it lies under the liver in front of the pancreas, and in the back part of the abdominal cavity. When overloaded it occupies nearly the whole of the epigastric and the left hypochondric regions, turns upon its own axis and pushes outwards towards the front and is in contact with the abdominal wall. It pushes in every direction, displaces the contiguous organs and often interferes with the action of the heart and left lung. Hence the dyspnoea, palpitations and distressing heart symptoms in indigestion and flatulence. The cardiac orifice of the stomach is on a level with the junction of the seventh costal cartilage and the sternum, being a little to the left of the middle line. The pyloric orifice lies under the liver on the right side near the outer end of the cartilage of the eighth rib. It can only be felt when enlarged and hardened by disease, and then not with any degree of certainty.

Spleen. This viscus is so completely under the ribs that when of normal size it cannot be felt. It lies between the axillary lines, beneath the ninth, tenth and eleventh ribs on the left side, and is attached to the great end of the stomach. Its superior edge is on a level with the spine of the ninth dorsal vertebra and its lower with the spine of the eleventh. The only way by which we can ascertain the size and position of the spleen in health is by the extent of dullness on percussion, and this certainly cannot be very accurate. As the thin edge of the lung intervenes between the spleen and the abdominal wall opposite the ninth rib, we cannot expect distinct dullness here. It is most distinct over the tenth and eleventh ribs. When, therefore, the spleen can be distinctly felt below the ribs, it must either be enlarged or displaced in a downward direction. The degree of enlargement and the extent of displacement determines the amount of its lower round border that can be detected below the tenth and eleventh ribs. It is also forced downwards by a deep inspiration.

Pancreas. The pancreas extends transversely across the abdomen, its head embraced by the descending duodenum and its tail by the spleen. It lies in front of the abdominal aorta and opposite the junction of the first and second lumbar vertebræ. From this it follows that the proper place to feel for it is in the linea alba and two or three inches above the umbilicus. It can only be felt

when the abdomen is quite empty or where great emaciation exists, and only then on deep pressure. This should be remembered, for under the condition I have mentioned, a normal pancreas may be mistaken for a diseased one or for a disease of the transverse arch of the colon or aneurism of the abdominal aorta.

Kidney. These organs are in the back part of the abdominal cavity, and lie on the quadratus lumborum and psoas muscles. They are opposite the spines of the two lower dorsal and the two upper lumbar vertebræ. The right one is three-quarters of an inch lower than the left. The pelvis of the kidney lies nearly on a level with the spine of the first lumbar vertebra. The upper border is nearly on a level with the eleventh inter-costal space, and the lower border is nearly on a level with the third lumbar spine. Both organs are forced downwards nearly half an inch by a deep inspiration. I have never been able to detect a normal kidney with the fingers, and I doubt very much if it is possible to do so. It is accessible to pressure just below the twelfth rib and along the outer border of the erector spinæ muscle. There you may detect tenderness upon pressure, but you cannot detect its rounded lower border no matter how hard you press or how relaxed the abdominal walls, unless the organs be greatly enlarged. An enlarged kidney may be mistaken for enlarged liver, spleen, or an accumulation of fæces in the lumbar part of the colon and vice

versa.

Large intestine. The large intestine is about five feet in length and its course describes an arch which extends from the caput coli to the anus. It completely surrounds the convolutions of the small intestines. It commences in the right iliac fossa, at the ileo cæcal valve and by the cæcum. It ascends through the right lumbar region, passing over the right kidney, crosses the abdomen two or three inches above the umbilicus, descends through the left lumbar region in front of the left kidney and through the left iliac fossa as the sigmoid flexure. Except at the angles of the transverse colon, where it lies deeply beneath the short ribs, it is accessible to pressure throughout its entire tortuous course, and under favorable circumstances we can detect hardened fæces in it. I have seen two or three cases of this kind. In one case the accumulated fæces during life was supposed to be a tumor.

Colotomy. This operation may be performed in the right or left loin below the kidney, in that part of the colon not covered by the peritoneum. The operation has three surface marks, the last rib, the crest of the ilium, and the outer border of the erector spinæ. The incision should be a sloping one, and in a direction downwards and outwards, about three inches long and midway between the rib and ilium. The guide to the colon is the edge of the quadratus lumborum. It lies one inch external to the erector spinæ or three inches from the lumbar spines. The gut follows a vertical line and runs for at least two inches between the lower border of the kidney and crest of the ilium. In this connection it is well to remember a post mortem appearance of the colon which sometimes occurs. Just below the ninth rib and in the neighborhood of the gall bladder it is sometimes tinged with bile. This part of the colon is in contact posteriorly with the right kidney and the duodenum.

Small intestines. All that space which lies below the umbilicus is occupied by the small intestines. The convolutions of the jejunum lie near to the umbilicus, and usually protrude in umbilical hernia. The convolutions of the ilium lie lower down.

Bladder. This viscus cannot be detected by palpitation unless it is considerably distended. In this case it gradually rises out of the pelvic cavity into the abdomen, displacing the small intestines and sometimes reaching as high as the umbilicus. Under this circumstance the outline of the distension is perceptible to the hand as well as to percussion. Fluctuation can also be detected. The best way to detect this is introducing the index finger of the right hand into the rectum and pass it up until you reach the base of the bladder, and then gently tap the swelling with the finger of the left hand.

ANALOGY OF THE EYE AND EAR.

BY W. H. WINSLOW, M.D.

Structure. There are certain parts of the ear and eye, which in structure and function have a sort of correspondence. The properties of sound and light are analogous, and variations in the two great organs of special sense adapt them to the various requirements of the vibrations which act upon them.

The concave surface of the auricle, and the external canal collect and direct the vibrations of sound to the drumhead, as the expanded cornea, aqueous humor and pupil gather the undulations of light and transmit them to the lens.

The auricular cartilage, tragus-hairs, and ceruminous and sebaceous glands are comparable to the tarsal cartilage, the cilia, meibomian and lachrymal glands.

The similarity in the shape and functions of the drumhead and lens is obvious; each concentrates and transmits ærial undulations; but the drumhead and its chain of bones must be taken together, as the analogue of the lens and its capsule, in order not to destroy the correspondence of deeper parts. Then the bony labyrinth and cochlea, with their inner periosteum, represent the sclerotic and choroid coats; the peri and endolymph, the vitreous, the membranous labyrinth and organ of Corti, the retina.

The papillary terminations of the vestibular branch of the auditory nerve may represent the rods of the retina, and the delicate ciliated cells of the organ of Corti, the cones.

Functions. Normal ears are generally capable of perceiving the distance and the source of sound, the direction from which it comes, and the position the sound occupies in the musical scale. It is well known that some persons are unable to recognize musical notes. In common parlance, "they do not know one note from another." So the ability to determine the distance or the direction of sound may be absent, though the deficiency is not so readily recognized.

Normal eyes have, also, a triple function. The retina readily perceive the distance, the figure and the color of objects, but any one of these functions may be deficient. Persons are sometimes found with acute vision for objects, but deficient in color sense, so that they cannot recognize one or more of the primary colors.

The analogy of functions between the terminal filaments of the auditory and optic nerves is thus manifest, in the sensibility of the one to the notes of the musical scale, and in the other to the colors of the spectrum; and this throws some light upon the conception of the blind man, who said, "red was like the sound of a trumpet." Much may be detected in the correlation of nerves, in accord with the correlation of forces.