Volume 1

Collected works of Francis Sibson / edited by William M. Ord.

  • Francis Sibson
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Collected works of Francis Sibson / edited by William M. Ord. Source: Wellcome Collection.

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    right costal cartilages ; this right extremity of the lower margin is usually in adult males above, in women and children below that edge. The lower margin of the liver is usually from two to four inches below the extremity of the sternum. In cases of enlarged liver, (Diagram lo, and for a posterior view Diagram 7,) these boundaries extend farther to the left and descend lower into the abdomen. Stomach.—The position of the outer boundary of the greater curvature of the stomach depends upon the quantity of gas and food it contains; it is sometimes perfectly empty, (Diagrams 2 and 21,) when the outer bound is some inches from the outside of the ribs; in some it is moderately, in others, again, enormously distended, (Diagram i,) where it presses against the ribs, just within the left side. The lower bound of the stomach varies with its own distension, and with the lower bound of the liver. Where the liver descends low, (Diagrams 8, 10, and 21,) it draws down with it the pyloric extremity of the stomach and the lower limb of the greater curvature. The lesser curvature lies immediately behind the liver; the cardiac orifice is just behind the xiphoid cartilage. The division of the stomach into cardiac and pyloric portions, by an hour-glass contraction, is well shown in Diagrams 14, 20, and 23. The pyloric portion of the stomach is generally found empty: a curious example of this is presented in Diagram 15; its usual state is shown in Diagram 21, and many others. The liver at its lower edge thins off; the dull sound of the liver and the resonance of the stomach are well contrasted ; but to ascertain the precise bound of the liver the percussion must be very light, other- wise the sound will pass through its marginal film and excite stomach vibrations. The ease with which stomach vibra- tions are excited by deep, strong percussion, through the thinned marginal part of the liver, affords an excellent