Palpation is one of the best and most important methods of examination. A good clinician is as a rule an artist in palpation. The best way to practise this method is as follows: The patient should assume an easy, comfortable, recumbent position; the physician stands to the right of the patient and places his right hand, which should not be cold, flat upon the abdomen. Palpation is first practised with the tips of the fingers without exerting much pressure. The entire abdomen may be examined in this manner by moving the hand from the left lower border of the ribs down to the left iliac region, going then to the right iliac region and then up to the margin of the ribs on the right side. If the patient contracts his abdominal walls too much, it is best to divert his attention from the examination by conversing with him upon other topics. Very often then the abdominal walls will become more relaxed and palpation is rendered possible. Pay attention to any resistance you encounter, also the sensitiveness or tenderness of the different regions. By this method of light and tender palpation we may discover a tumor and determine its position, size, consistence, as well as its mobility.

In examining the lower part of the abdomen we also palpate the inguinal region and ascertain whether there are swollen glands or not.

To determine the position of the abdominal organs it is always advisable to make use of both hands. The left band should push the organ or region to be examined toward the palpating right hand. The colon is very often felt somewhat below the navel running transversely across the abdomen as a ribbon-like body. The pulsating aorta, lying in the median line of the body somewhat above the navel, is also frequently very clearly felt. The spleen, if enlarged or displaced, can be distinctly explored especially during a deep inspiration, the left hand of the examiner pressing the left hypochondriac region downward and the right hand palpating just below the margin of the left ribs. The kidneys are accessible to palpation if they are displaced downward or are movable. In examining the right kidney the left hand of the physician is placed behind the right lumbar region of the patient, pressing this part somewhat upward, while his right hand lies flat upon the right hypochondriac region, the patient being requested to take a deep breath. In examining the left kidney the position of the hand is reversed.

The liver can be palpated when enlarged or when it is prolapsed.

Palpation With Exertion Of Pressure

This can be done with one or two fingers. The object of this method of examination is to test the degree of sensitiveness, tenderness, or painfulness of different regions of the abdomen. In this manner the circumscribed painful area of an existing ulcer may be discovered or the diffused tenderness of the whole gastric region that is often met with in inflammatory conditions of this organ. Boas1 has devised an algesimeter for the purpose of indicating at what degree of pressure pain is experienced by the patient. It is provided with a scale giving the different pressures in weights; thus a pressure amounting to 5 or 10 kgm. in weight causes pain only in catarrhal conditions, whereas in ulcer of the stomach a weight of only half a kilogram produces intense pain. As a rule, I think we can dispense with this instrument. The amount of pressure exerted and felt by the hand is thoroughly sufficient to an experienced practitioner.