516 DIGESTION. 



denum lies opposite the wound. As soon as it is exposed it is 

 drawn out, and the pancreatic duct looked for about two centi- 

 metres below the (Ittctux choleflochus. The part of the pancreas 

 in which the duct lies is generally closely attached to the duo- 

 denum, and somewhat overlaps it. The largest and lowest of 

 the bundles of vessels which pass from the duodenum to the 

 pancreas, lies over the duct. These vessels are to be pushed 

 aside, and a thread passed under the duct, which is recognized 

 by being larger and paler than the vessels. Care must be taken 

 not to injure the vessels and cause bleeding, and the pancreas 

 roust be pulled or pressed as little as possible. The duct is 

 opened with scissors, and a plain silver canula, about five mil- 

 limetres in diameter, and 10 or 12 centimetres long, pushed 

 into it up to its first division, which is generally visible; the 

 ligature is then tightened; another thread is passed through 

 the serous coat of the duodenum, and the canula fixed to the 

 intestine by it. The ends of these threads, and the end of the 

 canula. are kept outside the wound, the duodenum returned 

 to the abdominal cavity, and the wound closed by first sewing 

 together the muscles, and then the skin. A small India-rubber 

 bag. furnished with a stopcock, is then tied to the outer end of 

 the canula. emptied of air. and the stopcock closed. The 

 juice then collects in it, and is drawn off by the stopcock (see 

 -17). Generally, it flows abundantly ; but if it does not, 

 a little ether should be injected into the stomach by a stomach- 

 pump. The juice may be collected for several hours; but 

 after the expiration of twenty-four hours, the character of the 

 secretion changes. In a few hours more, the canula and 

 threads should be gently drawn out. The wound general!}* 

 heals (juickly. 



165. Method of making a Permanent Fistula. For 

 permanent fistula?, Ludwig and Bernstein choose small dogs, 

 as in them the duodenum is more easily reached from the mid- 

 dle line, and is not drawn so far from its natural position by 

 the fistula as in larger animals. The dog must be kept fasting 

 on tin- day of the operation, as the pancreatic vessels are full 

 during digestion, and bleed easily. Narcotize the animal by 

 injecting opium into the tibial vein, and open the abdomen by 

 an incision about two centimetres long in the linea alba, mid- 

 way between the ensiforin cartilage and the umbilicus. The 

 duodenum is then searched for, and drawn out of the wound 

 along with the attached pancreas, and a thread looped round 

 the dmt. Instead of then putting in a canula, a piece of lead 

 wire is inserted into the duct, so that one end of it passes into 

 the Intestine and the other into the gland to a considerable dis- 

 The middle part of it is twisted together, and projects 

 through the wound. Owing to the T shape thus given to the' 

 wire, it cannot either slip out or move about in the duct; but 



