the most distressing symptom of the disease. The patient was placed upon an ointment of pyrogallic acid, consisting of a drachm and a half of the acid, five drachms of resin cerate, and two drachms of lard. A week afterwards an extensive blackish crust had formed, which was removed with a poultice, and the open wound treated with a simple ointment. Two weeks later the pyrogallic acid ointment of increased strength, two and a half drachms to the ounce, was again used. Under this remedy, which acted as a caustic, together with repeated poul¬ ticing when a thick eschar formed, an open suppurating wound was pro¬ duced. This treatment was persevered with for six weeks, when the wound was allowed to granulate under a simple emollient ointment. It was noticed that as long as the pyrogallic acid ointment was applied the itching was either in abeyance or entirely absent, returning as soon as this was aban¬ doned for a simple ointment. During the summer the wound, including the ulcer, healed over, became paler, and the breast was in every way more comfortable, but three months afterwards the. disease gradually relapsed into its former state. In October, 1882, a vigorous treatment with inunc¬ tions of tar ointment, and later with sapo viridis and tar ointment was insti¬ tuted, but the tar produced redness, heat, and swelling, and had to be dis¬ continued. The itching was subsequently markedly relieved by a lotion