Compliments of the Author Case of Sarcoma of the Kidney in a Negro Child y BY W. H. GEDDINGS, M. D. C. REPRINT FROM VOLUME II (5 ji ideological 1878 A CASE OF SARCOMA OF THE KIDNEY IN A NEGRO CHILD. BY WILLIAM H. GEDDINGS, M. D., Aiken, S. C. September 21, 1876. Miley Hankerson, negro, aged three years, of healthy parents. About a month ago the mother noticed, for the first time, an enlargement of the abdomen, which has since steadily increased in size. The child ap- pears to be well nourished, eats heartily, and does not com- plain of pain or even discomfort. The abdomen is greatly distended, more so on the left than the right side. There is dullness on percussion over the whole of that side, except low down in front, where the sound is tympanitic. Palpation reveals a hard swelling with smooth surface, but not entirely even, as quite a large nodule may be felt slightly protruding from the main growth, and apparently a part of the same. The growth rises from the pelvis, ter- minating under the false ribs. There is nothing in the history of the case to show that the child has ever had in- termittent fever. The case was seen by Dr. Edward Ged- dings, and Dr. T. G. Croft, in consultation with me, and we agreed that the growth was one of three things; sarcoma, medullary carcinoma, or a splenic tumor. The latter being excluded by the history of the case, and by the fact that malaria does not exist in this region, the diagnosis lay be- tween sarcoma and medullary carcinoma. It should have been previously stated that the absence of anything like fluctuation, even without the marked hardness, excluded all idea of its being a cyst. There being no rational indica- tions for treatment, the child was ordered good nutritive diet, with quinine and iron. The case presented nothing 2 SARCOMA OF THE KIDNEY IN A NEGRO CHILD. of interest from this date to the death of the patient, ex- cept the extremely rapid growth of the tumor, which soon attained the enormous proportions portrayed in the accom- panying heliotype. With the increase in the size of the tu- mor, the appetite of the patient became ravenous, so much so that the mother frequently had difficulty in finding food sufficient to appease her insatiable hunger. Notwithstand- ing the large quantity of food consumed, emaciation pro- gressed rapidly, and .the legs became so reduced in size that the child could with difficulty sustain the heavy weight of the tumor; still she managed to move round until two days before her death. Despite its size, the growth did not in any way interfere with defecation, the bowels being quite regular throughout the whole illness. Unfortunately no examination of the urine was ever made, but, after the au- topsy had revealed the true nature of the case, the mother remembered that the urine, which was frequently voided on the floor, presented in the earlier stages of the disease a milky appearance, and left a glazed stain on drying. The only measurement recorded was made on the 22d of April, about three weeks before the death of the child, at which time the abdomen measured twenty-nine inches in circumference. Death occurred from exhaustion at the age of three years and nine months, on May 14. Autopsy thirteen hours after death. The body was much emaciated, the abdomen enormously distended by a large and irregular growth, the distention being greater on the left than the right side. On the right side there was a slight protrusion about the size of a man’s fist. In the cavity of the abdomen there was a large tumor with two outgrowths, the one extending upwards towards the stomach, and the other downwards in the direction of the pelvis. The surface of the tumor was smooth, of a yel- lowish color, with large vessels coursing over it, the latter being much distended with venous blood. Several small cysts were seen on its surface. Across its anterior lower portion, and firmly attached to it, was the transverse colon ; WILLIAM H. GEDDINGS. 3 hence the tympanitic sound observed during life in that situation. The whole tumor was bound down by adherent peritoneum, its upper surface firmly attached to the stomach, while posteriorly it was bound by adhesions to the structures in the neighborhood of the vertebral column. The spleen was somewhat compressed, but otherwise healthy. The genital organs were normal. The bladder contained a small amount of clear urine ; both ureters were in position, the right normal in appearance, and extending to the corre- sponding kidney, which was enlarged but otherwise healthy- The left ureter, however, was surrounded by vessels dis- tended with blood. Soon after issuing from the bladder it was lost in the substance of the tumor, in which no trace whatsoever of the kidney could be found. The peritoneal cavity contained about eight ounces of clear fluid. The tumor, after removal, measured eleven inches in its longest, and eight inches in its shortest diameter, not including the nodules. The weight of the whole mass was thirteen and a half pounds. On dividing the tumor in its longest diameter, the cut surface presented a rough, uneven surface of a grayish yel- low color, semi-transparent, but more opaque and yellow in the older portions, which in some places had undergone softening. From the whole cut surface exuded a milky juice. The liver was of normal size, but presented, on its under surface, immediately beneath the capsule, and extend- ing into the substance of the organ, yellow masses about the size of marbles which, when cut, also exuded a milky juice. Dr. J. C. Warren, of Boston, kindly consented to examine the specimen microscopically, and pronounced it to be a sarcoma. TRANSACTIONS OF The American Gynecological VOL I., FOR THE YEAR 1876.' C 400 pages. Many illustrations. *' . The Annual Address by the President, Dr. Fordyce Barker, op Ne w York, and the following papers : — I. Etiology of Uterine Flexures, with the proper mode of treatment indicated. By Thomas Addis Emmet, New York. II. Cicatrices of the Cervix Uteri and Vagina. By Alexander J. C. Skene, M. D., New York. III. Extirpation of the Functionally Active Ovaries for the Remedy of otherwise Incur- able Diseases. By Robert Battey, Rome, Ga. IV. On Central Rupture of the Perineum. By J. Matthews Duncan, M. D., Edinburgh, Scotland. V. Viburnum Prunifolium (Black Haw); its Uses in the Treatment of the Diseases of Women. By Edward W. Jenks, M. D., Detroit, Mich. VI. An Illustration of Xenomenia. By Theophilus Parvin, M. D., Indianapolis, In- diana. VII. Relations of Pregnancy to General Pathology. By Robert Barnes, M. D., Lon- don, Eng. VIII. The Spontaneous and Artificial Destruction and Expulsion of Fibrous Tumors of the Uterus. By W. H. Byford, Chicago, 111. IX. Case of Abdominal Pregnancy, treated by Laparotomy. By T. Gaillard Thomas, M. D., New York. X. Pneumatic Self-Replacement in Dislocations of the Gravid and Non-gravid Utertfs. By Henry F. Campbell, M. D., Augusta, Ga. XI. Hydrate of Chloral in Obstetrical Practice. By W. L. Richardson, M. D., Boston, Mass. XII. Labor Complicated with Uterine Fibroids and Placenta Previa. By James R. Chadwick, M D., Boston, Mass. XIII. Latent Gonorrhea, with Regard to its Influence on Fertility in Women. By Emil Noeggerath, M. D., New York. XIV. Death from Urinemia in Certain Cases of Malignant Diseases of the Uterus. By Alfred Wiltshire, M. D., London, England. XV. Clinical Memoir on some of the Genital Lesions of Childbirth. By William Good- ell, M D., Philadelphia, Pa. XVI. Hermaphroditism. By Lawson Tait, F. R. C. S., Birmingham, England. XVII. Cases of Cystic Tumors of the Abdomen and Pelvis. By George H. Bixby, M D., Boston, Mass. XVIII. Case Uterus Bipartitus; both ovaries removed for the relief of epileptic seizures ascribed to ovarian irritation. By E. Randolph Peaslee, M. D-, New York. XIX. The Origin and History of Calculi found in the Bladder after the Cure of Vesico- Vaginal Fistula by Operation. By Henry F. Campbell, Augusta, Ga. XX. Rare Forms of Umbilical Hernia in the Fetus. By James R. Chadwick, M. D., Boston, Mass. XXI. In Memoriam Gustav Simon. By Paul F. Mund£, M. D., New York. Price of Volume I., $5.00. As contributions to advanced gynecology they exceed in value anything which we have ever before seen collected in any one volume. — N. V. Medical Record. This volume of Transactions is certainly superior to any book of the kind that has been issued by the American Press.— St. Louis Clinical Record. Now we have the first of, we hope, a long row of volumes which will bear comparison with the Transactions of European Societies. Indeed, these must look to their laurels in this noble emulation. — Edinburg Medical Journal. This volume is one of the best collections of gynecological papers that has been published this year. — A nnales de Gynecologic. VOLUME II. 650 pages, 12 chromo-lithographs and many other illustrations. Contains the following papers, with the discussions to which they gave rise : — I. Annual Address, on Medical Gynecology. By the President, Dr. Fordyce Barker, of New York. II. The Functions of the Anal Sphincters, so called. With two wood-cuts. By Dr James R. Chadwick, of Boston, Mass. III. Excision of the Cervix Uteri; its Indications and Methods. With one wood-cut. By Dr. John Byrne, of Brooklyn, N. Y. IV. Report on the Corpus Luteum. With twelve chromo-lithographic plates. By Dr. John C. Dalton, of New York. * V. The Pathology and Treatment of Puerperal Eclampsia. By Professor Otto Spiegel- berg, of Breslau, Prussia. VI. Dilatation of the Cervix Uteri for the Arrest of Uterine Hemorrhage. By Dr. George H. Lyman, of Boston. VII. The Principles of Gynecological Surgery applied to Obstetric Operations. By Dr. A. J. C. Skene, of Brooklyn, N. Y. VIII. On the Necessity of Caution in the Employment of Chloroform during Labor. By Dr. William T. Lusk, of New York. IX. The Present Status of the Intra-Uterine Stem in the Treatment of Flexions of the Uterus. By Dr. Ely Van de Warker, of Syracuse, N. Y. X. Supplement to the report of a case of Xenomenia made at the first Annual Meeting in 1876. By Dr. Theophilus-Parvin, Indianapolis, Ind. XI. A Case of Vaginal Ovariotomy. By Dr. William Goodell, of Philadelphia, Penn. XII. Is there a Proper Field for Battey’s Operation? By Dr. Robert Battey, of Rome, Ga. XIII. Subsulphate of Iron as an Antiseptic in the Surgery of the Pelvis. By Dr. H P. C. Wilson, of Baltimore, Md. XIV. Tetanus after Ovariotomy. By Dr. Theophilus Parvin, of Indianapolis, Ind. XV. Sarcoma of the Ovaries. By Dr. Washington L. Atlee, of Philadelphia, Penn. XVI. The Value of Electrolysis in the Treatment of Ovarian Tumors, as seen in the Light of Recent Experience. By Dr. Paul F. Mund6, of New York. XVII. Congenital Absence and Accidental Atresia of the Vagina; Mode of Operation to Establish the Canal, and to Evacuate retained Menstrual Blood. With three wood- cuts. By Dr. Thomas Addis Emmet, of New York. XVIII. Case of Sarcoma of the Kidney in a negro child. With Heliotype. By Dr. W. H. Geddings, Aiken, S.,C. XIX. The Hystero-Neuroses. By Dr. George J. Engelmann, of St. Louis, Mo. XX. Cases illustrating Important Points connected With Ovariotomy. By Dr. Gilman Kimball, of Lowell, Mass. XXI. The Radical Treatment of Dysmenorrhea and Sterility by Rapid Dilatation of the Canal of the Neck of the Uterus With one wood-cut. By Dr. Ellwood Wilson, of Phil- adelphia, Penn. XXII. Dr. Uvedale West’s Views of Rotation, as illustrated by the Contrast between the Mechanism of Simple Occipito-Posterior Positions and those of the Bregmato-Coty- loid Variety. By Dr. John P. Reynolds, of Boston, Mass. XXIII. Vascular Tumors of the Female Urethra; with the Description of an Instru- ment devised to Facilitate their Removal. By Dr. A. Reeves Jackson, of Chicago, 111. XXIV. Lying-in Hospitals; especially those in New York. By Dr. Henry J. Gar- rigues, of Brooklyn, N. Y. XXV. The Simpler Varieties of Perineal Laceration; their Consequences and Treat- ment. By Dr. Thaddeus A. Reamy, of Cincinnati, Ohio. &XVI. The Cyclical Theory of Menstruation. By Dr. John Goodman, of Louisville, Ky. XXVII. In Memoriam Charles E. Buckingham. With a Heliotype Portrait. By Dr. George H. Lyman, of Boston, Mass. Index of Obstetric and Gynecological Literature of all Countries, from July 1, 1876,10 January 1, 1877. The price of Volume II. is $6.50. The 2 volumes will be sent by mail or express, post-paid, for $10.00. Address, HOUGHTON, OSGOOD & CO., Boston.