THE SUPRARENAL GLANDS, OR ADRENAL CAPSULES 1449 



tant about an inch and a half from the median plane of the body, and its outer end about reaches 

 the midaxillary line" (Quain). 



Applied Anatomy. Injury of the spleen is less common than that of the liver, on account 

 of its protected situation and connections. It may be ruptured by direct or indirect violence, 

 torn by a broken rib, or injured by a punctured or gunshot wound. When the organ is enlarged 

 the chance of rupture is increased. The great risk is hemorrhage, owing to the extreme vascu- 

 larity of the organ, and the absence of a proper system of capillaries. The injury is not, how- 

 ever, necessarily fatal, and this would appear to be due in a great measure to the contractile 

 power of its capsule, which narrows the wound and thus antagonizes the escape of blood. In 

 cases in which the symptoms suggest such an injury and indicate danger to life, laparatomy must 

 be performed; and if the hemorrhage cannot be arrested by ordinary surgical methods the 

 spleen must be removed. The spleen may become displaced, producing great pain from stretch- 

 ing of the vessels and nerves, and this dislocation may render necessary removal of the organ. 

 The spleen may become enormously enlarged in certain diseased conditions, such as ague, leu- 

 kemia, syphilis, valvular disease of the heart, or without any obtainable history of previous 

 disease. It may also become enlarged in lymphadenoma as a part of a general blood disease. 

 In these cases the mass may fill the abdomen and extend into the pelvis, and may be mistaken 

 for ovarian or uterine disease. 



The spleen is sometimes the seat of cystic tumors, especially hydatids, and of abscess. These 

 cases require treatment by incision and drainage; and in abscess great care must be taken 

 if there are no adhesions between the spleen and abdominal cavity, to prevent the escape of 

 any of the pus into the peritoneal cavity. If possible, the operation should be performed in 

 t\vo stages. Sarcoma and carcinoma are occasionally found in the spleen, but very rarely as 

 a primary disease. In movable spleen, if the organ is normal, follow the advice of Rydygier 

 and loosen the parietal peritoneum to make a pocket, place the spleen in the pocket, and pass 

 sutures through the parietal peritoneum and splenic ligaments. A movable diseased spleen 

 should be removed. 



Extirpation of the spleen has been performed for wounds or injuries, floating spleen, simple 

 hypertrophy, and leukemic enlargement; but in the latter case the operation is now regarded 

 as unjustifiable, as it is practically certain to terminate fatally. The incision is best made in 

 the left semilunar line: the spleen is isolated from its surroundings, and the pedicle transfixed 

 and ligated in two portions, before the tumor is turned out of the abdominal cavity, if this is 

 possible, so as to avoid any traction on the pedicle, which may cause tearing of the splenic vein 

 and which inevitably induces grave shock. In applying the ligatures the surgeon must not 

 include the tail of the pancreas, and in lifting out the organ care must be taken to avoid 

 rupturing the capsule. 



THE SUPRARENAL GLANDS, OR ADRENAL CAPSULES (GLANDULAE 

 SUPRARENALIS) (Figs. 1206, 1207). 



The suprarenal glands are two small flattened bodies, of a yellowish color, 

 situated at the back part of the abdomen, behind the peritoneum, and immedi- 

 ately above and in front of the upper extremity of each kidney; hence their name. 

 The right one (Fig. 1206) is somewhat triangular in shape, bearing a resemblance 

 to a cocked hat; the left (Fig. 1207) is more semilunar, usually larger and placed 

 at a higher level than the right. They vary in size in different individuals, 

 being sometimes so small as to be scarcely detected; their usual size is from 

 an inch and a quarter to nearly two inches (4 to 5 cm.) in length, rather less in 

 width, and one-quarter of an inch (6 mm.) in thickness. Their average weight 

 is from one to one and one-half drams (6 grams) each. 



Relations. The relations of the suprarenal glands differ on the two sides of 

 the body. 



The right suprarenal (Fig. 1206) is situated behind the inferior vena cava and the 

 right lobe of the liver, and in front of the Diaphragm and the upper end of the 

 right kidney. It is roughly triangular in shape, and its base, directed downward, is 

 in contact with the inner and anterior aspects of the upper end of the right kidney. 

 It presents two surfaces for examination, an anterior and a posterior. The 

 anterior surface (fades anterior) presents two areas, separated by a furrow, the 

 hilum (hilus glandulae suprarenalis); one area, occupying about one-third of the 



