The mcum being now isolated, it is important to also remove the cause of the abscess or its contents without caus ing septic material to invade the general peritoneal cavity.
If, in handling, any adhesions are broken through, it is quite easy for a coil of intestine which is not infected to enter the abseess-cavity through the opening made and to become at once infected, then rapidly disappear and reach a situation where it is entirely beyond control; or, if such an acci dental break in the wall of the abscess have been made and a small quantity of the abscess-contents have escaped among the uninfected intestines, fatal infection may result. MeBurney (Buf falo Med. Jour., June, '96).
But two incisions personally used for appendicitis: the gridiron, or MeBurney incision, and the clean cut through all the tissues from the skin into the peri toneal cavity. The former should be selected when the conditions justify it; that is, in all clean cases, in those oper ated upon in the period of quiescence and in others when the inflammatory and septic processes are limited either within the lumen of the appendix or immediately about its walls and when there is no more than a limited local peritonitis. An incision shorter than three inches except hi cases of well marked abscess is not advisable. In this condition it is best simply to incise and puncture and drain the abscess, When a condition of sepsis prevails, such as to require a careful operation to prevent widespread infection and peritonitis, the writer prefers the clean incision through everything from the skin and including the peritoneum. The technique of both methods is given briefly. When the "gridiron" incision is used it may not be necessary to keep the patient in bed as long as when "through-and-through" incision is em ployed. J. A. Wyeth (Med. Record. June 7. 1002).
If the appendix is not readily found, the anterior longitudinal band of the excum is taken as a guide and followed until the appendix is encountered,— usually behind. In the annexed colored plate only the tip of the appendix shows; but the greater part of the organ lies behind the ececum, its orifice in the latter being situated immediately under the spot where the McBurney incision (b) crosses index line (e).
The peritoneum completely surrounds the mown and its appendix. Treves, Talamon (Amer. Med. Digest, June, Oct., and Nov., '00).
'When the abdominal cavity has been opened the exact position of the appen dix can be found by following the white fibrous bands along the convex surface of the crecum to the base of the appen dix. Murphy (Jour. Amer. Med. Assoc., Mar. 30, '95).
Experiments in operations and cadav ers have shown that the appendix al ways rises from that point upon the cseeum where the three descending mes enteric bands join one another. Thus by following the anterior broad band, down the encum, through adhesions, exudates, etc., the appendix is invariably discovered. P. Mueller (Centralb. f. Chin, July 6, 1901).
The possibility of an anomalous con formation or position of the appendix should be borne in mind.
In but three instances out of one hun dred and forty-four operations for dis eases not connected with the appendix was the appendix found outside of the peritoneal cavity. In sixty-six examina tions 40 per cent. of the appendices were free; in that number one-half of the en tire length was surrounded with peri toneum. Joseph D. Bryant (Mathews's Med. Quarterly, '94).
Case in which tip of vermiform appen dix was found in contact with the under surface of liver. Bland Sutton (Med. Press and Circular, Oct. 10, '94).
In two cases the appendix was found attached to the left Fallopian tube and bound up in an adherent mass on that side. In a great number of cases the appendix is adherent to the Fallopian tube on the right side. Porter (Berliner klin. Woch., Sept. 4, '95).
In one hundred and fifty cases of post mortem examinations the length of the appendix varied from to 9 inches. Only two came above the general meas urements: one 6 7„ and the other, the longest the author has been able to find any record of, 9 inches. Both of these extra-long appendices were found in males. C. J. Ringwell (Med. Record, July IS, '96).