252 Anatomy Applied to Medicine and Surgery. 



palm, upon the postero-lateral aspect of the left side of 

 thorax, so that the lower part of the middle of the wrist 

 will be about one inch from the spine, and the line of the 

 middle finger will be over the tenth rib. The area cover- 

 ed by the hand will indicate, fairly well, the situation of 

 the normal spleen (Fig. 9). 



Clinical Examination. Percussion. Like the 

 liver, the spleen is partly hidden by the lower margin of 

 the lung, so that there is an area of "relative" as well as 

 one of "absolute" dullness on percussion. When percuss- 

 ed from above, downwards, the "relative" dullness ends 

 opposite the inferior limit, or lower border of the lung, 

 i.e., at the level of a line passing around the thorax cross- 

 ing the mammary, the axillary and the scapular lines at 

 the sixth, eighth and tenth ribs, respectively. Below this, 

 and in a direction parallel to the ribs, is the area of "abso- 

 lute" dullness. When the spleen is enlarged, the area of 

 dullness is increased, and, when the organ is displaced 

 downwards, as in visceroptosis, or, when it is forced up- 

 wards, as in distention of the abdomen from ascites, 

 meteorism, etc., the area of dullness is interfered with. 

 In the healthy organ, deep percussion often fails to bring 

 out, with any degree of accuracy, the splenic area, because 

 of the presence of a tympanitic note from the underlying 

 stomach or colon when empty, or, on the other hand, the 

 normal area of splenic dullness may be apparently in- 

 creased when the stomach is distended with food, or the 

 bowel with hardened faeces. When percussing vertically 

 downwards, near the posterior part of the organ, it must 

 not be forgotten that the splenic dullness merges into that 

 arising from the lumbar muscles and the left kidney. 



Palpation. The spleen cannot be palpated, when nor- 

 mal, except in the condition termed wandering spleen, or 

 in those cases of downward displacement, the result of in- 



