198 Anatomy Applied to Medicine and Surgery. 



right of the vertebral coulmn, from which point it gradu- 

 ally approaches the line for the right border so as to join 

 it about the end of the eleventh rib. 



Displacement. The situation of the liver is not 

 the same in every normal subject, for, while the above 

 may be taken as the usual position in the majority of cases, 

 there are many variations even in health, both as to size 

 and position. Respiration is constantly changing thiei 

 relative situation of the liver, since, in inspiration, it is 

 forced downwards and forwards by the diaphragm, while 

 in expiration it is raised up, partly by the arching of the 

 diaphragm, and partly by the compression of the abdomi- 

 nal muscles. 



When the patient is in the erect posture, the liver pro- 

 jects beyond the chondral margin, but, when in the re- 

 cumbent position, it disappears behind that margin. The 

 liver is held in its normal position by the suspensory and 

 the coronary ligaments ; by the areolar tissue connecting 

 the posterior surface of the right lobe to the diaphragm ; 

 by the attachment of the vena cava to the margin of the 

 phrenic opening ; by the viscera on which it rests ; by the 

 pressure of the abdominal muscles, and by the dome-like 

 arching of the diaphragm. It may be drawn upwards by 

 any disease that causes increased arching of the dia- 

 phragm, such, for instance, as fibroid phthisis, or a con- 

 tracted right lung, the result of a long-continued hydro- 

 thorax. It may be displaced downwards by a subphrenic 

 abscess or by flattening of the diaphragm, as in emphy- 

 sema, or in pleurisy with effusion, or it may be displaced 

 downwards in hepatoptosis as in Glenard's disease, where, 

 owing to relaxed ligaments and a weakened support from 

 pendulous abdominal walls, visceroptosis occurs; or its 

 lower border may be increased downwards by such dis- 

 eases as passive congestion, amyloid or waxy degenera- 



