. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. mor mass to the left of the nipple line. The generalsituation of the tumor is indicated in the annexed chart. Thereare no glandular enlargements. Thespleen is not palpable and the dull-ness is almost obliterated. The patient has no sweats, nocough. There is a leucocytosis, thewhite corpuscles numbering overtwenty thousand to the cubic milli-metre ; haemoglobin, forty-one percent.; red blood-corpuscles slightlyover four million to the cubic milli-metre. The urine (many examin
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. mor mass to the left of the nipple line. The generalsituation of the tumor is indicated in the annexed chart. Thereare no glandular enlargements. Thespleen is not palpable and the dull-ness is almost obliterated. The patient has no sweats, nocough. There is a leucocytosis, thewhite corpuscles numbering overtwenty thousand to the cubic milli-metre ; haemoglobin, forty-one percent.; red blood-corpuscles slightlyover four million to the cubic milli-metre. The urine (many examina-tions) has usually been clear, acid ;specific gravity, 1012 ; at first no al-bumin, but subsequently slight sugar ; microscopically, a fewblood-cells, but as a rule, even aftercentrifugalizing, neither casts norblood-cells were found. The sedi-ment obtained was also examined for tubercle bacilli, with negativeresult. The temperature was at times a little above normal, and onthe evening of the 20th of August he had a chill, the temperaturerising to 1035°. On the 6th of September a medium-sized aspirator. Fig. 33.—Outline of the tumor massin Case XLIV. 128 THE DIAGNOSIS OF ABDOMINAL TUMORS. needle was thrust upward and backward beneath the twelfth rib,and a little blood-stained fluid removed, which contained roundcells twice the size of leucocytes. The needle seemed imbeddedin the firm substance. The patient objected to an exploratory op-eration. The situation and shape of the tumor, the mobility, andthe readiness with which it could be pushed forward bypressure from behind pointed to a renal origin. The na-ture of the growth was less certain. If he is correct in dat-ing the first symptoms as far back as eighteen months thetumor has not attained the size usually reached by newgrowths of the kidney within this time. There has alsobeen no blood in the urine. The single chill does not speakspecially against new growth. Can it be tuberculous ne-phritis ? The family his
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