. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. evel of the navel and in the an-terior axillary line nearly to the levelof the anterior superior spine. Theprominent mass which is seen withsuch distinctness can be felt a handsbreadth below the liver margin; it issmooth, rounded, resistant, and as thefingers are pushed beneath it there isthe impression of a globular body. Itcan be freely moved from side to side,and changes in position as she turns to the left. The dotted linein the diagram indicates the position when she ro
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. evel of the navel and in the an-terior axillary line nearly to the levelof the anterior superior spine. Theprominent mass which is seen withsuch distinctness can be felt a handsbreadth below the liver margin; it issmooth, rounded, resistant, and as thefingers are pushed beneath it there isthe impression of a globular body. Itcan be freely moved from side to side,and changes in position as she turns to the left. The dotted linein the diagram indicates the position when she rolled over on theleft side ; the fundus of the gall bladder then almost reaches themiddle line. The surface of the liver is smooth. There are no nodules. Ondeep inspiration the spleen can not be felt; there are no glandularenlargements. There is a systolic murmur at the apex of the heart,but the sounds are clear at the base. The stools are clay-colored;the urine contains much bile pigment. November 7th.—This morning Dr. Kelly made an incision fifteencentimetres long over the tumor. On opening the peritoneal cavity. Fig. 30.—Showing: the position ofthe gall bladder in Case XXXVI. 102 THE DIAGNOSIS OF ABDOMINAL TUMORS. the liver looked of a dark greenish-brown color. Projecting be-neath the edge of the right lobe for a distance of about five centi-metres was the rounded end of a dilated gall bladder. The liversubstance above it was considerably atrophied. There were no ad-hesions. The chief bulk of the dilatation was beneath the liver,and the dilatation was much greater than indicated by the portionwhich could be felt projecting beyond the edge. One hundred andfifty cubic centimetres of turbid, grayish pus were removed withthe aspirator. Calculi could be felt in the cystic duct and at thefirst portion of the common duct. After aspiration the gall blad-der was carefully stitched to the external wound and incised anda large gall stone removed weighing thirty-eight grammes. Thest
Size: 1219px × 2049px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookidlecturesondi, bookyear1901
