. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. s are not enlarged and the examination of the stom-ach and intestines is negative. A rectal tube was passed, but no amoebae were found in the mucus ob-tained. The blood examination wasnegative. I aspirated in the parasternal lineat the most prominent point of the tu-mor, but obtained no pus. I did not see this patient again,but abstract the following from notes : Although no pus wasobtained on the first aspiration, thereseemed to be no question as to the cor-rectn
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. s are not enlarged and the examination of the stom-ach and intestines is negative. A rectal tube was passed, but no amoebae were found in the mucus ob-tained. The blood examination wasnegative. I aspirated in the parasternal lineat the most prominent point of the tu-mor, but obtained no pus. I did not see this patient again,but abstract the following from notes : Although no pus wasobtained on the first aspiration, thereseemed to be no question as to the cor-rectness of the diagnosis. Chills oc-curred on July 14th, 17th, 19th, and23d, and on August 1st, 3d, and patient was urged to have anoperation, but declined. The tumormass remained prominent, but nodefinite fluctuation developed. OnAugust 20th the patient suddenlybegan to cough, calling for the nurse and saying that he feltsomething had burst inside him. He expectorated several spit-cupfuls within a short time of a dirty, yellowish-green pus. Theodor was not offensive ; microscopically, it showed degenerated pus. Fig. 24.—Outline of the liver andsituation of the tumor in Case xxvm. TUMORS OF THE LIVER. 77 cells ; no amoebae. An interesting feature is that on the followingday the prominence in the right epigastric region had almost disap-peared. The physical signs at the right back had not the area of dullness the respiratory murmur was simply enfee-bled, and there were a few fine rales on coughing. The temperaturerange was from subnormal to 102°; once only, after a chill, 103 3°.He was repeatedly advised to have an operation, but declined, sayingthat he would sooner take his chances. The expectoration of puru-lent matter continued, but in diminishing quantities ; thus on the23d it was one hundred and twenty cubic centimetres ; by the 26th,thirty cubic centimetres ; and on the 28th, forty cubic August 1st it had fallen to only ten cubic centime
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