Diagnosis and therapy in the eighteenth century

Abstract

Clinical diagnosis of breast cancer was easy in the many instances where patients presented themselves with an ulcerating, foul-smelling defect and complaining of intolerable pain. Van Swieten was amongst those who have left us with gruesome descriptions of such cases. If the lump had not yet penetrated the skin, the chief consideration was, of course, to distinguish between benign or malignant types of scirrhus and between scirrhus and scrofula — tuberculosis of the breast being by no means a rare occurrence at the time.⁹³ It was also important to decide whether the tumour had a local origin — trauma, inflammation, milk retention — or whether it resulted from an internal cause, such as a general corruption of humours, suppression of menstruation or melancholy. The occurrence of itch, burning and pain, especially of the lancinating type in a previously painless lump was an almost pathognomonic symptom announcing a turn towards malignancy. Some authors, for example van Swieten, mention anosmia as a typical symptom.¹²²