. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. ble. The temperature betweenAugust 29th and September 11th was not above normal. The dys-enteric symptoms had improved verymuch, and from September 9th to the13th he had only had one or twomovements a day. On September11th he made, for the first time, com-plaint of a pain in the epigastric re-gion, and there had been for two daysslight fever, the temperature rising to100°. There was a little sensitivenessover the liver in the middle line, butthe organ did not appear to be en
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. ble. The temperature betweenAugust 29th and September 11th was not above normal. The dys-enteric symptoms had improved verymuch, and from September 9th to the13th he had only had one or twomovements a day. On September11th he made, for the first time, com-plaint of a pain in the epigastric re-gion, and there had been for two daysslight fever, the temperature rising to100°. There was a little sensitivenessover the liver in the middle line, butthe organ did not appear to be en-larged. On September 17th there wasnoticed for the first time a roundedprominence occupying the left half ofthe epigastric region, which moved upand down with respiration and whichpulsated with each heart beat. It ex-tended from the costal margin in theparasternal line to a little beyond the middle line. It was rounded,smooth, firm, but elastic, and did not appear to fiuctuate. The pul-sation was very marked and seemed almost expansile. On placingthe patient, however, in the knee-elbow position the pulsation FiG. 25.—Outline of the liver andsituation of the tumor in CaseXXIX. TUMORS OF THE LIVER. 79 tirely ceased; no bruit was heard over it. The situation of thetumor is indicated in the annexed diagram. The liver dullness be-gan at the sixth rib and extended just belov/ the costal margin inthe nipple line. In the parastcinal line it did not begin until theseventh rib, and in the middle line the dullness was about the mid-dle of the ensiforra cartilage and was then continuous with thetumor mass on the left side. In the midaxillary line the dullnessbegan at the seventh rib and extended to the costal border. Thesplenic dullness could not be obtained, nor could the margin be was no increase in the hepatic dullness behind. On the 18th the temperature rose to 101 2°, the highest pointreached, and the patient had no chills, but was sweating tumor wa
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