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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    incorporated with the neighbouring structures, so as to be absolutely immobile,- being also of very rapid growth, and accompanied by extreme emaciation. Such cases are obviously unsuitable for surgical interference. It does not follow, however, that these latter conditions indicate an advanced stage of the more defined, more mobile, and more slowly growing tumours. The evidence seems rather to show that the symptoms, sometimes at least, depend on the nature of the growth, and that the cases are favorable or unfavor- able for surgical treatment from the first. Although I incline to the belief that the structure of the growth in the case under consideration is a principal factor in the success which at present attends the treatment, yet the methods of operating on such tumours are also worthy of our close attention. It may be questioned whether I was justified in prolonging the operation and running the risk of damaging important structures by attempting to remove glands which were not obviously diseased, especially in view of the fact that the tumour might fairly have been presumed to be a sarcoma, and therefore probably would not tend to spread along the lymphatics. I could, however, only decide what to do by the naked-eye conditions observed, and the glands near the kidney were certainly enlarged and hard. Moreover the records seem to teach that if a surgeon undertakes to perform this operation he should do it in a most thorough fashion. In spite, therefore, of the fact that no distinct evidence of disease has been found by microscopic examination of the lymphatics which I removed with the tumour, if I should meet with a similar case in the future I would certainly take away as many of the glands as possible. It was also in view of the intensely malignant character of these growths that I endeavoured to avoid opening the cap- sule of the tumour, and to remove all vestiges of it which had accidentally been separated. The importance of this point has been strongly urged by Mr. Knowsley Thornton. On the other hand, Mr. Henry Morris and Mr. Bland Sutton advise that in operating on solid tumours of the kidney the surgeon should cut down on the growth, should carefully open the true renal capsule, and should enucleate the tumour from within it. When we have to deal with a growth which is probably malig- nant, and which is surrounded and sharply defined by a firm fibrous capsule—if we have a choice between, on the one hand, enucleating the growth from within its capsule, and, on the other hand, removing the growth and its capsule without