. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. h the hand can be passed over it, and the mass in thisway held down. It can readily be feltfrom behind, and on bimanual pal-pation can be grasped between thehands, and on firmest pressure be-low the ribs behind the mass can bepushed forward so as to lift distinctlythe abdominal wall. The lower andposterior surfaces appear to be irreg-ular. The sensation given on deeppressure is of an elastic percussion there is tympany overthe mass in front, a flat tympany inth
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. h the hand can be passed over it, and the mass in thisway held down. It can readily be feltfrom behind, and on bimanual pal-pation can be grasped between thehands, and on firmest pressure be-low the ribs behind the mass can bepushed forward so as to lift distinctlythe abdominal wall. The lower andposterior surfaces appear to be irreg-ular. The sensation given on deeppressure is of an elastic percussion there is tympany overthe mass in front, a flat tympany inthe raidaxillary line, and dullness be-hind. The right kidney is distinctlypalpable and descends far enough oninspiration to be held down. For thefirst twenty hours in hospital patientpassed only 380 c. c. of urine, clear,straw-colored; specific gravity, 1006; slight trace of albumin; nosugar; a few leucocytes, and flakes of epithelium. Patient menstruated from the 25th to the 28th. The tumor masswas present on the 25th; no examination was made on the the 27th the tumor had disappeared entirely. The abdominal. FiQ. 41.—Position of the tumormass in Case LXTII. TUMORS OP THE KIDNEY. 177 walls were so relaxed that palpation could be freely and thoroughlymade. The left kidney could be felt on deep palpation. It did notappear to be in any way enlarged; it felt, in fact, rather small andround. A daily note was then made on the patient and the urinecarefully measured. The patient says she can always tell a day orso before the attack comes on by feeling dull and the onset of back-ache. From October 28th to November 6th the daily note with refer-ence to the left kidney was negative. It was felt every day. Sheseemed to be doing very well; gained in weight, and had not somuch tenderness. November 7th.—Last night patient had a heavy feeling in theabdomen after eating, and a little distress in the back, as if an attackmight be coming on. This morning, however, she felt well againg
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