THE ABDOMEX. 35 



To make this examination with anything like success, it is 

 desirable to relax the abdominal muscles. The man should 

 be on his back, the head shoulders and thorax being well 

 raised, to relax the recti muscles ; and the thighs bent on the 

 abdomen, to relax the several fasciae attached to the crural 

 arch. To induce complete relaxation, where a very careful 

 examination is desired, chloroform should be given. 



In manipulating the abdomen we should not use the tips 

 of the fingers. This is sure to excite the contraction of the 

 muscles. The flat hand should be gently pressed upon it, and 

 with an undulating movement. 



76. It is well to bear in mind that the central tendon of 

 the diaphragm is about the level of the lower end of the 

 sternum at its junction with the seventh costal cartilage ; 

 that the right half of the diaphragm rises to about the level 

 of the fifth rib that is, about an inch below the nipple ; that 

 the left half does not rise quite so high. In tranquil 

 breathing the diaphragm descends about half an inch. 



The position of the abdominal viscera varies,, to a certain 

 extent, in different persons. In some of them, especially the 

 stomach, their position varies in the same person at different 

 times. 



Let us take, first, the largest of the abdominal viscera 

 the liver. 



77. Ziiver. The liver lies under the right hypochondrium, 

 and passes across the middle line over the stomach into the 

 left hypochondrium, generally speaking, as far as the left 

 mammary line. The extent to which it can be felt below 

 the edges of the ribs depends upon whether it is enlarged or 

 not, as well as upon its texture, and also upon the amount of 

 flatus in the stomach and intestines. As a rule, in health its 

 lower thin border projects about half an inch below the costal 

 cartilages, and can be felt moving up and down with the 

 action of the diaphragm ; but it requires an educated hand 

 to feel it. An uneducated hand would miss it altogether. 

 That part of it, however, which crosses the middle line below 

 the ensiform cartilage is much more accessible to the feel ; 

 here it lies immediately behind the linea alba, and in front <>f 



D 2 



