Operative surgery . that it maybe divided if need be, but alsoto prevent, if not desirable,entrance to the sheath of therectus muscle. The relative di-rection of the fibers of the re-spective structures that overliethe caecum should be carefullynoted, also its relation to con-tiguous vascular, nervous, andother structures (Fig. 921), notonly to enable one to recognizethe structures in proper order, but also to facilitate an intelligent separationof their fibers should circumstances require it. For the purposes of operative treatment of appendicitis five classes ofcases are considered, the arra
Operative surgery . that it maybe divided if need be, but alsoto prevent, if not desirable,entrance to the sheath of therectus muscle. The relative di-rection of the fibers of the re-spective structures that overliethe caecum should be carefullynoted, also its relation to con-tiguous vascular, nervous, andother structures (Fig. 921), notonly to enable one to recognizethe structures in proper order, but also to facilitate an intelligent separationof their fibers should circumstances require it. For the purposes of operative treatment of appendicitis five classes ofcases are considered, the arrangements of which are suggested by the rela-tions noted to exist between their respective histories and the conditionsrevealed by operation, together with their relative danger to life: 1. Acute appendicitis characterized by sudden perforation and diffuseseptic peritonitis. 2. Subacute appendicitis of insidious development usually complicatedwith perforation, attended with more or less circumscribed suppuration, and. Fig. 921.—Transverse section through pelvis atthe level of anterior superior spinous pro-cess and saero-vertebral angle. «. Dottedline, indicating h. Transver-salis fascia, c. Aponeurosis of external ob-lique, d. Iliac fascia, e. Psoas parvus. /.Post-peritoneal connective tissue, g. Anteriorcrural nerve, h. External iliac artery. veins, j. Internal iliac artery. A*. Sacro-iliac junction. These relations are importantin estimating the influence of the situation ofthe appendix on the symptoms, signs, andcoraphcations in disease of the organ. OPKKATIOXS ()\ VISCKUA CONN Kl TKl» WITH IKIM TU possibly hv pliK-hitis, :il)sciss of i\w. liver, .sul)i»lircni(! abscess, abscess in tliepelvis, etc. ;}. Acute apitciuliriiis with perforation and circiiiuscribcd suppurative peritonitis. 4. Recurrent and relausinu ;ii>[t(ii(li(il is, with varying intervals of attack
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Keywords: ., bo, bookcentury1800, bookdecade1890, bookidoperativesurgery02brya
