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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referto the simple enlargements of the organ in hypertrophiccirrhosis, in amyloid and fatty degenerations, or to thecases of uniform increase in volume met with in cancerand abscess. I shall call your attention only to those inwhich a prominent nodular mass or swelling—a tumor—was detected, and the nature of which had to be decided. The usual causes are cancer, abscess, syphilis, hydatids,and occasionally tuberculosis. The tumors in connectionwith the gall-bladder I shall consider separately. Undercertain circumstances the liver itself may form a tumor-like structure. The cases which have come before me fordiagnosis in the past twelve months are distributed as fol-lows : The liver itself, one; abscess, four; syphilis, two; cancer, four. 8 67 68 THE DIAGNOSIS OF ABDOMINAL TUMORS. I. Tumor formed by the Liver itself.—I showyou here a little patient (Case XXV) in the upper partof whose abdomen you can see, even from a distance, aprominent tumor, which pulsates actively at the rate
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of ninety per minute, lifting the skin in the epigastricregion. This case has been under our care on and off forthe past two years. She is thirteen years of age, and hasan old mitral-valve lesion from rheumatism, with enor- TUMORS OP THE LIVER. 69 mous enlargement of the heart. The apex beat is, as yousee, far out in the sixth and seventh interspaces. Theprsecordia is very prominent, and there are signs indicat-ing that the pericardium is adherent. During the pasteighteen months ascites has constantly recurred, so thatshe is now tapped once a week, yesterday for the seventy-first time. When the abdomen is distended nothing isnoticed, but after the fluid is withdrawn this remarkabletumor-like mass appears in the epigastrium (Fig. 21). Onpalpation it is smooth, with a rounded edge, descends withinspiration, and expands visibly; and under the fingers,during the cardiac systole, it can be traced to the right,where at about the nipple line it passes beneath the costalmargin. As it pulsates

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