"Neutral Proflavine Sulphate" in Infected Wounds involving Bone
Authors: J. F. Heggie, G. B. R. Warnock, R. W. Nevin
Journal: BMJ (1945)

Local amputation of the breast in young women produces a very unsatisfactory state of affairs.The patients become introspective, worry a lot, and tend to become chronic invalids.Many drift to the out-patient departments of the neurological hospitals.I have case reports of 20 unmarried women under 30 years of age who have been subjected to local removal of one or both breasts because of a history of a blood-stained discharge from the nipple.These women are afraid to marry because they consider that they are not normal.This-state of affairs must not be allowed to continue, as it means a life of constant misery.The following up of operation cases is most important if we are to get a clear idea of the real value of conservative sur- gery.Of my 52 cases of duct papilloma of the breast I have follow-up" records of 35; six patients are abroad and I cannot trace them.However, the clinical history of three cases will show the real advantage of conservative surgery for duct papilloma. Case HistoriesCase 1.-A nurse, aged 24, who had just finished her training in a London hospital, was seen in July, 1915, with a history of a blood-stained discharge from the left breast for some nine months.Nothing could be felt on examination and no discharge was visible from the nipple.The patient was told to come and see me when there was any further discharge from the nipple.In Sept., 1915, she came again, and a small cystic lump could be felt just lateral to the nipple in the lower and inner quadrant of the breast.A slight blood-stained discharge could be expressed from the nipple.Operation was undertaken, and a small intracystic papilloma was excised.The papilloma had a definite stalk, and microscopically was quite innocent.The patient left hospital a week later.She was seen in 1919 before her marriage, as she was concerned about the effect of pregnancy on the breast.The breast was quite normal, and there had been no discharge from the nipple since the operation.The patient was reassured that no ill effects would supervene if pregnancy took place.She was seen again in 1936 because of cholecystitis due to gall-stones.She had five children-three boys and two girls-and had breast-fed all of them without any difficulty whatever.. Cholecystectomy was carried out in July, 1936, and recovery was uneventful.Case 2.-A married woman aged 32 was seen in Jan., 1920; she was sent to me to have her right breast removed because of an intermittent blood-stained discharge.She was a big woman with large firm breasts.A small lump the size of a pea could be felt in the lower and outer quadrant of the breast.She was prepared to have the breast removed, but was advised to undergo excision of the lump instead.Local excision of the papilloma was carried out and the growth was found to be innocent.The patient was last seen in 1939, when she was in good health; the breast was quite normal, although somewhat atrophic.Her periods had stopped some three years previously.Case 3.-An unmarried woman, aged 26, a well-known golfer, was seen in 1922 because of a blood-stained discharge from the left nipple.There was little to make out on clinical examination, and the patient was told not to worry and to forget about her breast.She was seen in 1923 and again in 1924, and on neither occasion could anything be felt in the breast, although there was a slight intermittent discharge of blood-stained fluid from the nipple.When seen in May, 1925, a small lump could be felt in the lower part