408 VELLA'S FISTULA. THE SECRETION OF INTESTINAL JUICE. [BOOK n. 



The following details must be remembered in fixing the ends of 

 the intestine to the incision. On no account must the sutures pass 

 through the free edge of the two ends of the gut ; they should on 

 the contrary pass through the peritoneal wall of the gut about 8 mm. 

 from the free edge and then through the edges of the muscular 

 wound. In this way the two free ends of the gut project a little 

 above the bottom of the wound and after the process of healing is 

 complete two perfectly accessible fistulous apertures are established. 

 For two or three days after the operation dogs which have been 

 subjected to the operative procedure above described should only 

 be supplied with water. About the third day they may be placed 

 on a milk diet, which should be continued, at least, until the bowels 

 have been moved. If the dog be then apparently normal it may be 

 placed on an ordinary diet. To conclude the description of the 

 operation and the treatment of the dog it may be added that the 

 one essential to success, which is almost invariable 1 , is the performance 

 of the operation under the strictest antiseptic precautions ; when 

 completed, however, no dressings should be applied to the wound. 

 In the course of about a week it will be nearly, if not completely, 

 healed and observations may be commenced. 



The Secretion of Intestinal Juice and the Conditions which 

 influence it. 



Although the statements of authors are not absolutely concordant, 

 nearly all who have made observations, either on pathological fistulae 

 in man, or on dogs with fistulse established either by the methods of 

 Thiry or of Vella, agree in saying that in the absence of chemical, 

 mechanical, or electrical, stimuli, either no secretion is poured out by 

 the intestinal mucous membrane or, at most, a very small amount. 



W. Busch 2 , who studied the secretion of the intestinal juice in a 

 woman with a fistula of the upper part of the small intestine, found 

 that in the absence of stimuli, so little fluid was secreted that it was 

 not able thoroughly to moisten a small piece of litmus paper inserted 

 into the gut. Demant 3 , on the other hand, who made observations 

 on an intestinal fistula in a man (affecting, it would appear, the lower 

 part of the small intestine), observed a very scanty secretion, in the 



extremities in the manner above described having been taken. The success of the 

 procedure has been absolute, not the slightest prolapsus of the mucous membrane 

 having occurred (July 29, 1893). 



1 How great is the influence of antiseptic methods on the success of the experi- 

 mental physiologist is proved by the fact that whereas if they are adopted death as a 

 result of establishing a Vella fistula is very rare, without them the mortality is very 

 high, 12 out of 18 dogs operated upon by Vella having died from the immediate results 

 of the operation. 



2 Prof. W. Busch, ' Beitrag zur Physiologic d. Verdauungsorgane,' Virchow's Archiv, 

 Vol. xiv. (1858), pp. 140186. 



a B. Demant, Ueber die Wirkung des menschlichen Darmsafts. Virchow's Archiv, 

 Vol. LXXV. (1879), pp. 419430. 



