File:The diseases of infancy and childhood (1910) (14783950993).jpg

Identifier: diseasesofinfa00kopl (find matches)
Title: The diseases of infancy and childhood
Year: 1910 (1910s)
Authors: Koplik, Henry, 1858- (from old catalog)
Subjects: Children
Publisher: New York and Philadelphia, Lea & Febiger
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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es the strip to what he calls the deep dulness of the spleen.From the ninth rib downward, there is absolute dulness, then flatness,due to the presence of the spleen proper behind the chest wall. The DISEASES OF THE SPLEEN. 733 anterior border of the spleen is located by percussing in a horizontaldirection toward the axillary line along the tenth rib. Palpation.—The enlarged spleen can be distinctly made out bypalpation. The abdomen should be relaxed. It is sometimes neces-sary to flex the thighs slightly, in order to relax the abdomen. Inyoung infants this is not necessary. The physician stands at the right side of the patient and withthe palmar surface of the fingers of the right hand palpates the ab-dominal parietes just beneath the border of the ribs (Fig. 169). Asthe patient inspires deeply, the hand is by steady pressure insinuatedbeneath the ribs in an upward and backward direction. In the vastmajority of cases under the tenth year, the normal spleen may thusbe felt. Fig. 169.
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Method of palpating the spleen. In practice, it may safely be said that a spleen which cannot befelt below the border of the ribs is not enlarged, unless some con-dition, such as the presence of fluid or tympanites, prevents thoroughpalpation. I have rarely failed to palpate the enlarged spleen satis-factorily. Enlargement of the spleen is found in rachitis, chronic^■astro-enteritis, sepsis, typhoid fever, malarial fever, varicella, syph-ilis, ansemia infantum pseudoleuksemica, leukaemia, Hodgkins dis-ease, congenital syphilis, cirrhosis of the liver, amyloid degeneration,heart disease, and simple catarrhal jaundice. From these statements it will be seen that enlargement of thespleen in infancy and childhood is pathognomonic o( no one disease.and should not lead to any one conclusion. It is only corroborativein the presence of other signs and symptoms. Without a very thor-ough and painstaking examination o( the Mood, the significance oithe enlarged spleen in the febrile and afebrile

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