522 DIGESTION. 



INTESTINAL JUICE. 



172. Intestinal juice was first obtained pure by Thiry, who 

 divided the jejunum or ileum in two places at a distance of 10 

 to 15 centimetres from each other, sewed up one end of the 

 piece thus isolated, and attached the other to the wound in 

 the abdominal walls. The short cul-de-8ac of intestine formed 

 in this manner remained attached to the mesentery, and its 

 vessels and nerves being uninjured, it yielded a normal secre- 

 tion which could thus be collected without admixture with 

 other digestive secretions and products. The continuity of 

 the alimentary canal was restored by sewing together the 

 divided ends of intestine. 



173. Intestinal Fistula. The method employed by 

 Tliiry has been somewhat modified by Paschutin, who prefers 

 the duodenum and the beginning of the jejunum, a part of the 

 small intestine which yields a very active secretion. In 

 making a fistula by his' method, the hair must be carefully 

 removed from the skin, and an incision 3 to 5 centimetres 

 long made in the linea alba. The duodenum is drawn out and 

 two stout ligatures passed round it about two and a half cen- 

 time! ivs beyond the spot where it separates from the pancreas. 

 The ligatures having then been separated from each other and 

 tightened, the intestine is divided between them. The upper 

 end of the duodenum is then replaced in the abdomen. 



The next step in the operation is to divide the jejunum in a 

 similar manner. The most obvious method of accomplishing 

 this would be to follow the intestine down to the point at 

 which the second division is to be made. This is, however, 

 rendered impossible by the extreme shortness of the mesentery 

 at the point where the duodenum ends in the jejunum. It is, 

 therefore, necessary to find the jejunum independently, by 

 following the intestine upwards from any loop which may 

 present itself in the wound. It is obvious, however, that be- 

 fore this can lie done, the operator must find out in what di- 

 rection the intestine must be followed. For this purpose, the 

 loop being held tight between the finger and thumb, a quantity 

 of half per cent, salt solution is injected into the lower cut end 

 of the duodenum, by a syringe with a conical nozzle, which is 

 I through the tightened ligature. As the fluid passes 

 downwards until it meets tin; obstruction presented by the 

 lingers, the upper part of the loop is at once recognized by its 

 becoming full. The distended gut is then followed up till the 

 beginning ef the jejunum is reached, which is recognized by 

 the mesentery becoming shorter. Two ligatures are passed 

 round it. and the intestine divided between them as before. 

 The under end is replaced in the abdomen, and the upper end 

 I by sutures so as to form the cul-de-sac. Before doing 



