A lecture on chronic and tuberculous mastitis : being a portion of the Hunterian lectures on 'Certain diseases of the breast' delivered before the Royal College of Surgeons of England / by Henry B. Robinson.

  • Robinson, Henry Betham, 1860-1918.
Date:
1892
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Credit: A lecture on chronic and tuberculous mastitis : being a portion of the Hunterian lectures on 'Certain diseases of the breast' delivered before the Royal College of Surgeons of England / by Henry B. Robinson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ]4 case of L. B. (Sir William MacCormac), the breast, the seat of an old abscess, became enlarged in the space of a few weeks, giving an isolated swelling, skin adherent with some pain, but no enlarged glands. Its acute development suggested cancer, and accordingly the breast was amputated; but to the naked eye on section it was evidently a chronic suppurative mastitis, and on histological investigation it proved to be tu- bercle. Rcclus* 11 quotes the following to prove the diffi- culty :— 1. A woman, aged 40, with a tumour the size of an egg, without any definite margin. It had a bossy surface, and was of woodeny hardness. The skin was involved and puckered, and the axillary glands were en- larged. So certain was the diagnosis of cancer from these facts, that the operation had been fixed, when a sudden haemoptysis took place; the tumour itself later on softening, with discharge of curdy pus. 2. After weaning three years before, a tumour formed in the outer part of the breast, bossy and infiltrating. During the next pregnancy it in- creased in size, but quite painless. There was no fluctuation ; the skin was puckered and the axillary glands enlarged. This appeared to be a carcinoma, but, on going into the history, she had had haemoptysis. Her age—30—suggested the possibility of tubercle, which was confirmed by an examination of the apices, and, on inquiry, history of haemoptysis was obtained. 3. Dubar. describes a case for diagnosis. The woman, aged 23, was strumous. Ten months after weaning, a lump, the size of an almond, was discovered at the upper and outer part of the breast. This in- creased in size, and the nipple became retracted and the skin adherent. From her strumous appearance, tubercle was considered, and, on inci- sion into this mass, curdy pus was set free. In none of these three cases was there any fluctuation. On the other hand, Habermass had a case which he considered tubercle, but on section it proved to be a case of multiple softening cancer. Prognosis.—When the lesion is secondary to a primary one elsewhere, the prognosis is here not affected, as, owing to the chronicity of the breast disease, the patient’s death is usually brought about by the primary lesion. When the disease is primary, it tends to be progressive locally, to involve axillary glands, etc., or to have lung lesions. Whether it is ever suc- ceeded, if left alone, by acute miliary tubercle, there is no evidence ; such a thing has not been recorded. Judging from analogy of what happens in other organs, such a sequel is very unlikely. Of six cases (quoted by Delbet) seen after oper- ation, two remained under observation for a long time without any recurrence, one recurred after nine months, and another after three years; Wo died of pulmonary phthisis. Owing to the difficulty of tracing hospital patients, the after-history of my quoted cases is almost a blank. One recurred slightly in the scar after a few months, but she has now gone for nearly a year without any recurrence. Should the patient be suckling, this should immediately be stopped, to prevent infection of the infant. This pathological lesion has its analogue in the tuberculous mammitis of cows. Koch12 writes it is certain that the milk of tuberculous cows may give rise to infection, and is of opinion that, un- less the udder is diseased, the milk will contain no bacilli, and is not infective. In the cases that have come under my notice, cultivations have not been made, and I have no suffi- cient evidence to offer as to the effect of the milk on the 11 Clin. Chir. de VIIotcTDicu, 1888.
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