192 PANCREATIC FISTULA. [BOOK II. 



Mode of establishing Pancreatic Fistulae. 



First expe- The first to observe the secretion of the pancreatic 



riments of De j u i ce was ]) e Q ra af, who succeeded in making a pancreatic 

 fistula and collecting pancreatic juice *. This observer 

 opened the duodenum, inserted a quill into the pancreatic duct, at- 

 tached a dependent flask to the quill and collected an appreciable 

 quantity of pancreatic juice which he described as clear and somewhat 

 glutinous, and (doubtless following the theoretical views of his master, 

 Franciscus de la Boe Sylvius) he asserted that it had a mixed acid and 

 saline taste. 



Many of the older physiologists repeated the experiment of De Graaf, 

 but with comparatively small results. 



Claude Ber- Claude Bernard was the first to study with care and com- 



nard's experi- pleteness the flow of the pancreatic juice by the aid of 

 merits and fistulae 2 . 



method. ^ ^ e following is Bernard's description of the method 



which he employed 3 : 



" The dog to be experimented upon is placed and firmly held upon its 

 left side, and an incision from seven to eight centimetres long is made in 

 its right hypochondrium, below the borders of the ribs; this incision 

 permits of the duodenum and a part of the pancreas being drawn out. 

 The larger of the two pancreatic ducts is rapidly isolated ; in the dog this 

 duct opens obliquely into the duodenum at a point about two centimetres 

 below the common bile duct. 



"The pancreatic duct is of a mother-of-pearl colour, and is of the size 

 of a crow's quill ; it is seen to be distended by pancreatic juice. The duct 

 is opened with the point of a fine pair of scissors. Immediately, some big 

 drops of a colourless, limpid, pancreatic juice flow away; the juice is 

 viscous, and the viscosity is such that it does not readily mix with the 

 blood which surrounds it, and that it remains isolated, much as an oily 

 liquid or a strong solution of gum. 



"A small silver cannula, having approximately a diameter of five 

 millimetres and a length of ten to twelve centimetres, is then introduced 

 into the duct and tied in with a ligature which has previously been placed 

 beneath the duct. The duodenum and pancreas are then returned to the 

 abdomen, and the wound is closed by sutures, care being taken that the 

 free extremity of the silver tube projects. In order to give greater firmness 

 to the arrangement, the cannula is attached to the intestinal wall by means 

 of a single suture, as shewn in the subjoined figure." (See Fig. 13, p. 193.) 



A small bladder of caoutchouc is then attached to the cannula so as 

 to collect the juice which is secreted after the operation. The whole 

 operative procedure occupied in Claude Bernard's hands from five to six 

 minutes. 



1 Eegnier de Graaf, ' Tract. Anatom. Med. de succi pancreatici natura et usu,' Lugd. 

 Batav. 1664. 



2 Claude Bernard, Archives de Medecine, &c., Vol. 19 (Jan., 1849) p. 60, Lemons de 

 Physiologie Experimentale, &c., Paris, 1856, Vol. n. p. 170 et seq., Lemons sur les Li- 

 quides de VOrganisme, Paris, 1859, Vol. n. p. 337 et seq. Claude Bernard, 'Memoire 

 sur le pancreas et sur le r61e du sue pancreatique dans les phenomenes digestifs.' Sup- 

 plement aux Comptes Rendus de VAcademie des Sciences, Paris, 1856. 



3 Bernard, Legons de Phys. Exp. Vol. n. p. 180. 



