A practical treatise on medical diagnosis for students and physicians / by John H. Musser.

  • Musser, John Herr, 1856-1912.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on medical diagnosis for students and physicians / by John H. Musser. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    The enlargement is noted at the edge of the liver in the usual situation, and may gradually increase to an enormous extent, so that it has been mistaken for an ovarian cyst. The gall-bladder is often quite movable, and on account of its location and movability, as well as its elongated shape, has been mistaken for a floating or movable kidney. If the gall- bladder is not too large, it can be felt as a rounded or pyriform mass when the hand is placed along the margin of the liver, becoming more marked when the patient takes a full breath. The enlargement is not attended by any other symptoms except mechanical ones, unless the con- tents of the gall-bladder are purulent. In obstruction with simple en- largement the fluid obtained by aspiration is thin, of a mucoid nature, and alkaline in reaction. It may contain cholesterin-plates, and some- times blood. It must be distinguished from the fluid of a hydatid cyst. Diagnosis. Simple enlargement of the gall-bladder must be distin- guished from enlargements due to inflammation. Cancer of pylorus pressing on the cystic duct. Enlargement of the gall-bladder, usually due to cystic obstruction as previously mentioned, may be mistaken for floating kidney, for tumor of pylorus, and for ovarian cyst. Tumors of the gall-bladder from any of these causes are recognized by their position and shape, and by the char- acter of the tumor. The position varies. The tumor is usually situated in the gall-bladder region, but may extend as low as the groin, or may be so large as to distend the ribs and fill almost the entire abdominal cavity. If, however, the case has been under observation from the begin- ning, the tumor must have been found originally in the gall-bladder region. This region corresponds to the point where a line drawn from the acromion process of the right shoulder to the umbilicus intersects the costal margin. The tumor grows from this point toward the umbilicus in nearly all the cases. It can be recognized by its shape, which is pyri-