|Year : 2000 | Volume
| Issue : 1 | Page : 71-72
A commentary on max wilms
Department of Pediatric Surgery, AIIMS, New Delhi, India
D K Gupta
Department of Pediatric Surgery, AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta D K. A commentary on max wilms. Indian J Urol 2000;17:71-2
| Introduction|| |
Nephroblastoma (Wilms' tumor) is still one of the commonest tumours of infancy and childhood. The 2-year survival of patients with Wilms' tumour was less than 10% in 1920 when surgery was the only modality of treatment available. Due to the addition of radiotherapy in 1950s, the survival started improving and touched to over 50%. In 1960s, with the discovery of Actinomycin and Vincristine, survival of patients with Wilms' tumour has now improved to over 90% for stage I with an overall 80% favourable outcome. This is credited to one of the tumours to have shown such a remarkable improvement over the years with the use of multimodality treatment.
In 1828, a case report (Agnes B., 3 years) resembling nephroblastoma was published in Gairdner in Edinburgh. After about 44 years, Eberth from Zurich described the histology of a tumour and called it "myoma sarcomatodes renum". Subsequently, many articles were published e.g. by Weigert, Cohnheim (1875), Kocher and Langhans (1878) who also called it an adenosarcoma, William Osler (1879) and Ribbert (1898).
The nephroblastoma got its name as "Wilms' tumor" after the legendary German surgeon Max Wilms who gave the first detailed description of Mixed Tumours of Renal Origin for the first time in 1899. Though he was a surgeon, he joined the department of pathology for more than 3 years during the initial years of his career and during this time studied the tumours of renal origin with great zeal and interest.
Legendary Surgeon - Max Wilms:
Max Wilms was born on November 5, 1867 in Hunshoven (Germany) near Aachen, a town near the German, Dutch and Belgian borders. He graduated in medicine from 1886-1890. As was required in those days, he did his compulsory military duty for 6 months (May-November) in 1891 in Cologne, Germany. After that, in 1892 he joined the Department of Pathology of Giessen University where he worked with utmost dedication and started publishing articles on varying subjects like Endocarditis, Gonorrhoea, Teratomas and Dermoid cysts. Subsequently he joined Augusta Hospital in Cologne and got the merit certificate for the commendable services he provided.
In 1897, Max Wilms joined the department of surgery with the great surgeon and the teacher, Prof Fredric Trendelenburg at the Leipzig University. This was one of the coveted positions one could have aspired to those days. It was here that the foundation of his bright career was actually laid. In 1899, Max Wilms delivered his first lecture on "Contusion of Lower Abdominal Organs and their Surgical Treatment". He subsequently wrote articles on various subjects varying from tumours, surgical infections, keloids, amputation, tuberculosis and trauma.
It was in 1899, that he wrote the first part of the "Mixed Tumours of the Renal Origin" in detail. It was highly appreciated. The second part of which was published in 1901 and the third part in 1902. All these volumes expressed new concepts in the kidney tumours and laid the foundation for the recognition of the mixed renal tumours. This is why the name of Max Wilms was associated with nephroblastomas. He was neither the first one to have described it nor was he an expert to treat such tumours. It is also not known as how many tumours did he manage throughout his career.
In 1906, Max Wilms was made full professor at the Liepzig University. It happened on the strong recommendation of his teacher, Prof. Trendelenburg, who liked him very much. Soon enough, he wrote a massive 803-page Surgical Volume with more than 1000 references, all organized in his own handwriting. In April 1907, Prof. Max Wilms joined as the Director of Surgical Department at the Basel University Hospital, where he served for more than 3 years. Here, he established the techniques for subcutaneous ureterostomies and also the primary closure of the bladder with osteotomy. He invented an instrument to approximate the iliac bones to maintain the exstrophy bladder closure. The same principle is followed even now albeit with splints. In 1894, as soon as colour photography was developed by Lumiere brothers in Lyon, Max Wilms started using colour slides for his lectures. This shows how keen and quick he was to accept new ideas and transfer any invention into practice.
In 1910, at the age of 42 years he joined as Head of the Surgical clinic at the Heidelberg University, which was best known for the quality patient care and the surgical teaching throughout Germany. Max Wilms worked very hard with complete devotion and dedication, not only as a surgeon and a teacher but also as a scientist. He was very kind and helpful. He wanted to make best use of the time. He performed the first pyloromyotomy in only 5 minutes and the next two only in 3 minutes each, thus surpassing even Mr. Ramstedt's own record.
Max Wilms was awarded with a number of medals and titles, including the prestigious title "Geheimer Hofrat" in December 1917. He liked and decided to settle down in Heidelberg. He also got his own house built which was quite spacious and beautifully constructed. It was very airy and with landscapes. His house was situated at a walking distance from the University Hospital. His salary was quite good and it was further supplemented by the income he used to earn by running successful practice, delivering lectures and conducting teaching courses. He got married, though late, at the age of 47 years (November 18, 1914) with Else Sefferth from Leipzig. She was not only a loving wife (13 years younger), but also a great help in his day-to-day commitments. His wife lived through the horrors of World War II and died recently in 1974 at the age of 94. Max Wilms, however, had no children.
Max Wilms wrote more than 130 articles, mostly as a single author and with his own pen. The articles used to be simple, informative and substantiated with references. It was difficult to believe how hard he worked during his busy clinic and operations. Was there any time left for him to develop any hobby? Did he like music, did he like arts, did he mend his garden himself, did he attend the dinner parties, and did he share table jokes? All these would not be easy to answer and possibly become more and more difficult to know as time passes.
Max Wilms operated upon a French prisoner for a peritonsillar abscess and contracted diphtheria during the World War I. Though the prisoner was saved, he himself developed septicemia and died on May 14, 1918 at the age of only 50 years within a week of getting infected. Condolences poured in from all corners specially the medical community and the military services. He was taken to Cologne for the burial rites. When Wilms died, the tumour therapy relied mainly on surgery and irradiation. It is not known if he encountered more Wilms' tumours after he had defined them in detail and also since when the nephroblastomas have started being called as Wilms' tumours.
Max Wilms had immense love for work. He liked to do it as soon as possible, as he thought you would spend more time if you delay it. He was extraordinarily brilliant with the power of quick decision-making. Max Wilms was not a man who wanted to be the best but he liked to do his duty according to his ability and he could prove his worth. Centennial celebrations are being held all over the world in honour of this brilliant surgeon from Germany who worked tirelessly to achieve so much in a short span of life. The European Society of Pediatric Urology (ESPU meeting, April 1999, Istanbul), and the the Indian Association of Pediatric Surgeons (25th Annual Conference of LAPS, Calcutta, October 1999) appreciating his immense contributions, held commentaries on Max Wilms.
| Acknowledgement|| |
My sincere thanks to Retired Prof. Gotz Borgwardt, Chief of Pediatric Surgery, University of Berlin, Germany, for providing volumes of original information, documents and slides on Late Prof. Max Wilms for compilation of this concise commentary on him.