. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. I have great confidencehad in June pronounced this to bethe condition present. The situationwas suggestive, naturally, of an en-larged spleen ; the right edge seemedthin and there was an indistinct feel-ing of a notch, but the very super-ficial character, the absence of a defi-nite notch or notches, and, above all,the resonance over one half of thetumor, seemed inconsistent with thisview. A phantom tumor in a hys-terical woman had also been suggest-ed. The large size, the un
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. I have great confidencehad in June pronounced this to bethe condition present. The situationwas suggestive, naturally, of an en-larged spleen ; the right edge seemedthin and there was an indistinct feel-ing of a notch, but the very super-ficial character, the absence of a defi-nite notch or notches, and, above all,the resonance over one half of thetumor, seemed inconsistent with thisview. A phantom tumor in a hys-terical woman had also been suggest-ed. The large size, the unusual situ-ation, and the slight character o fthe gastric symptoms did not favor gastric carcinoma, suggested, ofcourse, by the profound emaciation and the existence of resonanttumor in the left hypochondrium. The next few days, however, developed additional symptomswhich made this view very much more likely. On the 12th shehad taken six oysters and one on the 13th. On the 15th she hadeructations of dark, very offensive material, and regurgitated oneof the oysters in a condition of decomposition, but undigested. On. Fig. tumor area in CaseXXIII. 62 THE DIAGNOSIS OF ABDOMINAL TUMORS. the 16th she regurgitated the chopped meat in a similar conditionof decomposition, and a second oyster which had been very slightlyacted upon. The odor of the materials brought up was intenselyoflFensive. She had also at this time slight diarrhoea. The tumordid not show any mateinal changes, but the area of resonanceseemed to vary somewhat, and, on drinking, gurgling could bedistinctly heard over the mass, and sometimes with the hand uponthe tumor the flatus could be felt. September 19th.—For the first time the patient to-day hadattacks of actual vomiting, the first at about six in the morningand the second at noon. On both occasions she brought up abouthalf a pint of dark, bloody fluid of a most horribly offensive char-acter, having a distinctly faecal odor, as well as an odor of decom-po
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