. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. rned to this country last year. Four monthsago he had an attack of pain in theabdomen with vomiting, and thesesymptoms have persisted ever vomiting is chieiiy after takingfood, and the pain is also most se-vere at this time. He has never vom-ited blood. Bowels have been con-stipated. He has lost in weight, hethinks, as much as fourteen is short of breath on exertion,and when he walks about for anylength of time the feet and anklesswell. Present Condition.
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. rned to this country last year. Four monthsago he had an attack of pain in theabdomen with vomiting, and thesesymptoms have persisted ever vomiting is chieiiy after takingfood, and the pain is also most se-vere at this time. He has never vom-ited blood. Bowels have been con-stipated. He has lost in weight, hethinks, as much as fourteen is short of breath on exertion,and when he walks about for anylength of time the feet and anklesswell. Present Condition.—He is veryanaemic, but not emaciated; his faceis full; blood count, 3,000,000; haemo-globin, thirty per cent.; eyelids a lit-tle puffy; hands very pale; pulse, 87,soft, compressible; radials a little thickened; vessels of neck throb;the heart sounds are loud and clear at the apex, the second veryringing and accentuated at the base; no murmur. The examinationfo the lungs was negative. Abdomen full and a little prominent; on palpation, everywheresoft and painless until the right epigastric region is reached. Here,. Fig. 15.—Situation of the tumor inCase XVIII. 50 THE DIAGNOSIS OP ABDOMINAL TUMORS. under the costal border in the parasternal line, there is a resistantmass which extends to the right almost as far as the middle lineand to the left as far as the nipple line, and below at least six cen-timetres from the costal border. During a deep inspiration themass descends and the fingers can then be placed between it andthe costal margin. In the middle line in the epigastric regionnothiug is palpable. There is resonance over the above-describedtumor mass. There is no peristalsis apparent; no gurgling to befelt in the mass. After dilatation of the stomach the tympany inthe parasternal line was at the seventh rib, and extended two fin-gers breadth below the navel. The tumor was piished far overneaily beyond the nipple line. A test breakfast withdrawn an hour after gave a hundre
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