THE ABDOMEN. 37 



middle line, just below the level of the junction of the seventh 

 costal cartilage with the sternum. 



80. Pylorus. The pylorus lies under the liver, on the 

 right side, near the end of the cartilage of the eighth rib ; but 

 it cannot be felt unless occasionally when enlarged and 

 hardened by disease. 



8 1. Spleen. The spleen, if healthy, cannot be felt, so 

 completely is it sheltered by the ribs. It lies on the left side, 

 connected to the great end of the stomach, beneath the ninth 

 tenth, and eleventh ribs, between the axillary lines lines' 

 drawn vertically downwards from the anterior and posterior 

 margins of the axilla. Its upper edge is on a level with the 

 spine of the ninth dorsal vertebra, its lower with the spine of 

 the eleventh. 



Its position and size, therefore, in health can only be 

 ascertained, and not very accurately, by the extent of dul- 

 ness on percussion. The greatest amount of dulness would 

 be over the tenth and eleventh ribs ; above this the thin edge 

 of the lung would intervene between the spleen and the 

 abdominal wall. If, therefore, the spleen can be distinctly 

 felt below the ribs, it must be enlarged. In proportion to its 

 enlargement, so can its lower rounded border be detected 

 below the tenth and eleventh ribs, especially when forced 

 downwards by a deep inspiration. 5 



82. Pancreas. The pancreas lies transversely behind the 

 stomach, and crosses the aorta and the spine about the junc- 

 tion of the first and second lumbar vertebrae. The proper 

 place to feel for it, therefore, would be in the linea alba about 

 two or three inches above the umbilicus. Is it perceptible 

 to the touch ? only under very deep pressure, and very 

 favourable circumstances, such as an emaciated and empty 

 abdomen. It is worth remembering that it may be felt under 

 such conditions. The pancreas of normal size, in thin persons, 

 has been mistaken for disease disease of the transverse arch 

 of the colon, or aneurysm of the abdominal aorta. 



83. Kidney. The kidney lies at the back of the abdomen, 

 on the quadratus lumborum and psoas muscles, opposite the 

 two lower dorsal and two upper lumbar spines. The right, 



