. A practical treatise on medical diagnosis for students and physicians . s,according as they exhibit: (1) abdominal enlargement with effusion ; (2)enlargement with tumors; (3) a combination of the two; or (4) enlarge-ment without evidence of fluid or tumor in the abdomen. In the formsincluded in the second and fourth subdivisions the abdomen may subse-quently undergo retraction. 1006 DISEASES OF THE PERITONEUM. 1. Enlargement with Effusion. The local symptoms and the physicalsigns are those of ascites; but the distention is never so great as in ascitesfrom cirrhosis of the liver. Often the fl
. A practical treatise on medical diagnosis for students and physicians . s,according as they exhibit: (1) abdominal enlargement with effusion ; (2)enlargement with tumors; (3) a combination of the two; or (4) enlarge-ment without evidence of fluid or tumor in the abdomen. In the formsincluded in the second and fourth subdivisions the abdomen may subse-quently undergo retraction. 1006 DISEASES OF THE PERITONEUM. 1. Enlargement with Effusion. The local symptoms and the physicalsigns are those of ascites; but the distention is never so great as in ascitesfrom cirrhosis of the liver. Often the fluid is confined by adhesions inthe right or left quadrant of the abdomen, in which situation fulness andfluctuation may be readily detected. 2. Enlargement with Tumors. (Plate XXXIX.) The tumors areusually found in the upper zone of the abdomen, and may be localized ineither quadrant, or extend from the right to the left. They are usuallydue to tuberculosis of the omentum, with secondary contraction. Insome instances an indurated tumor, somewhat tender on pressure, may. Tuberculous peritonitis; pulmonary tuberculosis. + site ot cardiac impulse. (Original.) extend across the abdomen midway between the xiphoid cartilage and the \umbilicus, or at the level of the umbilicus, varying from two to four Jinches in width and sometimes continuous with the liver-dulness. Inother instances more distinctly localized masses may be felt either to theright or to the left of the umbilicus. They may be movable and vary jwith the position of the patient. I have never seen tuberculous massesin the lower quadrants. In children with tabes mesenterica the tumorsmay be made out close to the vertebral column in the median line, Jextending to the brim of the pelvis, although at the lower portion theyare not so distinct. The intensity of the dulness over the tumors dependsupon their relation to the bowels and the degree of intestinal distention. jInstead of dulness a modified tympany or muffled resonance
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