. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. up to a week ago, when she began to vomit. Prior to this shenoticed that the abdomen was swollen. The vomiting has beenchiefly after taking food, and she has not brought up any largequantities. Present Condition.—Patient is thin, but the emaciation is notextreme. The lips and mucous membranes are of a fairly goodcolor. Tongue is slightly furred with a white coating. Pulseregular ; temperature normal ; superficial glands not enlarged. The abdomen is prominent, particularly in
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. up to a week ago, when she began to vomit. Prior to this shenoticed that the abdomen was swollen. The vomiting has beenchiefly after taking food, and she has not brought up any largequantities. Present Condition.—Patient is thin, but the emaciation is notextreme. The lips and mucous membranes are of a fairly goodcolor. Tongue is slightly furred with a white coating. Pulseregular ; temperature normal ; superficial glands not enlarged. The abdomen is prominent, particularly in the umbilical andleft hypochondriac regions. Under observation there occur inthese parts undulatory waves of peristalsis, and the outlines of thestomach become unusually distinct, the greater curvature reachingfully three inches below the level of the navel, the lesser curvaturejust above this point. As the waves of contraction pass there is avertical constriction just to the left of the middle line. The peri-stalsis comes on spontaneously, and any stimulus, such as flipping 10 THE DIAGNOSIS OF ABDOMINAL with a towel or even palpation, at once excites it. On palpation,except during- the time of the contraction referred to, the abdomenis everywhere soft. Just above and to the right of the navel there is to be felt an oblong mass, whichtakes a direction upward and out-ward toward the costal margin. Itis oblong, slightly movable, firm,smooth, and not painful. On October 3d a test breakfastwas given at 8 A. M. At nine oclockthe stomach tube was introduced andabout a quart and a half of verysour-smelling, brownish material re-moved. Duiing the passage of thestomach pump the patient vomited,and she felt very faint. The exami-nation for free hydrochloric acid wasnegative. The patient left the hospital onOctober 14th in much the same con-dition, and has not been heard V. Remarkably Movable Tumor of Pylorus; DilatedStomach; Gastro-enterostomy.—Mary M., aged fi
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