. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. pineof the ilium. It feels very superficial;is not tender ; is very hard ; and oneor two ridges can be felt upon are no changes in its consist-ence. On deep inspiration it descendsslightly. It is freely movable and canbe pushed over as far as the gas is to be felt to bubble throughit. On light percussion there is a flat tympany over it. As the patient had had very few intestinal sjraptoms and hadhad dyspepsia for several years, with recently two attacks of
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. pineof the ilium. It feels very superficial;is not tender ; is very hard ; and oneor two ridges can be felt upon are no changes in its consist-ence. On deep inspiration it descendsslightly. It is freely movable and canbe pushed over as far as the gas is to be felt to bubble throughit. On light percussion there is a flat tympany over it. As the patient had had very few intestinal sjraptoms and hadhad dyspepsia for several years, with recently two attacks of vomit-ing, the attention was naturally directed, in the first place, to thecondition of the stomach. Palpation was negative in the region ofthe pylorus. There was no clapotage. The organ did not appearto be dilated. The upper limit of resonance was at the fifth rib inthe nipple line, and the lower limit above the navel. On October17th the tests for free hydrochloric acid were negative. On the21st it seemed that the stomach tympany was somewhat more than before. There were no peristaltic waves. On several. FiQ. 35.—Situation of the tumor inCase XLV. TUMORS OF THE INTESTINE. 133 occasions a test breakfast was given, and on October 26th themucus withdrawn was blood-stained ; no free hydrochloric tumor could be readily separated from the liver and could bemoved far down into the right iliac fossa. While the symptoms inthis case pointed rather to disease of the stomach, the situation andgeneral character of the tumor were those of an intestinal growth-The stomach, too, seemed somewhat relaxed, and the absence offree hydrochloric acid was suggestive. On November 7th Dr. Halsted operated and found that thetumor occupied the caecum and the commencement of the ascend-ing colon. It was readily removed. The patient seemed to dovery well, taking his nourishment and gaining in strength untilthe 13th, when, after an attack of nausea and coughing, the stitchesgave way an
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