ABDOMINAL VISCERA IN MAN. 291 



- The Liver (fig. 3, Part I., and Plate LIL, Part II.). 



So much has been said concerning the liver and the other 

 solid viscera in the upper part of the abdomen in various 

 parts of the paper, that little remains except to indicate their 

 general position and to summarise their chief changes of 

 position. 



In considering the changes in position of these viscera it is 

 better to take the upper border as an index of displacement, for, 

 as is especially seen in the case of the liver, enlargement of the 

 organ generally affects the position of the lower border more 

 than the upper. 



In these cases there was an unusually large number of 

 instances in which the liver was either displaced downwards 

 from intrathoracic causes, or in which its lower border occupied 

 a low position from enlargement of the organ; so that the 

 average obtained of the position of the lower border of the liver, 

 and depicted in fig. 3, Part I., is in all probability nearly 1 cm. 

 lower than it is in the average healthy body. 



Also it must be remembered that the liver, of all the solid 

 viscera in the abdomen, even including the spleen, is the most 

 subject to changes in position in respiration and in the different 

 positions of the body. The anterior parts of the liver especially 

 are subject to a considerable range of movement from above 

 downwards and from right to left. 



There is this great advantage in connection with the liver- — 

 which, as we have seen, is so important an agent in determining 

 the position of other abdominal organs — that it can in most 

 cases be percussed out in the living subject. 



.Average Position. — The movable left extremity is situated in 

 the average about equal distances — nearly 3 inches — both above 

 E.F. and from the middle line in the region of the sixth left 

 costo-chondral junction ; being precisely 7'1 cm. from the 

 middle line and 7'4 cm. above E.F. 



The upjjer border in the middle line is situated nearly 1 cm. 

 below the infra-sternal notch, or 9 cm. above E.F. In the right 

 lateral line it is situated rather less than 1 cm. above the infra- 

 sternal notch (-6 above), being 10-4 cm. above E.F. 



The upper border of the liver is in the right lateral line at 



