Human anatomy; Medicine -- Study and teaching; Palpation
73. =Spermatic cord.=--The spermatic cord can be felt as it emerges
through the external ring, and its course can be tracked into the
scrotum. The vas deferens can be distinctly felt at the back of the
cord, and separated from its other component parts.
74. =Epigastric artery.=--The direction of the deep epigastric artery
corresponds with a line drawn from the inner border of the internal
ring up the middle of the rectus muscle, towards the chest.
In thin persons the absorbent glands which lie along Poupart’s ligament
can be distinctly felt. They are usually oval, with their long axes
parallel to the line of the ligament.
75. =Abdominal viscera.=--Now let us see how far we can make out
externally the position and size of the abdominal viscera.
To make this examination with anything like success, it is desirable to
relax the abdominal muscles. The man should be on his back, the head,
shoulders and thorax being well raised, to relax the recti muscles; and
the thighs bent on the abdomen, to relax the several fasciæ attached to
the crural arch. To induce complete relaxation, where a very careful
examination is desired, chloroform should be given.
In manipulating the abdomen we should not use the tips of the fingers.
This is sure to excite the contraction of the muscles. The flat hand
should be gently pressed upon it, and with an undulating movement.
76. It is well to bear in mind that the central tendon of the diaphragm
is about the level of the lower end of the sternum at its junction with
the seventh costal cartilage; that the right half of the diaphragm
rises to about the level of the fifth rib--that is, about an inch below
the nipple; that the left half does not rise quite so high. In tranquil
breathing the diaphragm descends about half an inch.
The position of the abdominal viscera varies, to a certain extent,
in different persons. In some of them, especially the stomach, their
position varies in the same person at different times.
Let us take, first, the largest of the abdominal viscera--the liver.
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