. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. efore me for diagnosis, two were in children under the ageof ten. Case LXIV. Gradual Development of an Enormous Tumorin Left Side of Abdomen.—E>. R., a boy of ten years, seen with Dr. Hewetson, May 10, 1893. I hadseen him about six or eight monthsbefore for a few minutes in the dis-pensary. Unfortunately, the notesmade at that time have been has had for nearly a year a pro-gressively increasing tumor in theleft side of the abdomen. Until twomonths ago he has be
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. efore me for diagnosis, two were in children under the ageof ten. Case LXIV. Gradual Development of an Enormous Tumorin Left Side of Abdomen.—E>. R., a boy of ten years, seen with Dr. Hewetson, May 10, 1893. I hadseen him about six or eight monthsbefore for a few minutes in the dis-pensary. Unfortunately, the notesmade at that time have been has had for nearly a year a pro-gressively increasing tumor in theleft side of the abdomen. Until twomonths ago he has been able to getabout by himself, but he is now so•weak and the tumor is so large thathe is scarcely able to w^alk. He hasbecome very much emaciated, andsince I first saw him the tumor hasincreased greatly in size. His chiefcomplaint at present is of pain downthe left leg, and about the ankleand hip of the same side. The ab-domen is greatly distended, particularly on the left side, and thesuperficial veins are very full. The lower part of the thorax onthe left side is much expanded, and the costal margin Fig. -Outline of the tumor inCase LXIV. TUMORS OF THE KIDNEY. 185 Tlie entire left half of the abdomen is occupied by a solid mass,which extends from the ribs to the pubes, and is extremely firmand immobile. The surface is smooth, except toward the lowerand right margins, where it is irregular. Percussion over it iseverywhere flat. It extends upward as far as the seventh rib, andbehind to the angle of the scapula. Just above the anterior supe-rior spine of the ilium there is a prominent bulging. The inguinalglands are enlarged and hard, and the supraclavicular glands onthe left side are also slightly enlarged. The left leg is slightlyswollen, and the veins are enlarged and prominent, as are also theveins over the flank and buttocks. There have never been anyurinary symptoms; he has not passed any blood, but he has hadpain lately owing to pressure upon the nerve
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