. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. 890 theyrecurred. He has had uneasy sensa-tions after meals, and belching, some-times bringing up acid fluid. Duringthe past summer he had a good dealof vomiting, and once in June broughtup dark-brown fluid, which was saidto be blood, and the next day the samematerial was noticed in the appetite is fair, but he is afraidto eat, and lately has only been tak-ing liquids. He has not lost verymuch in weight — only about fivepounds in the last six months. Present Condi
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. 890 theyrecurred. He has had uneasy sensa-tions after meals, and belching, some-times bringing up acid fluid. Duringthe past summer he had a good dealof vomiting, and once in June broughtup dark-brown fluid, which was saidto be blood, and the next day the samematerial was noticed in the appetite is fair, but he is afraidto eat, and lately has only been tak-ing liquids. He has not lost verymuch in weight — only about fivepounds in the last six months. Present Condition. — Patient isemaciated, pale, and a httle sallow ;mucous membranes distinctly an-aemic. Tongue has a patchy coatingand indented edges. Examination of the thoracic organs is negative. The abdomen is symmetrical, a little depressed below the costalborder ; no peristalsis visible. On palpation, the left epigastricregion is occupied by a superficial mass with a rounded, irregular,nodular surface. It extends sometimes almost to the middle line,and below crosses the transverse costal line. To the left it extends. Fig. 16.—Outline of the tumor massin Case XIX. 54 THE DIAGNOSIS OF ABDOMINAL TUMORS. to the nipple line. It is a little painful on firm pressure ; descendswith inspiration. The pulsation of the aorta is transmitted throughit. Percussion gives a flat tympany over the mass. Ewalds testbreakfast, withdrawn fifty-five minutes after, yielded about sevenhundred cubic centimetres of brownish fluid with a heavy sedi-ment of undigested food ; odor acid. The filtrate turned bluelitmus red, congo red to blue, and yielded a rose-red color withphloroglucin vanillin. Uffelmans test negative. The urine wasnormal. The patient remained up and about the ward, and with acareful diet was made much more comfortable. The condition ofthe gastric juice was frequently tested; thus on January 4thEwalds test breakfast, withdrawn an hour later, yielded aboutfive hundred cubic centimetres of
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