Fascia Lining the Abdomen. 181 



are raised and the latter is made more prominent ; where- 

 as, if it be an internal growth, this contraction of the ab- 

 dominal parietes would more or less obscure the growth. 

 Phantom tumor, as already mentioned, is generally the 

 local contraction of a pQrtion of the rectus muscle, especi- 

 ally the upper segment; i.e., that portion immediately 

 below the ensiform cartilage, and, since, the skin overlying 

 it is supplied by the same nerve as the muscle, we can 

 readily understand the sensitiveness of the integument 

 present over the tumor. Osier, in his work on "Abdomi- 

 nal Tumors" mentions a phantom tumor due to a local 

 contraction of the circular muscular fibres of the stomach. 

 In manual examination of the abdomen, the patient should 

 lie on his back with his legs drawn up and the examiner's 

 fingers (not the tips) should be gently pressed into the 

 muscles as they are relaxed. This relaxation of the mus- 

 cles may be secured by asking him to take a deep inspira- 

 tion- and then to hold his breath as long as possible. There 

 naturally follows a gasp after this pause, and during this 

 relaxation the fingers of the surgeon may be employed to 

 ascertain the condition present. It is sometimes advis- 

 able to have the patient assume the genu-pectoral position 

 to assist in the diagnosis of abdominal tumors, as, for in- 

 stance, in distinguishing an aneurism of the aorta from a 

 growth overlying the vessel and receiving pulsation from 

 it. If the patient be placed in the knee-chest position the 

 growth that merely overlies the artery will fall away from 

 it, and pulsation will, therefore, cease, whereas, if this 

 position has no effect on the pulsation, then it is probably 

 an aneurism. 



