MKTHOPS: fJASTRKJ FISTUI.K. 11 



pure gastric juice has been already settled, but it does not afl'ord us tlie 

 means of observing the secretion of the juice and of studying its pro- 

 perties during digestion. Obviously to accomplish this there must be 

 the continuance of normal gastric digestion side by side with a quanti- 

 tative collection of perfectly pure juice. That which was quite simple 

 in the case of the pancreas (where the gland duct is separate from 

 the alimentary cavity with its food contents) becomes a task of 

 the greatest difficulty in the case of the stomach, since its glands are 

 microscopic and are embedded in the walls which surround the food 

 receptacle. 



A happy idea for overcoming difficulties of this kind was hit upon 

 by Thiry. In order to procure succus entericus a secretion like- 

 wise formed by microscopic glands embedded in the intestinal wall 

 and to study it in the act of formation, he isolated a cylindrical piece of 

 gut, formed this into a cul-de-sac, and sewed its open end into the 

 abdominal wound. The idea was taken advantage of by Klernensiewicz* 

 in 1875 for the purpose of obtaining the secretion of the pyloric end of 

 the stomach in pure condition. But, unfortunately, his dog lived only 

 three days after the operation. Heidenhain,f however, soon after- 

 wards succeeded in keeping one alive, llej also isolated a portion of the 

 cardiac end of the stomach, out of which he formed a pouch which 

 poured its secretion externally. 



In this way the above requirements were fulfilled. When the food 

 in the ordinary way reached the stomach, which was still in position, a 

 perfectly clear juice began to flow from the pouch, and could easily be 

 measured quantitatively. But to draw conclusions with complete 

 certainty concerning the normal work of the organ during digestion it 

 was necessary to retain the nervous connections of the isolated piece 

 intact. In Heidenhain's operation this was obviously not the case, 

 since in making the transverse incision by which he resected the piece 

 of stomach the branches of the vagus which course lengthwise along the 

 wall of the cavity were cut through. To overcome this disadvantage a 

 further improvement of the method was therefore necessary. 



With this view we (myself and Dr. Chigin) have modified Heiden- 

 hain's operation in the following way. The first incision, which begins 

 in the fundus of the stomach, two centimetres from its junction with 

 the pyloric end, is carried in the longitudinal direction for ten to twelve 

 centimetres, and divides both the antei'ior and posterior walls. A tri- 

 angular flap is thxis formed, the apex of which lies in the long axis of 

 the stomach. A second incision is made exactly at the base of this flap, 



:: Sitwngsberichte der Wiener Alcade.mie, 1S7.~>. 



f Heidenhnin : Pfl iiger's Arrliir. Bd. xviii. J Jf>. l!d. xix. 



