. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. present trouble dates from April of this year?when he began to have pain in the right side, fever, and chilly sen-sations. The temperature sometimes rose to 103°, and he had asense of distention and fullness in the right side, but there was nobulging, as at present. No history can be obtained of any localdisease in the gastro-intestinal tract. He is positive that there hadbeen no diarrhoea. After a month, during the greater part ofwhich time he was in bed, the fever disappea
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. present trouble dates from April of this year?when he began to have pain in the right side, fever, and chilly sen-sations. The temperature sometimes rose to 103°, and he had asense of distention and fullness in the right side, but there was nobulging, as at present. No history can be obtained of any localdisease in the gastro-intestinal tract. He is positive that there hadbeen no diarrhoea. After a month, during the greater part ofwhich time he was in bed, the fever disappeared, but the pain andfullness in the right side persisted. Toward the end of June henoticed that there was a prominence below the right costal marginwhich has steadily increased. He has lost much in weight—from250 to 185 pounds. Since June he has had at times slight fever, but TUMOES OF THE LIVER. ?71 no chills, and only occasional sweating. The bowels have beenirregular, and he has had to take purgatives. There has never atany time been jaundice. Present Condition.—Fairly well nourished, a little pale, but. neither emaciated nor cachectic. Temperature last evening 101°;pulse 104, occasionally intermits. The radials are sclerotic. Thetongue is red, not dry. Abdomen.—A large tumor mass fills up the right half, and isstrikingly prominent, as indicated in the figure from a photograph 72 THE DIAGNOSIS OP ABDOMINAL TUMORS. (Fig. 22). Below, it reaches the transverse umbilical line; above,it passes beneath the costal margin. To the left the swelling be-gins at the middle line. The skin over it is glossy and a little red-dened. The respiratory movements of the abdomen are slight. Onpalpation, the entire right side above the transverse iliac line isoccupied by a solid mass which is resistant except at the mostprominent point, where it is soft and fluctuating. It is nowherepainful on pressure. Below, no definite sharp edge can be , it is continuous with and not to be s
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