. A new manual of surgery, civil and military. 3° F. and thepulse 130 beats per minute and very feeble. Her tongue is thickly coated and the edges arered in small spots. She is intensely thirsty, but does not retain the liquid given to her. GENERAL SURGERY OF THE ABDOMEN 239 The patient is evidently suffering from acute perforative appendicitis with beginningdiffuse peritonitis. This may be due to the perforation of an ulcer which has existed for aconsiderable period of time, or to gangrene of the appendix, from thrombosis of some ofits vessels, or to the perforation of an appendix distended w
. A new manual of surgery, civil and military. 3° F. and thepulse 130 beats per minute and very feeble. Her tongue is thickly coated and the edges arered in small spots. She is intensely thirsty, but does not retain the liquid given to her. GENERAL SURGERY OF THE ABDOMEN 239 The patient is evidently suffering from acute perforative appendicitis with beginningdiffuse peritonitis. This may be due to the perforation of an ulcer which has existed for aconsiderable period of time, or to gangrene of the appendix, from thrombosis of some ofits vessels, or to the perforation of an appendix distended with pus with its cecal end occludedby cicatricial tissue. The patient is extremely ill, and it is plain that unless the method oftreatment employed during the past three days is radically changed she cannot survive long. Considerations of treatment. So far the patient has received the treatmentprescribed by many of the leading text-books on internal medicine. She hasbeen limited to liquid diet, has received saline cathartics and enemata, has. Closure of Wound of McBurney s Incision for the Eemoval of the Vermiform Appendix. The incision is parallel with Pouparts ligament. Its center is in the line drawn from theumbilicus to the anterior superior spine of the ilium and half way between these two points. The aponeurosis of the external oblique abdominal muscle is shown split parallel withits fibres in the direction of the skin wound. The internal oblique abdominal muscle is split in the direction of its fibres at right angleswith the direction of the wound in the skin. Sutures have been applied to the transversalisfascia and peritoneum and deep silkworm gut sutures have been inserted through all layersdown to, but not through, the peritoneum. A few catgut sutures are to be applied to bringthe edges of the internal oblique abdominal muscle together, and a continuous catgutsuture for the purpose of uniting the aponeurosis of the external oblique abdominal muscle. The skin is sutur
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
