THE SPLEEN 151 



duct, 2 inches long; the common duct, 3 inches long. Just before 

 it opens into the duodenum, the common duct expands into a 

 little pouch called the ampulla of Vater. A gall stone may lodge 

 in this place. 



Clinical notes. The liver is pressed downward by the movement (con- 

 traction) of the diaphragm in inspiration, and can then be felt below the 

 costal arch in front. During expiration it slips upward with the rise of the 

 diaphragm. 



Gall stones may form in the gall-bladder or in any of the ducts. If in the 

 gall-bladder they may exist for a long time without causing symptoms, the 

 bile flowing into the intestine without obstruction; if in the cystic duct the 

 symptoms are also deferred, but if in either the hepatic duct or the ductus 

 communis, obstruction to the outflow promptly causes jaundice and other 

 disorders, with distention of the gall-bladder. Inflammation of the gall- 

 bladder is Cholecystitis, of the liver hepatitis. 



The viscidity of the bile is increased in inflammation of the gall-bladder 

 and often dogs the ducts to the point of obstruction, as in jaundice. 



THE SPLEEN 



Although there are reasons for including the spleen in the list of duct- 

 less glands it is decided to include the description of this organ in the 

 present connection. It is a very important organ with a remarkably free 

 blood supply, which suggests great activity for some purpose or purposes, 

 and the only direct connection of the spleen with any other . organ is by 

 blood-vessels with the liver, but the significance of this is a matter of con- 

 jecture at the present time. 



The spleen (or lien) is situated at the left of the stomach, 

 directly beneath the diaphragm by which it is entirely covered. It 

 is oval in shape, convex on the lateral -surface and concave on the 

 medial, where a depression called the hilus is seen for the passage of 

 vessels and nerves (Fig. 109). 



The fibromuscular capsule which forms the surface of the spleen sends 

 numerous septa into the interior, and within the spaces of the network thus 

 formed the splenic pulp is contained. This consists of blood which has 

 escaped from the open terminals of numberless capillaries, of lymphoid cells 

 and broken down red cells, coloring matter and particles of waste. Small col- 

 lections of lymphoid cells around the capillaries may be seen upon section 

 of the organ; they are the Malpighian bodies of the spleen; their function is 

 obscure. 



The splenic artery is the largest branch of the celiac axis and 

 the consequent large blood supply gives a dark red color to the 



