204 Anatomy Applied to Medicine and Suigety. 



ed projection of the gall bladder detected." Glenard ad- 

 vises palpation of the liver in the following manner : "With 

 the left hand grasp the right flank, fingers behind, and 

 then, with the thumb which is free, the edge and surface 

 of the anterior part of the right lobe can be felt as the liver 

 descends in inspiration." 



Operations on the Liver. In a section of the 

 liver, the hepatic veins can be distinguished from the por- 

 tal branches by the fact that the former are open or patu- 

 lous, whereas, the latter are more or less collapsed. The 

 explanation of this is, that there is a close union between 

 the walls of the hepatic veins and the channels in which 

 they lie, so that, when divided they are held open, but in 

 the case of the branches of the portal vein, there is no such 

 union, since these vessels are enclosed in Glisson's capsule, 

 and hence, when divided, they collapse. Until recently 

 there was a great dread of hemorrhage occurring, espe- 

 cially from the open hepatics, during operations for the 

 removal of a portion of the liver tissue. Keen reported in 

 1899 seventy-six cases of resection of the liver for neo- 

 plasms, and in his own case he used a thermocautery, but 

 by means of the suture devised by Terrier and Auvray and 

 improved by Thompson, of Galveston, the hemorrhage 

 may be so controlled as to bring within the domain of 

 surgery the safe removal of a portion of the liver. This 

 suture, of the thickest silk, finds sufficient connective tis- 

 sue in both the walls of the hepatic veins and in Glissons' 

 capsule to securely retain it, if applied tightly enough, 

 Aspiration of an hepatic abscess may be done through the 

 right axillary region and between the ninth, tenth and 

 eleventh ribs, since these spaces would be below the level 

 of the lower reflection of the pleura in this situation. 



Operations on the Gall Bladder. Gall stones 

 are very common and may never produce any symptoms, 

 or, on the other hand, they may cause trouble by their pre- 



