Identifier: lecturesondiagno00osle (find matches)
Title: Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893
Year: 1901 (1900s)
Authors: Osler, William, Sir, 1849-1919
Subjects: Abdominal Neoplasms
Publisher: New York : D. Appleton and Company
Contributing Library: University of California Libraries
Digitizing Sponsor: Internet Archive

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be relied on as characteristic, as I will mention to you inthe fourth of the cases in the cancer series this was a verymarked feature. Fluctuation may be obtained readilywhen the tumor mass becomes superficial. The tumormay persist, as in Case XXVI, for months without verymuch change. With or without the presence of tumor,when liver abscess is suspected, the long aspirator needleshould be freely used. TUMORS OF THE LIVER. 81 III. Syphilis of the Liver.—Of four cases diagnosti-cated during life as syphilis of the liver, two presenteddefinite tumors. Diffuse syphilitic hepatitis does not pro-duce a tumor, but gummata, either in the inherited or ac-quired disease, may form tumors in two stages: first, whenfresh and developing, constituting nodular masses of largesize, which may persist for months ; and, second, gummatawhich have undergone cicatricial contraction and healingmay so fissure and divide the liver by bands of connectivetissue that an extremely nodular, irregular mass may oc-
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FiG. 26.—Showing the extreme irregularity of a syphilitic liver. cupy the right hypochondrium. Of the four patients thisyear, two died, but in neither of them were tumors felt. Ishow you here a photograph of the liver of one of them(Fig. 26), which will give you an idea of the extraordinary 82 THE DIAGNOSIS OF ABDOMINAL TUMORS. subdivision of the organ, an extreme grade of which formsthe so-called botryoid liver, in which globular masses ofnormal tissue are held together by fibrous bands. Theother case also, which came to autopsy, had an extremelyirregular liver, and was of exceptional interest, inasmuchas the recurring ascites, for which she had been tajiped re-peatedly, disappeared entirely under iodide of potassium,as did also nodes on her shins. In the following casesdefinite tumor masses were present and the correctness ofthe diagnosis in both instances was in a measure borne outby the therapeutic test. In anomalous tumors of the liverit is well to bear in mind that gummata may

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