. Lezioni sulla diagnosi dei tumori addominali, consegnate alla classe post-laurea dell'Università Johns Hopkins, 1893. Durante la preminenza delle onde tumorali di contrizione passano da sinistra a destra e talvolta c'è una depressione ben marcata che separa le masse prominenti a sinistra e a destra della linea mediana. Durante i periodi di contrazione le masse sono irrefirm e resistenti; negli intervalli si dispaparono quasi completamente la pera e l'addome in queste regioni è abbastanza morbido. Nella linea destra parasternale, appena sotto il bordo del fegato, è un nodulartumor. Fig. 1 è da una fotografia

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. Lectures on the diagnosis of abdominal tumors, delivered to the post-graduate class of Johns Hopkins university, 1893. During the prominence of the tumor waves of contrac-tion pass from left to right and there is sometimes a well-markeddepression separating the prominent masses to the left and right ofthe middle line. During the periods of contraction the masses arefirm and resistant; in the intervals they almost completely disap-pear and the abdomen in these regions is quite soft. In the rightparasternal line, just below the edge of the liver, is a nodulartumor. Fig. 1 is from a photograph taken during the passage of the waves of contraction, three of which are plainly to be seen at the situations marked with the crosses. The letter / is placed in the depression separating the stomach into right and left. After sev-9, 4 THE DIAGNOSIS OF ABDOMINAL TUMORS. eral attacks of vomiting, and after having the stomach thoroughlywashed out, the distention was very much less marked, and theperistaltic movements were less frequent. The nodular tumormass was then felt to be very much more in the middle line. For. Fig. 1.—From a photo^aph by Dr. Hewetson, showing undulatorj-waves of peristalsisin Case I. The crosses are placed on the three prominent waves. The letter / in-dicates the depression on the lesser curve. a week or ten days before his death this patient had tetany, whichis not a very uncommon event in dilatation of the stomach. Deathoccurred September 26th. The autopsy showed at the pyloric extremity of the stomach acrater-like tumor mass eight by seven centimetres, the marginsthick, elevated, and indurated. Externally there was great thick-ening about the pylorus, with numerous nodules on the perito-naeum. At the pylorus the tumor was massed about the orifice, TUMORS OF THE STOMACH. 5 througli which, however, the little finger could pass. The coats ofthe stomach were enormously thickened. Fig. 2, from a photo-graph taken on the post-mortem table, shows well the dil

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