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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    consisting of a drachm each of sulphate of zinc and sulphuret of potash, a half drachm of glycerine, and four ounces of water. A month later, fric¬ tions with sapo viridis, and inunctions with sulphur ointments of different strengths were resorted to, but without benefit. On the 16th of December, 1882, in consultation witli Dr. Strawbridge, and with the assistance of Dr. Stelwagon, the wound was operated upon with the dermal curette, or scraping-spoon, the patient being under ether. Much of the tissue of the general surface of the patch was found to be soft, as in degenerating lupus vulgaris, and came away readily, but about the region of the nipple the tissues were tough, and could be removed only with difficulty. A cavity, three-quarters of an inch in depth and an inch in width, was made in the site of the nipple. The wound was dressed with simple ointment, and in two months had healed so kindly that it was thought a cure would probably result. But such was not the case, for it now began to reappear, accompanied with itching, and in six weeks had resumed its former characteristics. Excision of the whole gland was now advised, but at the time of writing the patient has not decided to submit to the operation. Case II. Mrs. S. A. B., aged 40, brunette, spare and debilitated, the mother of three children, applied to me October 15, 1882, for advice con¬ cerning a chronic inflammatory disease of the skin affecting the left breast and nipple, which she stated had defied the most varied treatment. The disease had begun six years before, in the form of a fissure on the nipple, which persisted, accompanied with slight oozing and crusting, and with itching, for about a year, without much change, when under the use of ointments and poultices, the disease began to spread slowly over the nipple. Soon the nipple showed signs of contracting and sinking into the breast, and during the next three years, becoming smaller each year, entirely disappeared. After this the disease spread slowly around the nip¬ ple, involving the areola, accompanied by slight oozing from time to time of a puriform nature, with itching, which has been gaining in intensity from year to year. At first this latter symptom was insignificant, but for the last three years it has been constant and most violent; of late it has been almost intolerable. At first the increase in the size of the lesion was scarcely perceptible from year to year, but during the last six months it has been much more rapid. Upon examination the affected breast is noted to be small, but is larger, fuller, and firmer than the sound one. In places it is distinctly lumpy, hard, and even knotted, feeling like an ordinary scirrhous in the early stage. This indurated state of the gland, she states, is a recent develop¬ ment. The lymphatic glands are not involved. The nipple and areola are entirely wanting, a glazed, here and there excoriated, partly crusted, bright, violaceous red, chronically inflamed, infiltrated, rounded patch, occupying this region. The lesion is firm ; is about two inches in diam¬ eter ; has a slightly raised border, and is very sharply defined against the sound skin. It has an eczematous look, and at first glance would doubt¬ less be mistaken for this disease. The sharp line of demarcation, the border, the infiltration, the glazed surface, and the vivid colour, are, how¬ ever, peculiar. Taken between the fingers the infiltration is noted to be superficial, and is not so deep as one would suppose from the appearance. It is not necessary to dwell upon the treatment to which the lesion was subjected ; suffice it to say strong ointments of calomel, tar, and pyrogallic acid were in turn resorted to without benefit. The pyrogallic acid oint-