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Article
August 17, 1994

Splenomegaly and Percussion: Is the Background Noise Due to Tongue in Cheek?

JAMA. 1994;272(7):516. doi:10.1001/jama.1994.03520070034022
Abstract

To the Editor.  —In the article entitled "Does This Patient Have Splenomegaly?" by Dr Grover and colleagues,1 the authors suggest that an expert in the art of percussion needs a soft touch, a sharp ear, and a tongue in cheek. If so endowed, the clinician will detect an enlarged spleen in a certain number of cases in which he or she strongly suspects splenomegaly before tapping and listening. The use of accessory organs in physical diagnosis was wonderfully demonstrated by a professor who taught physical diagnosis to the class of 1942 at the University of Michigan. He was Raphael Isaacs, of sainted memory, who was famous as a hematologist. He set about to show us how he could tap and outline the notch in a normal spleen (marked it with a crayon) and find the declivity between the ascending aorta and the pulmonary artery (also penciled on the subject's

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