CHAP. II.] METHODS OF ESTABLISHING GASTRIC FISTULAE. 73 



other healthy and active people,' and it did not merely permit of the 

 withdrawal of the gastric juice, and the introduction and withdrawal 

 of catheters, thermometers, &c., but also of the ocular inspection of 

 the resting and secreting organ. 



Since this first, most successfully observed, case of gastric fistula, 

 other cases have occurred of gastric fistulae in the human subject, 

 the study of some of which has led to important extensions of our 

 knowledge. Especially does this remark apply to a case of gastric 

 fistula established by M. Verneuil, in a boy in whom impassable 

 stricture of the ossophagus came on as the result of swallowing 

 a caustic alkali, and which has been subjected to elaborate study by 

 Richet 1 ; this case presented the valuable feature that the contents 

 of the stomach were altogether unmixed with saliva. 



Establish- The establishment of a gastric fistula as a result 



ment of gastric of an accident suggested the possibility of imitating the 

 fistuiae in the process by art. Accordingly a Russian and a French 

 r amm s. observer, Bassow 2 , and Blondlot 3 , almost simultaneously 

 made the attempt ; especially through the systematic and successful 

 experiments of the second of these observers the procedure was 

 carried to great perfection, and has been frequently repeated, many 

 valuable facts having been discovered in this way. After Blondlot, 

 Bardeleben 4 , Bernard 5 , Bidder and Schmidt 6 , Schiff 7 , Holmgren, 

 Panum 8 and Heidenhain 9 , have perfected and modified the method 

 of establishing gastric fistulse. 



The following is a description of the whole operative procedure, 

 which we quote in the words of Dr Lauder Brunton, F.R.S. 



Establish- ^J ect ^ ma king a gastric fistula is two-fold ; 



ment of a gas- ^ rs ^ ^ obtain gastric juice for examination; and second, 

 trie fistula to observe the process of secretion within the stomach 



itself. 



"The method adopted by Bassow 10 was simply to make an incision 

 in the abdominal parietes, to sew the stomach to the edge of the wound, 

 and then to make an opening in the stomach itself. The fistula was 

 plugged with a piece of sponge. It was, however, very liable to close, 

 and was so made to allow the interior of the stomach to be observed. 

 Blondlot prevented the wound from closing by placing in it a cannula, 

 which was closed by a cork, so that the gastric juice and products 



1 Kichet, Le sue gastrique chez I'homme et les animaux. Paris, 1878. 



2 Bassow, Bulletin de la Societe des Naturalistes de Moscou. Vol. xvi. (1842). 



3 Blondlot, Traite analytique de la digestion. Paris, 1842, p. 202. 



4 Bardeleben, Archiv f. physiol. Heilkunde, Vol. vm. (1849). 



5 A. Bernard, Lemons de physiologic experimentale. Paris, 1856, p. 386. 



6 Bidder and Schmidt, Die Verdauungssafte, p. 29 et seq. 



7 Schiff, Lemons sur la physiologie de la digestion. Paris, 1867. Vol. i. p. 15. 



8 Panum, 'Pepsin und Magenfistelanlegung.' Maly's Jahresbericht, Vol. i. p. 193. 



9 Heidenhain, 'Anlegung von Magenfisteln' in Hermann's Handbuch der Physio- 

 logie, Vol. v. Part i. p. 107 et seq. 



10 Bassow, Bulletin de la Societe des Naturalistes de Moscou, Vol. xvi. (1842). 



