To men who devote their lives to this special work this is a difficult problem. Even in the hands of such men positive diagnosis is not always possible before the abdomen is opened, and not always then until the tumor has been examined under the microscope. It is only fair to make this statement in the beginning as a reason for not drawing the differentiating lines very acutely. We must bear in mind that there may be exceptions to the usual rule in many of the symptoms in any given case. He who takes written notes and keeps a record of his cases for future reference will be doubly repaid for his time in his future work. No better method of informing oneself in this line of work can be suggested than the careful note-taking of every case that passes under observation.
In studying the differential diagnosis of abdominal and