Page:Lectures on the diagnosis of abdominal tumors (microform) - delivered to the post-graduate class Johns Hopkins University, 1893 (IA cihm 01686).pdf/20

 what the impression of a rounded body, and on bimanual palpation it is not very movable.

The edge of the spleen is not palpable; neither kidney can be felt ; the edge of the liver is not palpable ; nor does there appear to be any definite enlargement of the organ. On inflating the stom- ach the prominence in the epigastric and umbilical regions be comes very marked and its lower curve extends to a little below the nave). The upper limit of stomach tympany is just at the sixth rib in the nipple line, There are no glandular enlargements, The patient became gradually worse and died about Christmas time,

Case IV. Dilated Stomach, forming a Visible Tumor; an Oblong Mass én the Right Epigastric and Umbilical Regions.— Annie D., aged forty-eight years, Bohemian, admitted October 1st, complaining of swelling in the abdomen, pain in the back, and vomiting.

She knows of no hereditary disease in her family. Her husband died of tuberculosis,

Patient was always strong and well; she has had three chil- dren. Her present trouble began eight months ago with pain of a dull, aching character in the stomach, and dyspepsia, but until re- cently she has had no vomiting, and has kept about and at work up to a week ago, when she began to vomit. Prior to this she noticed that the abdomen was swollen. The vomiting has been chiefly after taking food, and she has not brought up any darge quantities,

Present Condition,—Patient is thin, but the emaciation is not extreme. The lips and mucous membranes are of a fairly good color. Tongue is slightly furred with a white coating, Pulse regular ; temperature normal ; superficial glands not enlarged.

The abdomen is prominent, particularly in the umbilical and left hypochondriac regions, Under observation there occur in chese parts undulatory waves of peristalsis, and the outlines of the stomach become unusually distinct, the greater curvature reaching fully three inches below the level of the navel, the lesser curvature just above this point. As the waves of contraction pass there is 2 vertical constriction just to the left of the middle line. The peri- stalsis comes on spontaneously, and any stimulus, such as flipping

�