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.

    5/10 (page 3)
    tained a little albumen, and after that time no abnormality was detected. The specific gravity varied from 1024 to 1002. The sutures in the abdominal wall were removed eight days after the operation, and the wound healed well. On November 9, 1893, nearly a year after the operation, the child was still slightly aneemic, but otherwise healthy and well developed. Urine was secreted freely. A specimen examined at this date was acid, and contained no albumen. Its specific gravity was 1019, and nothing abnormal was de- tected in it by microscopic examination. The whole abdomen was soft and natural in every respect. The scar was three and three quarter inches long, firm, strong, and free from any sign of irritation. The measurements were as follows, and I give also for compai’ison those of the day before the operation. Nov. 14,1892. Nov. 9, 1893. Inches. Inches. Circumference at umbilicus ... ... ... 21 19 Ensiform cartilage to umbilicus 5 4£ Umbilicus to pubes ... ... ... ... ... 4 4 Right anterior superior iliac spine to umbilicus ... 6 3£ Left anterior superior iliac spine to umbilicus ... 4^ Thus, although the child was a year older, all the measure- ments, except that from the umbilicus to the pubes, were shorter at the later date. On January 25, 1894 (and on going to press), Dr. Marshall reported the child to be “ in perfect health ” and well grown. The tumour (see fig.) has been added to the museum of the Royal College of Surgeons (No. 3597E). It consists of an oval mass measuring six inches vertically and four inches from side to side% The posterior half of the kidney is appa- rently normal, while the anterior portion is partly replaced by, and partly expanded for a short distance over, the neo- plasm. Mr. Targett has kindly prepared some microscopic specimens, and his description of these is as follows:— “ Specimens were taken from the margin of the growth, and included a portion of healthy kidney substance. The latter was separated from the growth by a zone of dense fibroid tissue which formed a capsule to the tumour. Micro- scopically the tumour was composed of tubes cut in various directions and closely packed together. They varied con- siderably in size, but there appeared to be no special arrangement of large and' small tubes. The majority had a definite lumen, but to some (and these were chiefly the smaller collections of cells) the term tube was hardly applicable, as no lumen existed in them. The stroma of the growth was