. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. ing, on September 6th of last year, she had a very severeattack of colic and was extremely weak. These attacks of colichave occurred throughout the winter and the last one she had wasonly a few weeks ago. Present Condition. — Small-framed woman, looks ill, veryanaemic and sallow ; no definite jaundice ; no special 92; tension a little increased. Abdomen flat, natural-looldng. Palpation is everywhere nega-tive until one reaches the liver region. Here inside t
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. ing, on September 6th of last year, she had a very severeattack of colic and was extremely weak. These attacks of colichave occurred throughout the winter and the last one she had wasonly a few weeks ago. Present Condition. — Small-framed woman, looks ill, veryanaemic and sallow ; no definite jaundice ; no special 92; tension a little increased. Abdomen flat, natural-looldng. Palpation is everywhere nega-tive until one reaches the liver region. Here inside the nipple linethere is a definite rotmded projection, the outlines of which canbe readily determined, particixlarly below and to the left. It pro-jects as a somewhat conical mass and is rounded at the right bor-der. It is a little painful on deep pressure. The fingers can notbe inserted definitely beneath it, but on either side the edge of theliver is distinct; as she draws a deep breath the fingers seem topass over a prominence into a depression on the surface of the liver 104: THE DIAGNOSIS OF ABDOMINAL just at the level of the costal margin. During the attacks the pro-jection, as she calls it, forms a prominent tumor which can be seenbeneath the skin and is then exquisitely sensitive. The liver dull-ness extends to the upper border ofthe sixth rib. The right kidney isdistinctly palpable and descends be-low the edge of the liver, from whichit can be readily separated. At a subsequent examination thetumor was not nearly so large, andshe insists that it is extremely va-riable in size. Whenever the colic issevere the tumor becomes very muchmore prominent, a point confirmedrepeatedly by Dr. Ames. She is ex-cessively anaemic, and though anxiousfor an operation, it was thought bestto postpone it until the condition ofher blood was more satisfactory. Additional Note. — The tumormass in the epigastrium developedconsiderably and became very much firmer, reaching almost to
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