. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. agram, whichwas mads with great care, illustratesthe various positions which the masscan be made to assume. It can alsobe pushed into the right hypochon-driac region, so as to be covered al-most completely by the ribs, and insubsequent examinations this was notinfrequently the situation in whichit was found, and from which it couldonly be dislocated by the deepest in-spiration or by deep pressure in therenal region. The mass is not tendereven on firm pressure. There is dull-
. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. agram, whichwas mads with great care, illustratesthe various positions which the masscan be made to assume. It can alsobe pushed into the right hypochon-driac region, so as to be covered al-most completely by the ribs, and insubsequent examinations this was notinfrequently the situation in whichit was found, and from which it couldonly be dislocated by the deepest in-spiration or by deep pressure in therenal region. The mass is not tendereven on firm pressure. There is dull-ness over it, but not complete patient notices that the mass changes in position as she moves about, and when she sits up itmoves far down into the abdomen, while when on her back it isfrequently beneath the right ribs. When this mass is out frombeneath the right costal margin the right kidney can not be felt,nor on the left side, on the deepest inspiration, could the kid-ney be palpated. Behind there are depressions in the renalregions. The edge of the liver can not be felt ; the area of splenic dull-. FiG. 6.—Showing the positions intowhich the tumor could be placedin case V. 12 THE DIAGNOSIS OF ABDOMINAL TUMORS. ness is not increased ; the edge can not be reached even on deepinspiration. A test breakfast, withdrawn an hour and ten minutes after,gave two hundred cubic centimetres of fluid in the stomach, whichcontained no free hydrochloric acid. The stomach was inflatedwith gas, and the outline of the greater curvature reached almostto the navel. When the gas was in the stomach, palpation of themost careful character gave no sensation of any fluid passingthrough the tumor. This patient came in with a diagnosis of probable can-cer in the stomach, which the history of repeated attacksof vomiting and progressive loss of weight and the exist-ence of a tumor in the abdomen seemed to justify. Ex-treme mobility is a feature of certain tumors of the py-lorus, as in the
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