BMJ 1996; 313 doi: (Published 20 July 1996) Cite this as: BMJ 1996;313:142
  1. W F Paveley

    A palpable success

    Many years ago a young mother came to see me. At the end of the consultation she made one of those “seeing I'm here, doctor” requests for me to look at her baby's nappy rash. Normally I would deal with this while the baby sat on the mother's knee, but for some reason I asked her to lay the baby on the examination couch. On partially unclothing the baby I was able, quite easily, to confirm the mother's diagnosis. While discussing the management of the rash I, almost absentmindedly, laid my hand on the baby's abdomen—probably to soothe my little patient. I was amazed and appalled to feel a mass occupying almost half of the left hand side of the abdominal cavity. I immediately referred the baby to the paediatric hospital department with a gentle and, I hope, diplomatic suggestion that palpation of the baby's abdomen should be kept to the absolute minimum. The following day a large Wilm's tumour was successfully removed.

    Some years later my young patient proudly presented me with a first year school photograph. This lay in the top drawer of my desk for many years until I retired a few years ago.

    I often wondered what the outcome would have been had I not so fortuitously and almost casually laid my hand on the baby's tummy.—W F PAVELEY is a retired general practitioner in Derby

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