. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. mic,and the facies can scarcely be termed cachectic. The emaciationis marked about the thorax ; the skin is smooth and clean ; super-ficial lymph glands are not tongue is a little swollen, indented,and furred. The abdomen is flat, very much be-low the level of the costal is a slight prominence just tothe right of the navel, and on deep in-spiration a ridge-like mass descendsbelow the point. On palpation, there can be felt justabove and extending to
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. mic,and the facies can scarcely be termed cachectic. The emaciationis marked about the thorax ; the skin is smooth and clean ; super-ficial lymph glands are not tongue is a little swollen, indented,and furred. The abdomen is flat, very much be-low the level of the costal is a slight prominence just tothe right of the navel, and on deep in-spiration a ridge-like mass descendsbelow the point. On palpation, there can be felt justabove and extending to the right of thenavel a firm mass which descends oninspiration and can be rolled beneaththe fingers, giving one the impressionof a tubular, sausage-like tumor. Ondeep inspiration, it moves down nearlythree inches and can be readily held atthe navel, and then slips away from be-neath the fingers. The patient was placed upon a careful diet of milk andQgg albumin, upon which the nausea disappeared and he be-came very much more comfortable. The examination on the17th showed that the elongated mass above referred to had. Fig. 14.—a, position of the tumorin expiration ; 6, in inspira-tion. 48 THE DIAGNOSIS OF ABDOMINAL TUMORS. changed in position and lay to the left of and just ahove thenavel. The liver is not enlarged ; the edge of the spleen is not pal-pable. The patient got dissatisfied with the diet, and left the hospitalOctober 17th, though he seemed to be considerably improved. April 6, 1893.—Patient returned to the hospital, having had,in the space of nearly six months which has elapsed since thelast note, very marked gastric symptoms and occasional attacks ofvomiting of large quantities of fluid. He has lost in weight,though he does not look much more emaciated than when heleft. Examination.—Abdomen is scaphoid and the walls held ratherrigidly. Between the ensiform cartilage and the navel the solidrounded tumor present in September can be felt in the same posi-tion, but
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