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Un dea symbolaa suivants apparattra sur la darnlAre image de cheque microfiche, selon le cas: la symbola — »• signifie "A SUIVRE", le symbols ▼ signifie "FIN". Mapa, piatea, charta, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one expoaura are filmed beginning in the upper left hand comer, left to right and top to bottom, aa many framea aa required. The following diagrams illustrate the method: Les cartea, planches, tableaux, etc., peuvent Atre filmia h dea taux da rAduction diff Arents. Lorsque le document est trop grand pour Atra raproduit en un seul clichA, il eat filmA A partir de Tangle supArieur gauche, de gauche A droite, et de haut an baa. an prenant le nombre d'images nAcessaire. Lea diagrammas suivants illustrent la mAthoda. % a 3 1 2 3 4 5 6 ^f Not e on the Diagnosis, by Means of the Microscope, of Paget's Disease of the Nipple and Breast. BY DR. A. B. MACALLUM, Lecturer in Physiology, University of Toronto. Reprinted from The Canadian Practitioner, October i6, 1890, by The J. E. Bryant Co., Ltd., 58 Bay Street, Toronto. »i •I NOTE ON THE DIAGNOSIS, BY MEANS OF THE MICROSCOPE, OF PAGET S ' DISEASE OF THE NIPPLE AND BREAST. HY DR. A. B. MACALLUM, Lecturer in Physiology, University of Toronto. In Paget'.s disease the carcinomatous condi- tion of the breast is generally supposed to follow on a long-standing affection of the surface of the nipple, which is comparable in certain respects to chronic eczema, but which, on histological ex- amination, presents characters not observable in the latter trouble. As the usual methods of treatment for eczema are useless here, it is of im- portance at the outset to determine whether the case in hand is ordinary eczema or the disease in question. The ordir-'ry methods of diag- nosis have been hitherto purely c^jnical : the long duration of the supposedly eczematous con- dition, the infrequent itching, the feel of the nipple like a coin under a cloth, etc. Recently Darier and Wickham have proposed a new test,"**" *Darier— Comjjtes Bendus de la Societe de Biologie de Paris of the 13th April, 1899. Wickham— Archives de Medicine Experimentale, J&uuary, 1890 ; also his monograph, Maladie de la Peau dite Mala- die de Paget, Masson, Paris, 1890. See also Prof. R. Ramsay Wright's lecture on Sporozoa, 4'nAcTiTioNEB, January, 1890. which, on account of its easy application, may diminish the importance of the other means of diagnosis. Itdependsontheoccurrence inside the epithelial cells in the afifected part of peculiar ele- ments, which are considered by these observers as parasitic sporozoa (or psorospermiae) and the condition of the nipple is, accordingly, from their point of view, a case c)f psorospermosis. The bodiesare usually found in, but not confined to, the lower layers of the epidermis, in the " eczematous " part, and they may be observed in the cells filling up the galactophorous ducts. They are usually large, and they may, accordmg to Darier, measure in diameter from o:ie-third to even one-half the thickness of the stratum mu- cosum of the epidermis where they are placed. If now, one of the small crusts or scabs from the diseased nipple, examined with appropriate methods of preparation under the microscope, should be found to contain the bodies in question in greater er less abundance, the diagnosis of Paget'sdiseaseis, these authorsclaim, established, I have had two cases of Paejet's disease of the breast for examination, and from one case — that of Dr. Burt's, of Paris, Ont. — I made a large number of sections, which furnished all the material necessary for a full study of these bodies. Tn the second case, which was under the care of Dr. Primrose, in the Toronto (Gen- eral Hospital, I had the privilege of examining after Darier's method, slightly modified, the dis- ease of the unremoved breast, and found there as m the first case, the bodies in question. Fig- ures I and 2 are drawn from preparations so made from Dr. Primrose's case. ML. (Fig. I.) EXPLANATION OF FIGURES. Fig. i.~a, b, c, d, e, examples of isolated epith- elial cells with endocytes ; «, the pushed-aside nucleus of the epithelial cell ; in b, the endocyte has two nuclei ; end, the endocyte, sh, its refract- ing membrane ; in / the endocyte has under- gone a process of degeneration and disintegra- tion. X 500. (Fig. 2.) Fig. 2. — A gro'ip of epidermal cells with endo- cytcs, end^ n^ the nucleus. In one cell there are several endocytes {end') present within the same membrane, x 500. As these structures and analogous intracel- lular forms in epitheliomata are likely to be the subject of a great deal of interest in the near future ; and moreover, as the views of Darier and Wickham, as to their nature, may not be endors.d by all pathologists, it is convenient to have a name for them which will express no preference for any particular theory. I have, therefore, selected the term endocyte* which is both readily applicable and intelligible, and it will, I hope, serve the purpose until the question *Endon within, and liutos a vesicle or cell. 7 of the nature of these bodies is satisfactorily solved. Darier's method was either to mount the crusts on the slide in water under a cover glass, and study them v/ith a moderately high-power objective, or, better, to tease out a crust on the slide in Gram's iodine solution, and examine as before. When more or less fat is present, it is removed by placing the crust for several hours in a io% solution of ammonia. The mechod which I adopted was somewhat different, and had the advantage, also, of making a permanent preparation. The crust, or a portion scraped from the nipple, was teased out in a drop of tincture of iodine on ihe slide, the cover glass put on, and after a couple of minutes a drop of 50% glycerine run in. The alcohol and the iodine fix the endocytes, and the iodine gives them a brown, yellow tint, which fades slowly in gly- cerine. In the preparation from Dr. Primrose's patient, there were not a large number of free cells, with endocytes enclosed, although forms like those of Fig. i were met with ; but the most unmistakable evidence of the occurrence of the endocytes was furnished by some of the unteased portions themselves (Fig. 2). Here they were readily seen with their clear, hyaline membrane, in a great majority of the cells, whose nuclei frequently appeared pushed to one side and crescentic in outline. 8 In an examination of the sections made from the excised breast of the same case, there were found a large number of endocytes in the epith- elial cells, covering the retracted nipple, as well as in those filling the ducts. As already stated, endocytes are present in epitheliomata, but less abundantly ; and they have rarely the cystic membrane, and the large size found in those of Paget's disease, and they occur, moreover in the central cell of the " nest," which fact readily distinguishes them from those now under consideration. I leave the question of the nature of the endo- cytes for discussion in a future paper.* Although not endorsing fully the views of Darier and Wickham with regard to them, I have no doubt whatever of their great value in the diagnosis of Paget's disease, whether of the nipple or of any part of the skin. *To appear as one of the memoirs of the Pathological Society of Toronto.