CHAP. II.] THE OPERATION FOR GASTRIC FISTULA. 75 



diameter of the flange of the cannula. Divide the muscles parallel to the 

 course of their fibres. Tie every bleeding point before opening the peri- 

 toneum, so that no blood shall 'get into its cavity. Open the peritoneum 

 on a director. Lay hold of the stomach with a pair of artery forceps 

 at a point where there are not many vessels, and draw it forwards. Pass 

 two threads 1 with a curved needle into the gastric walls at a distance from 

 each other about equal to the diameter of the tube of the cannula, and 

 bring them out again at a similar distance from the points where they 

 were introduced. Make an incision into the gastric walls between the 

 two threads, rather shorter than the diameter of the tube of the cannula. 

 Put a pair of forceps, with the blades together, into the incision, and then 

 dilate it by separating the blades till it is large enough to allow the 

 cannula to be introduced. Push the cannula into the stomach so that 

 the outer plate lies against the external abdominal wall. Tie the stomach 

 to it by the threads, and then pass their ends through the edges of the 

 wound in the abdominal wall in such a way as to fasten the stomach to it 

 and at the same time to keep the cut edges in apposition. No other 

 suture is required. Leave the cannula uncorked for at least half-an-hour 

 after the operation is finished, for whenever the dog recovers from the 

 chloroform it will vomit, and if the cannula be corked the fluid contents 

 of the stomach are apt to be forced past the side of the cannula into the 

 abdominal cavity. Feed the dog on milk for one or two days, and if the 

 operation be performed in winter, keep it in a place warmed night and 

 day. The day after the operation the edges of the wound will be much 

 swollen, but the swelling will subside in a day or two. After the wound 

 has begun to heal, the cicatrix may thicken, and the outer plate of the 

 eannula begin to press too much on the rim, so that it ulcerates. If this 

 should occur, the cannula must be lengthened by unscrewing the two flanges 

 further apart. The cannula may be closed by an india-rubber stopper, 



or by a cork In order to collect the juice, let the animal fast 



for several hours, so that its stomach may be quite empty, but not for 

 more than a day, as the mucous membrane would become covered with 

 a thick coating of mucus. Let the assistant pat the dog, and keep it 

 quiet ; withdraw the cork from the cannula, and tickle the inside of the 

 stomach with a feather tied to a glass rod. Put a small beaker underneath, 

 so that the end of the rod rests on its bottom : the gastric juice will flow 

 into it down the sides of the rod 2 ." 



Various experimenters differ on the question as to whether it is 

 better to operate for gastric fistula on animals whilst fasting or with 

 the stomach distended. Of recent experimenters Panum has declared 

 himself in favour of operating when the stomach is full : Holmgren 

 and Heidenhain, on the contrary, operate when the stomach is empty, 

 the former distending the stomach with air by means of an elastic 

 tube introduced through the oesophagus. The operation is said to 

 be more successful when implicating the left than the right half of the 

 stomach. 



When it is stated, in conclusion, that the operation for gastric 



1 Sutures of carbolised catgut should now be used. 



2 Handbook for the Physiological Laboratory, p. 477 et seq. 



