Medical and surgical report of the Presbyterian Hospital in the City of New York . n, having the configuration of the was considerable rigidity of the upper portion of the right costalarch and of the upper part of the rectus directly beneath it. There wassKght icterus, with moderate pulse and temperature elevation. Atthe end of several days the local symptoms of inflammation, togetherwith the icterus, had subsided, and both pulse and temperature had re-turned to normal. Operation (Gas and Ether).—^Vertical incision along the outer THE COSTAL ARCH IN DISEASES OF ABDOMINAL ORG
Medical and surgical report of the Presbyterian Hospital in the City of New York . n, having the configuration of the was considerable rigidity of the upper portion of the right costalarch and of the upper part of the rectus directly beneath it. There wassKght icterus, with moderate pulse and temperature elevation. Atthe end of several days the local symptoms of inflammation, togetherwith the icterus, had subsided, and both pulse and temperature had re-turned to normal. Operation (Gas and Ether).—^Vertical incision along the outer THE COSTAL ARCH IN DISEASES OF ABDOMINAL ORGANS. 25 border of right rectus about four inches in length, and deepened to andthrough the peritoneum. The gall-bladder was embedded in a massof omentum, the upper border of the transverse colon being adherentto the anterior border of the liver. After separation of the adhesions,the gall-bladder was exposed and was found to be slightly increasedin size with a very much thickened wall. The neck of the bladderand the cvstic duct were then enucleated from the bed of adhesions in. Method of eliciting costal rigidity in upper part of arch, e. g., gall-bladder. which they were contained, and through their wall numerous calculicould be felt. The gall-bladder was so lirmly adherent to the undersurface of the liver that its separation could not be accomphshedwithout risk of hemorrhage. It was therefore opened, some fortycalculi of varying size removed from its interior, and after the excisionof its mucous membrane it was sutured to the parietal peritoneumas in a typical cholccystotomy. Drainage. 26 THE COSTAL ARCH IN DISEASES OF ABDOMINAL ORGANS. Post-Operative.—There was moderate temperature and pain. Aftera week or ten days the bile found its way down the common duct,and the clay-colored stools disappeared. On May 22, the date ofdischarge, a small superficial sinus persisted, which subsequentlyclosed. Subsequent History.—Patient continued well for about fourteenmonths. At the en
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