744 DISEASES OF THE SPLEEN. 



inches. If the spleen enlarges, its dulness partly extemL* forward aud 

 downward, and partly, by pushing the diaphragm before it, upward, but 

 rarely higher than the fifth rib. If the intestines be distended by gas, 

 and the abdominal walls be tense, the dulness extends more upward ; 

 if the intestines be empty, and the abdominal walls relaxed, it extends 

 more anteriorly and downward. The spleen-dulness changes its place 

 during respiration, being about an inch lower on deep inspiration, and 

 about an inch higher on full expiration. When the patient lies on the 

 right side, the spleen-dulness is less ; hence it is well to examine the 

 patient in different positions, and, if we wish to determine whether 

 the extent of dulness varies from time to time, we should carefully 

 note in what position of the patient the previous examination was 

 made. 



If tumors of the spleen project below the ribs, and be not too soft, 

 we may readily recognize them, and distinguish them from other 

 tumors by palpation. While they have only a moderute extent, they 

 can often only be felt when the patient inspires deeply ; on expiration, 

 they disappear beneath the ribs. When the growth is considerable, 

 the swelling gradually extends from the left hypochondrium, obliquely, 

 toward the navel. It almost always maintains the characteristic form 

 of the spleen, particularly the shallow excavation in the anterior 

 rounded edge. The tumor follows the movements of the diaphragm, 

 can be readily moved, and changes its position with the position of the 

 body. When the spleen is very large, instead of taking an oblique 

 direction, it often passes directly downward into the pelvis, and, be- 

 coming less movable, no longer follows the motions of the diaphragm. 

 The spleen-dulness may disappear from the thorax, as a result of 

 elongation of the ligament attaching the spleen to the diaphragm, from 

 the weight and size of the enlarged organ. 



In some cases even inspection shows the enlargement of the spleen 

 by a prominence of the left hypochondrium and left half of the abdo- 

 men, hi which the contours of the spleen are occasionally noticed. 



The spleen enlarged by hyperaemia does not by any means always 

 extend below the ribs, and, even when it does, may escape detection 

 by palpation if it be very soft. 



If hyperaemia of the spleen accompany abdominal typhus, on per- 

 cussion we usually find the dulness extending more backward, on ac- 

 count of the meteorism of the intestines ; if, on the other hand, it ac- 

 company an intermittent, the dulness rather extends toward the axilla, 

 and occupies the left hypochondrium. 



TREATMENT. In accordance with what we have said of its course, 

 hypenemia of the spleen is rarely the object of treatment. If we can 

 remove the original disease, it almost always disappears in a short 



