CASE OF ACNE ROSACEA, 
OR 
HYPERTROPHICA. 
OUTGROWTHS REMOVED 
BY 
OPERATION, 
BY 
CLINTON WAGNER, M. D., 
Physician to the Metropolitan Throat Hospital, New York. 
(Reprinted from the Archives of Clinical Surgery, July, 1876.) 
NEW YORK: 
Rutl edge &: Co., Publishers, 102 West Fortv-Nintii Street, 
1876. CONTRIBUTORS 
TO THE 
ARCHIVES OF CLINICAL SURGERY. 
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and others. CASE OF ACNE ROSACEA, 
OR 
HYPERTROPHICA. 
OUTGROWTHS REMOVED 
BY 
OPERATION, 
BY 
CLINTON WAGNER, M. D., 
Physician to the Metropolitan Throat Hospital, New York. 
(Reprintei from tie Arcliyes of Clinical Surgery. My. 1876.) 
NEW YORK: 
Rutledge & Co., Publishers, 102 West StSe'et, 
1876. CASE OF ACNE ROSACEA. 
OR HYPERTROPHICA. 
Outgrowths Removed by Operation. 
BY 
Clinton Wagner, M. D., 
Physician to the Metropolitan Throat Hospital, New York. 
Case of W. M., aged fifty-three, native of Alsace, but since i85i a 
resident of this country, short in stature, very stout and of full habit; 
occupation, wine merchant; has also followed the vocation of seaman, 
and during the rebellion served as lieutenant in a New York regiment; 
was admitted into the Metropolitan Throat Hospital, August 8, 1875; 
his nose was covered with growths as represented in Plate 1; livid in 
color; and cold, clammy, and greasy to the touch; the two largest at- 
tached respectively to the right and left ala were pedunculated, and 
interfered seriously with the act of taking food and drink. The others 
were sessile, the large one upon the ridge of the septum, broad and 
flattened. Neither the cartilages externally nor the mucous membrane 
internally were involved. He stated that small swellings or lumps 
first appeared upon his nose as far back as 1868. No increase in size 
was perceptible until 1872, when they began to enlarge and in a short 
time attained the volume they presented at the time of consulting me for 
treatment. He has been an habitual drinker for many years of the light 
claret and white wines of France, but not addicted to indulgence in 
spirituous liquors or beer. 
In the operation for the removal of the tumors, the pedunculated 
ones were divided close to the cartilage. From the large one on the 
right ala copious hemorrhage ensued from quite a large vessel; it was 
readily controlled however by torsion. From the sessile growths slices 
were taken by elliptical incisions and the remainder of the hypertro- 
phied tissue dissected out from under the surface of the infiltrated skin, 
care being taken to leave sufficient flap to cover the cartilage. The edges 4 
CLINTON WAGNER, 
of the wounds were brought together by fine silk sutures, about fifteen 
being required. Under simple dressings rapid healing followed. 
The portions removed weighed five hundred and ten grains. At the 
present time, nine months after the operation, there is no evidence of 
a return of the disease. Plate 2. The following observations upon the 
histology of this very rare form of Rosacea, together with the report of 
the microscopical examination of the growths removed from this case, 
are taken from Dr. Piffard’s recent work on “Diseases of the Skin.” 
Plate No. i. 
“Histology.—The histological processes in Rosacea are probably 
the same as occur in chronic congestive and inflammatory states else- ACNE ROSACEA—OUTGROWTHS REMOVED. 
5 
where. In the third stage, which alone I have had an opportunity of 
examining microscopically, I have found great thickening of the cork- 
um with development of new connective tissue and enlargement of 
the blood-vessels, principally the veins. The sebaceous glands were 
many of them enlarged, sharing with the other elements of the skin 
the common hypertrophic tendencies. They did not appear, how- 
ever, to have undergone any qualitative changes, with the exception 
that some of them were filled with impacted sebum. Small cell 
Plate No. 2. 
infiltration occurred to a limited extent along the course of the 
vessels. 
In a specimen from a case of excessive enlargement referred to me 
by Dr. C. Wagner for microscopical examination, in which the por- 
tions removed weighed about four hundred and forty grains, I found 
the following changes: The stratum corneum was exceedingly scant, 
consisting at most of but one or two layers, and in some parts entirely 
absent. The stratum Malpighii was very thick, with mostly large and 6 
CLINTON WAGNER, 
well formed cells. In some parts, however, the nuclei were shrunken 
and deformed, or entirely absent, leaving vacuoles. The papillae were 
enlarged in length and breadth, and contained many round and fusi- 
form cells. The sebaceous glands were not much altered except that 
the nuclei of the cells were indistinct, and did not imbibe carmine 
readily. In many cases the nuclei were shriveled or absent. The 
margins of the cells were irregular. Some of the glands were normal, 
but the others were undergoing degenerative, not hyperplasic changes. 
The derma was very greatly thickened, but presented the aspect of an 
adult tissue, and not one in the course of formation. There were a 
few round and spindle cells, but immature connective tissue was not 
seen. The lesion, on the whole, appeared to be a pure hypertrophy 
of the dermal connective tissue, manifested by an increase in the num- 
ber, but not in the size of its elements, with degeneration of the 
glands, probably from pressure.” 
A microscopical examination of the specimen was also made by Dr. 
E. B. Bronson, with the same result as obtained by Dr. Piffard. 
The accompanying wood cuts are from photographs. ARCHIVES 
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