. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. line. This bulgingduring peristalsis occupies the leftepigastric and the upper right quad-rant of the umbilical regions. On palpation, the abdomen iseverywhere soft, very resistant justbelow the ensiform cartilage andover the prominence above the latter the resistance varieswith the presence or abscence of theperistaltic waves. Immediately be-low the ensiform cartilage there isa definite ridge-like swelling whichis superficial, very tender, and doesnot extend entire
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. line. This bulgingduring peristalsis occupies the leftepigastric and the upper right quad-rant of the umbilical regions. On palpation, the abdomen iseverywhere soft, very resistant justbelow the ensiform cartilage andover the prominence above the latter the resistance varieswith the presence or abscence of theperistaltic waves. Immediately be-low the ensiform cartilage there isa definite ridge-like swelling whichis superficial, very tender, and doesnot extend entirely across the spacebetween the costal margins. It hasa boardy hardness. On drawing a deep breath the fingers can beplaced directly above it and it descends about an inch. In the leftlumbar region, just below the tenth rib and the adjacent costal mar-gin, there is to be felt a firm mass, extending seven centimetres ina vertical direction. Anteriorly in reality it can be felt within theright epigastric region, and outward it extends to nearly the mid-axillary line. On deep inspiration it descends and gives one some-. FiQ. 4.—Showing the position of thetumor masses in Case III. TUMORS OF THE STOMACH. 9 what the impression of a rounded body, and on bimanual palpationit is not very movable. The edge of the spleen is not palpable ; neither kidney can befelt ; the edge of the liver is not palpable ; nor does there appear tobe any definite enlargement of the organ. On inflating the stom-ach the prominence in the epigastric and umbilical regions be-comes very maiked and its lower curve extends to a little below thenavel. The upper limit of stomach tympany is just at the sixthrib in the nipple line. There are no glandular patient became gradually worse and died about Christmastime. Case IV. Dilated Stomach, forming a Visible Tumor; anOblong Mass in the Right Epigastric and Umbilical Regions.—Annie D., aged forty-eight years, Bohemian, admitted October 1st,complaining
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