. A practical treatise on medical diagnosis for students and physicians . ate VII.) The spleen lies inthe left upper quadrant, beneath and in contact with the diaphragmabove, and with the tail of the pancreas, the cardiac end of the stomach,and the suprarenal capsule below. It extends from the upper border ofthe ninth to the lower border of the eleventh rib, and from the mid-axillary line backward toward the spine. Palpation. As the spleen lies entirely behind the ribs, it does not, under normalconditions, admit of palpation ; but when it is enlarged, it becomes acces-sible to palpation in pro
. A practical treatise on medical diagnosis for students and physicians . ate VII.) The spleen lies inthe left upper quadrant, beneath and in contact with the diaphragmabove, and with the tail of the pancreas, the cardiac end of the stomach,and the suprarenal capsule below. It extends from the upper border ofthe ninth to the lower border of the eleventh rib, and from the mid-axillary line backward toward the spine. Palpation. As the spleen lies entirely behind the ribs, it does not, under normalconditions, admit of palpation ; but when it is enlarged, it becomes acces-sible to palpation in proportion to the degree of enlargement and of therelaxation of the abdominal walls. It moves with respiration and can notbe said to be enlarged unless the edge of the organ is palpable at theend of a deep inspiration, even if there is increased dulness in the loweraxillary region. An enlarged spleen usually retains its normal shape,and the direction of the enlargement is downward and inward. When theenlargement is moderate, the smooth, blunt, rounded anterior surface and. Feeling for the edge of the spleen. sharp edge of the spleen can be felt at the margin of the ribs during deepinspiration ; when the enlargement is great, as in leukcemia, the organ canbe grasped with both hands and its hilus clearly mapped out. The samething can be done in the rare instances of floating spleen, but here aknee-chest position will favor successful palpation. The posterior borderof an enlarged spleen can usually be made out by passing the hand back-ward over the resisting organ ; in children this border is always readilyfound. In fact, the spleen is always more readily palpable in childrenthan in adults ; it is also more movable, and therefore can be brought for-ward more easily to the median line by bimanual palpation. Betweenthe posterior border of an enlarged spleen and the mass of lumbar 536 PHYSICAL DIAGNOSIS OF DISEASES WITHIN THE ABDOMEN, muscle there is :t space which, as we
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