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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

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