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. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. of the umbilicus,there was felt a rounded tumor aboutthe size of an English walnut, freelymovable. On inflation, the stomachtympany extends two fingers breadthbelow the umbilicus. The patient remained in hospitalfor a couple of weeks; had no specialgastric symptoms, gained in weight,and returned to his home November27th. The case was regarded as oneof tumor of the pylorus, and he wastold if the trouble increased an oper-ation might be advisable. October 19, 259;?.—Patient ex
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. of the umbilicus,there was felt a rounded tumor aboutthe size of an English walnut, freelymovable. On inflation, the stomachtympany extends two fingers breadthbelow the umbilicus. The patient remained in hospitalfor a couple of weeks; had no specialgastric symptoms, gained in weight,and returned to his home November27th. The case was regarded as oneof tumor of the pylorus, and he wastold if the trouble increased an oper-ation might be advisable. October 19, 259;?.—Patient exam-ined to-day; has been very much bet-ter; entirely free from pain; has hadno vomiting; has been taking an or-dinary diet; no nausea; no sense ofdistress after eating. He looks and feels well. The abdomen is a little full in the umbilical region, flat in theepigastric. It is everywhere soft and painless ; nothing can befelt in the epigastric region. Midway between the navel and rightcostal margin there is the same well-defined, firm, hard nodule tobe felt, which is now painless. It descends with inspiration and. Fig. 13.—Positions into which thetumor could be moved in CaseXVI. NODULAR AND MASSIVE TUMORS OF THE STOMACH. 45 can be moved about in the positions noted in the diagrams. Thepatient says that it is not nearly so evident when the stomach isempty. It is prominent enough to be seen when the skin is pressedover it. It can be pushed far up under the right costal mar-gin and at first could not be felt, as it was high in this positionand only made to descend by deep inspiration. To the left it canbe pushed beyond the middle line to a point midway between thenavel and the left costal margin. It is very mobile. On inflationof the stomach the lower border was found to descend some dis-tance below the umbilicus—three or four fingers breadth—whilethe lesser curvature was almost as low as the umbilicus. Whenthe stomach was inflated the mass could not at first be felt, butaf
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