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August 7, 1897


JAMA. 1897;XXIX(6):264-265. doi:10.1001/jama.1897.02440320008001c

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The object of this brief communication is to call attention to a symptom which I think has hardly received sufficient attention at the hands of clinicians and which I know to have been misinterpreted. I allude to tympany in the flanks and its significance in the diagnosis of ascites. It is generally taught that the absence of tympany in the flanks is characteristic of ascites; while its presence can not be regarded as consistent with any considerable degree of accumulation of liquid in this region. A case now in my wards at the Hospital of the University of Pennsylvania illustrates the possibility of error arising from a too strict adherence tothis guide. A woman, aged 37 years, was admitted with mitral stenosis and insufficiency, with passive congestion, enlargement and tenderness of the liver, ascites and general anasarca. When lying on her back the lower abdomen was somewhat bulging, and over

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