METHODS: 1'ANCREATIC FLSTUL.K. "> 



This was accomplished either by tying a glass tube into the duct and 

 leading it through the abdominal wall (Claude Bernard), or by fastening 

 in a T-shaped piece of twisted lead wire in a similar manner (Lvd-wig's 

 School). These were named " permanent " fistulpe. Both modifications 

 proved effective, but only for a short period, generally for three to five 

 days, in exceptional instances for as long as nine days. After this time 

 the glass tube fell out and the fistula closed up ; even the lead wire 

 was unable to prevent this occurrence. In reality, therefore, these 

 must also be regarded as temporary fistulpe only. But this was not their 

 only defect. When the inhibitory influence of the operation Lad 

 passed off after one or two days, another abnormal condition, in many 

 instances set in, viz., an incessant irritation of the gland producing a 

 secretion independent of whether the dog was fed or not. The question 

 then arose, which was the better ; the " temporary " or the " permanent " 

 fistula ? Evidently neither was faultless. In the " temporary ?> form 

 the conditions were rendered abnormal by the effects of the operation ; 

 in the so-called " permanent " form by inflammatory results in the 

 pancreas, which often set in (especially in the older laboratories) within 

 one or two days. 



Only one thing remained, namely, to discover a means of access to 

 the gland lumen which would keep the duct open for any length of time ; 

 that is to say, till the above-mentioned disturbances had completely dis- 

 appeared. Such a means was first described by me in the year 1*7!', 

 and afterwards independently in the year 1880 by Heidenhain.* 



My method was as follows. It differs slightly from Heidenhain's. 

 From the wall of the duodenum, an oval piece, containing the orifice of 

 the pancreatic duct, is cut out, the bowel, the lumen of which is not 

 appreciably narrowed, stitched up, and the isolated piece of intestine 

 sewn (with the mucous membrane outwards) into the slit in the 

 abdominal wall. The whole heals quickly ; the opei-ation, which 

 requires no special skill, is only of short duration (about half an hour), 

 and is well borne by the animals. After two weeks they are ready 

 for observation. In the healed-up wound a roundish elevation, 7 to 10 

 mm. in diameter, is to be seen. This is formed of mucous membrane, 

 and in the more successful cases shows the cleft-like orifice of the duct 

 exactly in its middle. If the animal be now supported in a suitable 

 frame, the juice may be either directly collected as it drops from the 

 mucous papilla, or if there be a tendency to escape along the abdominal 

 wall, by means of a funnel with its wide end upwards fixed in the requisite 

 position. Neither of the two disadvantages which beset the investigators 

 who employed " temporary " or " permanent " fistula? any longer exists. 



* Hermann's Haiullmch tier Pltyts'wlogie. Bd. v. 



