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.

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    Dr. Money,* 60 cases were collated. Forty of the number died under the age of 6 years, and 20 under that of 2 years. The sexes again were equally affected. Similar evidence is given by Mr. Taylor and other writers, and it would seem established that these tumours are most frequent during the first five years of life, and are fairly equally distributed between the sexes, and perhaps occur rather more often on the left side than on the right. The ^ O Size to which they may attain is enormous. In the Middlesex Hospital Museum is a specimen which was removed from the body of a boy, aged 8 years, which weighed 31 lbs., and one was reported by Sir Spencer Wells as having weighed from 16 lbs. to 17 lbs. The mean duration of the disease, according to Sir William Roberts, is, in children, nearly seven months, the minimum 10 weeks, and the maximum over a year. The course of the disease appears to be longer the older the child. Although some of the earlier cases are described as encephaloid it may be taken that the greater majority are sarcomata, though Birch-Hirschfeld and Mr. Sutton found adenomatous tissue in a large number, and the conclusions concerning them, which are summarised by Mr. Paul in an admirable paper,f may be accepted ]n full:—(1) That these tumour’s show themselves generally •during the first few years of life, and are probably invariably of congenital origin ; (2) they are primarily extrarenal, though usually extracapsular, and distend and surround the kidney in preference to invading it; (3) they rarely cause marked urinary symptoms or much pain, death ensues from exhaustion or from pressure effects; (4) occasionally they give rise to metastatic growths, some infiltrate the kidney, all recur after removal; and (5) they frequently contain striped muscular fibre and embryonic renal tissue. Such growths he classes under one general title as congenital renal tumours closely allied to dermoids in origin. Considering the almost invariable malignancy of these tumonrs, probably such a clinical title is as good as any that can be found, and no great advantage is to be gained by naming them according to the prevailing cell elements, whether they be round or spindle shaped. The last variety, in which striated muscle appears, deserves, however, some special identification. Muscle fibres are found in connection with tumours of other organs, such * ‘ Transactions of the Medical Society,’ vol x. t ‘ Livei'250ol Medical and Chirurgical Journal,’ January, 1891.