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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    « 4 ment, from one to three drachms to the ounce, applied continuously, spread upon a cloth, with the view of producing a caustic effect, was em¬ ployed for several months, the crust being removed from time to time with a poultice. During the time that the ointment was applied and the lesion was discharging, there was great relief to the itching. Upon the wound granulating, however, the itching invariably returned, and the whole breast, moreover, became full and somewhat painful. In view of the indurated lesions within the gland (without doubt of a cancerous nature), and the inefficacy of the local treatment to relieve the infiltration, removal of the gland by excision was proposed, but the patient was un¬ willing to have the operation performed. I have reported these cases to show the clinical features of a disease which is entitled to special consideration. It must be distinguished from eczema, which it resembles, and from ordinary cancer, which it is alto¬ gether unlike in its earlier stages. It seems to occupy a ground having the characters of both diseases. The report is interesting as showing the natural history of the affection. This is peculiar. The course of the process is emphatically chronic. In both instances, moreover, the pro¬ gress of the disease was insidious as well as slow. Nothing of a malig- nant nature was suspected until after the lapse of five and ten years respectively. The itching, which eventually became such a marked symp¬ tom, was in both cases insignificant until the affection had-existed several years. It may be said not to have manifested itself until after the process had been well established. In this respect the disease differs dicidedly from eczema, where itching is one of’ the first signs noted. The circum- scribed, sharply defined outline of the lesion, and the slightly elevated border are also symptoms which do not obtain in eczema. The brilliant colour of the lesion is striking, and is more marked than in eczema. The absence of the “ eczematous surface,” characterized by appreciable dis¬ charge or by vesicles, pustules, or puncta, coming and going from time to time ; and the absence of exacerbations, so usual in eczema, may also be referred to. A point to which attention may also be directed is the infil¬ tration, which is firm or even hard, but is not deep-seated. It is rather superficial. In eczema, on the other hand, it is soft. The pains coming on later in the course of the disease, and the indu¬ rated, lumpy, or knotted lesions within the gland structure, of course point strongly to the malignant or cancerous nature of the disease, the existence of which cannot be doubted.