. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. e attacks have never been so severe as those whichshe had in May. She has noticed on several occasions that she hasvoided large quantities of urine, as much as five pints between 8 P. six o clock the next morning,usually of a very pale color. Shehas not had her attention drawn toany coincidence between the disap-pearance of the tumor and the largeamount of urine. Her bowels are regular, appetitegood, but she has been sleeping badlyof late, owing in part to the worryabo
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. e attacks have never been so severe as those whichshe had in May. She has noticed on several occasions that she hasvoided large quantities of urine, as much as five pints between 8 P. six o clock the next morning,usually of a very pale color. Shehas not had her attention drawn toany coincidence between the disap-pearance of the tumor and the largeamount of urine. Her bowels are regular, appetitegood, but she has been sleeping badlyof late, owing in part to the worryabout the tumor. Present Condition.—Well-nour-ished, healthy-looking woman of me-dium height. The abdomen looksnatural ; no special she turns a little on the rightside there can then be seen a projec-tion in the left flank just above theilium, and between the tenth rib andthe anterior spine there is felt a promi-nent solid mass, which above lies close beneath the ribs, whileanteriorly it feels superficial. It can be readily grasped betweenthe hands and moved to and fro. When she draws a deep breath17. Fig. 39.—Illustrating the positionof the tumor in Case LXI. 172 THE DIAGNOSIS OF ABDOMINAL TUMORS. it does not give one tlie impression of coming out from beneaththe ribs and is not much depressed. No sharp edge can be felt,but it is everywhere rounded in outline. Percussion in the splenic region is clear, and beneath the levelof the eighth rib there is a flat tympany in midaxillary line. Asshe turns on the right side the mass comes forward and produces abulging beneath the skin. It is tolerably firm and elastic, butfluctuation can not be obtained. The edge of the spleen is not palpable; the liver dullness is notincreased; the edge can not be felt. The right kidney is justpalpable on deep inspiration. Examination of the thoracic viscerais negative. The patient was requested to make a careful estimation of theurine each day, and note with reference to the presence
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