Nephrectomy (successful after fourteen months) for malignant tumour in a patient under two years of age / by John D. Malcolm.

  • Malcolm, John David.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Nephrectomy (successful after fourteen months) for malignant tumour in a patient under two years of age / by John D. Malcolm. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    * N f- Reprinted from Vol. XXVII of the ‘ Clinical Society’s Transactions .’] / * 2U -M.fr-*-- \ ' +/ Nephrectomy (successful after ^'fojjfteen months) for Malignant Tumour mSn pmffmt under two years of age. By John D. Malcolm, M.B., C.M. Read January 26, 1894. THE child, whose history I bring before the Society this evening, was placed under my care by Dr. Marshall, of Barnes, and Mr. Knowsley Thornton. She had a healthy family history, and was herself strong and well developed. It had been noticed that she had a “ full belly ” when she began to walk, before she was a year old. This was not thought to be of consequence till a definite swelling was felt in the right side six months later. The swelling steadily in- creased in size, and the child became less strong and lively, but she did not seem to suffer any pain. When admitted to the Samai’itan Free Hospital on November 7, 1892, the child was rather pale, but all her functions seemed in good order. The nurses were not able to collect the urine for twenty-four hours together. It was, however, secreted freely, and no abnormality was discovered in it. Its specific gravity varied from 1010 to 1018. The abdomen showed a bulging out of the surface over the whole of the right flank and hypochondrium, and well forward into the lower umbilical and hypogastric regions, where the outline of a rounded tumour was distinctly seen. The super- ficial veins on both sides were distended, especially towards the groins. On palpation, a well-defined, elastic, painless tumour, approximately oval in shape, and scarcely, if at all, moveable, was felt filling the right loin, and passing slightly beyond the middle line below the navel. It was close to the right lobe of the liver above, and extended towards the pelvis to below the level of the anterior superior iliac spine. On percussion the note was dull on the outer side of and behind the tumour, and over the most prominent part in front. The area of resonance overlapped the left side of the tumour so as to form two pointed projections, one between the abnormal dulness and that of the liver, and the other between the dul- ness of the tumour and Poupai’Fs ligament. On consultation with Sir Spencer Wells and Mr. Knowsley Thornton, a renal tumour was diagnosed, and its removal was