Lectures on the diagnosis of abdominal tumors, / by William Osler.

  • William Osler
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the diagnosis of abdominal tumors, / by William Osler. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    costal cartilage with the sternum, and extends three fingers' breadth. It can be separated from the dullness over the tumor mass m the epigastric region. The spleen is not enlarged. There are no super- ficial glandular enlargements. The patient had had a severe attack of vomiting this morning, and his stomach was not nearly so much dUated as usual. The vomited matter which I saw had the usual characters-dark brown, with frothy scum. The urine was somewhat diminished, and he complained very much of thirst. Two points of interest present themselves in this case, which otherwise seems to have all the characters of ordi- nary dilatation of the stomach from pyloric obstruction. In the first place, the nature of the attack of severe jaun- dice with the tumor mass in the epigastric region. From Dr. Barclay's account, there can he no question that the patient vomited a large quantity of pus, and that subse- quent to this the tumor disappeared and the jaundice got better. There are two suggestions in this connection: that there was a large carcinoma of the stomach, with suppura- tion at its base and about the tissues of the gastro-hepatic omentum, with compression of the bile ducts. Suppura- tion does occur at the base of malignant growths, more particularly when they form adhesions with adjacent organs, and I have placed such instances on record; in- deed, there may be a considerable collection of pus between the left lobe of the liver and the stomach. The other sug- gestion is that the jaundice and enlargement of the left lobe of the liver were associated with gallstones and sup- puration in the region of the ducts, with discharge into the stomach, and subsequent cicatricial contraction about the pylorus and dilatatio ventriculi. The jaimdice, how- ever, would scarcely have disappeared, and this is not a very likely condition. And, lastly, it is interesting to note here the situation of the tumor mass—not at all in the position usually felt in carcinoma of the pylorus, but, as