The Lettsomian lectures on the affections of the urinary apparatus in children / by John H. Morgan.

  • Morgan, John H. (John Hammond)
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: The Lettsomian lectures on the affections of the urinary apparatus in children / by John H. Morgan. Source: Wellcome Collection.

    18/74 page 14
    Athough not arising in or directly connected with tlie kidney, other congenital cysts are found to occur in the neighbourhood which might be confused with those with which we are now concerned. Such are the various forms of mesenteric cj'sts described by Mr. Treves in his work on surgery, and others related by Mr. Moynihan,* one of which occurred in a girl, aged 6 years, and was multilocular ; and two others are described in the Annals of Surgery,’ June, 1897, one of which occurred in a child, aged 4 years, and another in a boy, aged 8 years, which attained enormous size. It was twice tapped, and finally removed, when it was found to be multilocular, and attached to the great omentum by its entire width below the margin of the transverse colon, within the folds of which the cyst had developed. Two interesting cases in which the cysts were removed have recently been related by Mr. Eve in a paper read before the Eoyal Medical and Ohirurgical Society. In a congenital hydronephrosis there is one sign which only occasionally is given, but which is definitely reliable as indicating the nature of these tumours, viz., the sudden subsidence of the swelling followed by an increase in the flow of urine. If the dilatation becomes sufficient to form a tnmour, which it may do at any time between the third and eleventh year, or even later, the necessity for surgical interference will arise, partly as a means of diagnosing the exact nature of the swelling and partly to relieve the patient of the inconvenience and sometimes even of the pain and the effects of pressure upon the intestines which occasionally result. A trial may first be made of systematic rubbing, which was successful in the case of a girl, aged 8 years, under the care of Sir William Roberts, who suddenly passed a large quantity of urine, when the swelling subsided and did not return. The same treatment was temporarily successful in a child, aged 3 months, under the care of Sir William Broadbent, and in a third case, under the care of Mr. Thurnam, in a boy, aged 4 months. But where this treatment is not available, either on account of the pain caused or the risk of rupturing the cj'sb, the fluid must be withdrawn by the aspirator or trocar. In the absence of any very distinctly fluctuating area, Mr. Morris directs that in the case of the left kidney the puncture should bo made just anterior to the last intercostal space, whilst on the right * ‘Annuls of Surgery,’ July, 1897.
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