. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. teen,is fairly well grown, well nourished,looks a little pale ; abdomen promi-nent, and on the right side between the navel and the costal mar-gin there is a dfstinct hemispherical swelling about two inches indiameter. The tumor descends slightly on inspiration. The super-ficial abdominal veins are not especially dilated. The upper teethare not good, but are not notched. He has not a syphilitic facies. On palpation, the lower zone of the abdomen is soft. In theleft hypochond
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. teen,is fairly well grown, well nourished,looks a little pale ; abdomen promi-nent, and on the right side between the navel and the costal mar-gin there is a dfstinct hemispherical swelling about two inches indiameter. The tumor descends slightly on inspiration. The super-ficial abdominal veins are not especially dilated. The upper teethare not good, but are not notched. He has not a syphilitic facies. On palpation, the lower zone of the abdomen is soft. In theleft hypochondriac region the edge of the spleen is distinctly felt,with its notch at least two fingers* breadth below the costal mar-gin. Toward the right hypochondrium a firm, solid mass is felt,the edge of which is ill-defined below and to the right. Above, itseems to pass directly beneath the costal margin in the position ofthe liver. The tumor is painless. The liver dullness begins in themidsternal line at the level of the sixth costal cartilage, in the nip-ple line at the upper border of the fifth rib, and is directly con-. FiG. situation of the tu-mor nodules in Case XXX. * University Medical Magazine, vol. ii. 86 THE DIAGNOSIS OF ABDOMINAL TUMORS. tinuous with that of the tumor and reaches to within a fingersbreadth of the navel. In the axillary line there is dullness fromthe upper border of the eighth to the lower border of the tenthrib. The left lobe of the liver does not appear to be splenic dullness begins at the upper border of the eighthrib and extends two fingers breadth below the costal border. Fowlers solution was prescribed, four minims three timesdaily, to be increased by one drop each week. This was taken atintervals until the middle of January, about five months, when itbecame necessary to discontinue it on account of nausea andvomiting. During this time the color of the face had improved,the tumor had enlarged, and, on deep inspiration, the margin n
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