. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. eaof liver dullness, the edgeof the or-gan can be distinctly felt just belowthe costal margin. Although theedge of the spleen could not be feltunder the left costal margin, therewas at the first examination definitesplenic dullness over the ninth andtenth ribs in the mid-axillary blood condition shows a profound secondary aneemia, and isnot specially suggestive of a splenic form. The examination showsonly thirty per cent, of haemoglobin, a little over three million
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. eaof liver dullness, the edgeof the or-gan can be distinctly felt just belowthe costal margin. Although theedge of the spleen could not be feltunder the left costal margin, therewas at the first examination definitesplenic dullness over the ninth andtenth ribs in the mid-axillary blood condition shows a profound secondary aneemia, and isnot specially suggestive of a splenic form. The examination showsonly thirty per cent, of haemoglobin, a little over three million redblood-corpuscles to the cubic millimetre, and a little over ninethousand white corpuscles. The urine is negative, pale, no abnormal deposits, no is constipated. Stools formed, and presented no special fea-tures. A test breakfast showed no free hydrochloric acid. Comments.—April 19, 1893. It has been suggested that this mass might possibly be a dislocated and fixed spleen, but the solidity and firmness, the rounded character of the mass, and the indefiniteness of the notches (supposed to be felt), were. Fig. 20.—Outline of the tumor inCase XXIV. I MODULAR AND MASSIVE TUMORS OF THE STOMACH. 65 against this. Moreover, dislocated enlarged spleens are usuallyvery mobile, and, most important of all, the splenic dullness wasquite marked in the mid-axillary line, and the mass was every-where resonant. One of the most suggestive features of the case is the onset ofthe disease with diarrhoea. The situation of the mass, its fixity,and its size are against tumor of the colon. There are, on theother hand, instances of malignant disease of the small bowel inwhich the tumor mass has attained a very large size, and in whichprogressive emaciation, anaemia, and diarrhoea have been the mainsymptoms. The most remarkable case of this which I call to mindis one which I saw at the General Hospital, Montreal, with , for whom I made the dissection. A man, aged forty-oneyears, w
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