702 A MANUAL OF ANATOMY 



Area of Splenic Dulness. — ^This area is limited posteriorly by the 

 mid-scapular line between the ninth and eleventh left ribs, and 

 anteriorly by the mid-axillary line as it crosses the ninth, tenth, 

 and eleventh ribs, or by a line connecting the left sterno-clavicular 

 joint with the tip of the eleventh left rib. The length of the area 

 is about 3 inches, and its breadth from 2 to 2J inches. 



For the structure and development of the spleen, see Index. 



Position, Connections, and Component Parts of the Liver. — ^The 

 liver (hepar), which is the largest gland in the body, occupies 

 almost all the right hypochondrium, a great part of the epigastrium, 

 and a small part of the left hypochondrium, in which latter direction 

 it usually extends as far as the left Poupart plane. It is maintained 

 in position by the following peritoneal ligaments : the posterior or 

 coronary ligament, the right and left lateral or triangular liga- 

 ments, and the falciform or suspensory ligament. 



Topography. — The size of the liver is such a variable factor that 

 the following statement of its limits is only to be regarded as 

 'approximately accurate. In the right mammary line it extends 

 from a point about J inch below the right nipple to a point about 

 \ inch below the tip of the bony part of the tenth right rib, being 

 covered by the right ribs from the fifth to the tenth inclusive. In 

 the mid-axillary line the right aspect of the organ extends from the 

 seventh to the eleventh rib, and in [the scapular line its superior 

 and inferior limits are on a level with the ninth and eleventh thoracic 

 spinous processes respectively, the ribs to which it is here related 

 being the ninth, tenth, and eleventh. The left limit of the organ 

 usually corresponds to the left Poupart plane. In mapping out 

 the upper limit the middle line may be taken as the starting- 

 point. In this situation the limit is indicated by a line crossing 

 the sternum at the level of the sixth costal cartilages, this line being 

 slightly arched downwards. The line should then be prolonged to 

 the left, with a slight curve upwards, to a point about 2 inches 

 to the left of the left border of the sternum. In continuing the 

 line to the right it should be carried upwards so as to reach a 

 point about h inch below the right nipple. The line, on being pro- 

 longed from this point towards the right side, must be carried 

 slightly downwards so as to reach the mid-axillary line at the level 

 of the seventh right rib. The lower limit of the organ extends from 

 a point about | inch below the tip of the bony part of the tenth 

 right rib to the left extremity of the line indicating the upper 

 limit. The direction of the line indicating the lower limit is 

 upwards and to the left. 



Summary of Outline of Liver. — Commencing 2 inches from the left border 

 of the sternum and i inch below the nipple, draw a line downwards and to the 

 right to the left border of the sternum at the level of the sixth costal cartilage, 

 next across the sternum with a slight curve downwards, then upwards and to 

 the right to a point about | inch below the right nipple. From this point 

 carry the line downwards and to the right as far as the seventh rib in the right 

 mid-axillary line, then downwards and backwards to the ninth rib on a level 

 with the ninth thoracic spine, whence the line is carried downwards to the 



