. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. or bowel and is not so prominent, and can only befelt on deep pressure. It passes under the costal margin of the 186 THE DIAGNOSIS OP ABDOMINAL TUMORS. seventh rib. It is extremely firm, resistant, not very movable onbimanual palpation, and not sensitive. It fills the entire flank, and behind is superficial,and gives the impres-sion of occupying close-ly the whole lumbar re-gion. The surface isirregular, and on palpa-tion the prominencesreferred to are very dis-tinct. In the
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. or bowel and is not so prominent, and can only befelt on deep pressure. It passes under the costal margin of the 186 THE DIAGNOSIS OP ABDOMINAL TUMORS. seventh rib. It is extremely firm, resistant, not very movable onbimanual palpation, and not sensitive. It fills the entire flank, and behind is superficial,and gives the impres-sion of occupying close-ly the whole lumbar re-gion. The surface isirregular, and on palpa-tion the prominencesreferred to are very dis-tinct. In the right iliacfossa a soft mass can befelt, which is probablythe colon pushed over,partly adherent, and canbe felt on the tumormass. Above, as alreadymentioned, the tumor iscovered in the left halfof the epigastric regionby stomach and intes-tines, and there is a soft,movable mass, whichmay represent the curledand thickened omen-tum. I will read to youthe remarks wliicli Imade in ward classafter demonstratingthis child, and whichI find here with thetype - written reportof the case: In children, mas-not uncommon, Fig. 43.—Outline of the tumor mass in Case LXTV. Five tumors of the abdomen are as a rule, are either sarcomata of the kidney or of the TUMORS OF THE KIDNEY. 187 retro-peritoneal glands. The kidney tumors are tlie mostfrequent. Both ultimately produce large, solid growths,which may occupy the greater portion of the abdominalcavity. In the differentiation of these two forms werarely have any difficulty. Both develop painlessly, andthe child may make no complaint whatever ; the gen-eral health may not be seriously affected, even when themass has attained a considerable size. Death, indeed, mayoccur, as in a remarkable case which I have reported of em-bolism of the heart (the transference of sarcomatous throm-bi from the renal vein), before there were any symptoms toattract attention. Progressive emaciation, with enlargementof the abdomen, usually painless, as in the
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