chap, xvii.] THE SPLEEN. 357 



follow a line extending from the tip of the right tenth 

 cartilage across the median line of the abdomen below 

 the umbilicus. For the relief 'of this condition, 

 cholecystotomy, or incision into the gall bladder, has 

 been performed. In this operation the incision or 

 puncture is made over the most prominent part of the 

 tumour. Impacted gall stones have been removed 

 entire from the bile duct through an incision so made, 

 or the stone has been crushed in situ and extracted in 

 fragments. 



In cholecystectomy the whole of the gall bladder is 

 excised and the cystic duct closed. The bile finds its 

 way into the intestine direct through the common 

 duct. 



In cholecystenterostomy a fistula is established 

 between the gall bladder and the intestine. The 

 operation is carried out in cases in which there is an 

 insuperable obstruction in the common duct. 



THE SPLEEN. 



. In front. 



Stomach. 

 Splenic flexure of colon. 



Outer side. 

 Diaphragm. 



9th to llth ribs between 

 axillary lines. 



Spleen. 



Inner side. 



Stomach. 



Pancreas. 



L. kidney and capsule. 



Behind. 

 Diaphragm. 



The spleen. The spleen most closely approaches 

 the surface in the parts covered by the tenth and 

 eleventh ribs. Above this it is entirely overlapped 

 by the edge of the lung. It is in all parts separated 

 from the parietes by the diaphragm. " It lies very 

 obliquely, its long axis coinciding almost exactly with 

 the line of the tenth rib. Its highest and lowest 

 points are on a level, respectively, with the ninth 



