The present state of our knowledge respecting the connection between eczema and an affection resembling eczema of the nipple, and a malignant disease of the breast / by Walter F. Atlee.

  • Atlee, Walter F. (Walter Franklin)
Date:
[1884?]
Catalogue details

Licence: Public Domain Mark

Credit: The present state of our knowledge respecting the connection between eczema and an affection resembling eczema of the nipple, and a malignant disease of the breast / by Walter F. Atlee. Source: Wellcome Collection.

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    Article XVII. The Present State of our Knowledge Respecting the Connection BETWEEN Eczema and an Affection Resembling Eczema of the Nipple, and a Malignant Disease of the Breast. By Walter E. Atle^A.M., M.D., of Philadelphia. In the St. Bartholomew’s Hospital Reports^ for 1874, is the often re¬ ferred to paper of Sir James Paget, entitled “ On Disease of the Mammary Areola preceding Cancer of the Mammary Gland.” The whole paper is very little over two pages in length. He says:— “ I believe it has not yet been published that certain chronic affections of the skin of the nipple and areola are very often succeeded by the formation of scir¬ rhous cancer in the mammary gland. I have seen about fifteen cases in which this has happened, and the events were in all of them so similar that one descrip¬ tion may suffice. “The patients were all women, varying in age from forty to sixty or more years, having in common nothing remarkable but their disease. In all of them the disease began as an eruption on the nipple and areola. In the majority it had the appearance of a florid, intensely red, raw surface, very finely granular, as if nearly the whole thickness of the epidermis were removed; like the surface of very acute diffuse eczema, or like that of an acute balanitis. “ From such a surface, on the whole or greater part of the nipple and areola, there was always copious, clear, yellowish, viscid exudation. The sensations were commonly tingling, itching, and burning, but the malady was never attended by disturbance of the general health. I have not seen this form of eruption ex¬ tend beyond the areola, and only once have seen it pass into a deeper ulceration of the skin after the manner of a rodent ulcer. “In some of the cases the eruption has presented the characters of an ordinary' chronic eczema, with minute vesications, succeeded by^ soft, moist, y^ellowish scabs or scales, and constant viscid exudation. In some it has been like psoriasis, dry, with a few white scales slowly' desquamating; and in both these forms, especially' in the psoriasis, I have seen the eruption spreading beyond the . I'cola in widen¬ ing circles, or, with scattered blotches of redness, covering nea'dy the whole breast. “I am not aware that in any' of the cases which I have seen tlie eruption was different from what may' be described as long persistent eczema, or psoriasis, or by some other name, in treatises on diseases of the skin ; and I believe that such cases sometimes occur on the breast, and after many months’ duration are cured, or pass by, and are not followed by' any' other disease. But it has happened that in every' case which I have been able to watch cancer of the mammary' gland has followed within at the most two years^ and usually one year. The eruption has resisted all the treatment, both local and general, that has been used, and lias continued even after the affected part bf the skin has been involved in the can¬ cerous disease. “The formation of cancer has not in any case taken place first in the diseased part of the skin. It has always been in the substance of the mammary' gland, beneath or not far from the diseased skin, and always with a clear interval of ajyparently healthy tissue. “In the cancers themselves, I have seen in these cases nothing peculiar. Thev have been various in form ; some acute, some chronic, the majority following an average course, and all tending to the same end: recurring if removed, alfecting lymph-glands and distant parts, showing nothing which might not be written in the ordinary history of cancer of the breast. “The single noteworthy fact found in all these cases is that which I have stated in the first sentence, and I think it deserves careful study. For the No. CLXXIV.—April, 1884. 31