Medical and surgical reports . ;some pain in left shoulder. Physical Examination. — Corpulent. Pupils equal and yellow. Tongue fairly clean. T., ; P., 128; E., action somewhat irregular. Aorticsecond sound occasionally first pulmonic is replaced by a softmurmur; pulmonic second not accented. Lungs. — Pine moist rales in right backand axilla. On left back, near angle of scap-ula, there is dulness, diminished broncho-visicular respiration; increased voicesounds; fine crackling rales. Liver Dulness begins at fifth space. Abdomen. — There is muscular s
Medical and surgical reports . ;some pain in left shoulder. Physical Examination. — Corpulent. Pupils equal and yellow. Tongue fairly clean. T., ; P., 128; E., action somewhat irregular. Aorticsecond sound occasionally first pulmonic is replaced by a softmurmur; pulmonic second not accented. Lungs. — Pine moist rales in right backand axilla. On left back, near angle of scap-ula, there is dulness, diminished broncho-visicular respiration; increased voicesounds; fine crackling rales. Liver Dulness begins at fifth space. Abdomen. — There is muscular spasmand tenderness in the upper abdomen, espe-cially on left. A firm, smooth, resistantmass is felt occupying the epigastrium,mostly to the right of the median line andextending down to level of umbilicus,where edge of mass is apparently note is tympanitic over this mass. There is slight distention. No free fluid could be tenderness in lower altdomen. There is slight pitting of 52 ACUTE HEMORRHAGIC PANCREATITIS. July 27.—Seen in consultation by Drs. Post and Jackson, whoadvise operation at once. The diagnosis was an abscess or inflam-matory tumor in epigastrium, due to pancreatitis orlocahzed abscessfrom perforating gastric ulcer. Operation, by the writer, under local anfeslhesia with 1-1000cocaine solution. Incision 6 in. long, median line above entering the abdomen a tumor was felt just to the right of themedian line, adherent by light fresh adhesions to the abdominalwall. Tumor could be felt to fluctuate. The patient was thenetherized to the primary stags, and a second incision made just out-side the outer border of the right rectus muscle. Finger was passedinto the centre of the tumor, which was found to consist of necrotictissue and blood clot. A considerable amount of blood clot wasscooped out, and the cavity freely irrigated from one incision to theother. The finger reached the region of the pancreas. Gauz
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