A practical treatise on medical diagnosis for students and physicians (1904) (14776929303)

Glenard's method for palpation of the liver

Identifier: practicaltreatis1904muss2 (find matches)

Title: A practical treatise on medical diagnosis for students and physicians

Year: 1904 (1900s)

Authors: Musser, John Herr, 1856-1912 Pancoast, Henry

Subjects: Diagnosis Diagnosis, Radioscopic Diagnosis

Publisher: Philadelphia and New York : Lea

Contributing Library: Francis A. Countway Library of Medicine

Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

Text Appearing Before Image:

the liver is felt for, the right hand meanwhile forcing the intes-tines out of the way. The examiner sits on the right side of the bedfacing the patient, who lies on his back with the legs extended and theshoulders slightly raised on a bolster. The liver is pressed forward, withthe fingers of the left hand applied to the lumbar region, while the thumbof the same hand in abduction remains free to palpate the anterior surfaceof the body. The right hand in extreme adduction is then applied to theabdomen and, while deep pressure is made for the purpose of forcing thecoils of intestine up under the liver, the hand is rotated to a transverse 530 PHYSICAL DIAGNOSIS OF DISEASES WITHIN THE MiDOMEN. position on the abdomen. (See Figs. 191 and L92.) The patient nowtakes a deep breath, and at the same time the ball of the left thumbglides upward and outward and from behind forward. The last step isrepeated with the thumb at successively higher levels until the edge of the liver is felt Pig. 192.

Text Appearing After Image:

Glenards proc6d6 du pouce. Constriction of the liver from tight lacing (Schniirleber) occurs chieflyin women. Tight corsets, and, still more, tight waist-bands, force theliver downward, especially the right lobe, so that it can be palpated. Inmore pronounced cases a furrow, often palpable, is produced, and belowthis a constricted lobe which may extend as far down as the anteriorsuperior spine of the ilium and carry the gall-bladder with it. In otherinstances the right lobe is elongated, extending even to the crest of theilium.1 Lobes so depressed are usually thin and easily movable, and can begrasped with the hand and moved to and fro. If the lobe does not reachso far downward, it is more rounded and blunt in shape. It is not alwayseasy to demonstrate its connection with the liver, because coils of intes-tine overlying the liver in the furrow make palpation difficult, and causea tympanitic note between the liver-dulness and the dulness of the con-stricted lobe. 1 Musser. Transactions

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1904

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