DIGESTION. 153 



instance of gastric fistula, in an otherwise healthy woman, the result 

 of local inflammation and abscess, occurred in Germany in 1854, and 

 was investigated by Schmidt.* A third case, in some respects the 

 most remarkable of all, happened in France in 1876. The operation 

 of gastrotomy was performed by Yerneuil, upon a young man, for 

 impassable stricture of the rosophagus. The patient recovered with 

 a permanent gastric fistula, through which nourishment was success- 

 fully administered. The following year the case was employed by 

 Richet f for observations on the gastric juice. 



Since 1840, similar investigations have been largely carried on by 

 the aid of fistulae artificially produced in various animals, the dog being 

 most frequently employed for this purpose. These experiments have 

 shown that the ingredients of the gastric juice, as well as its mode of 

 action, are essentially the same in the carnivorous and herbivorous 

 animals, and in man. The best mode of establishing a gastric fistula 

 in the dog is as follows: A longitudinal incision, about six centimetres 

 long, is made through the abdominal walls in the median line, over the 

 ,2reat curvature of the stomach. The stomach is then seized with 

 hooked forceps, drawn out at the wound, and opened with the point of 

 a bistoury. A short silver canula, about three centimetres long and 

 one centimetre in diameter, with a narrow flange at each end, is inserted 

 into the wound in the stomach, the edges of which are fastened around 

 it with a ligature, in such a way as to prevent the escape of the gastric 

 fluids. The stomach is then returned to its place in the abdomen, the 

 external flange of the canula resting upon the abdominal integuments, 

 the edges of the wound being drawn together by sutures. In a few 

 days the ligatures come away, the wounded surfaces unite, and the 

 canula is retained in a permanent fistula ; its flaring extremities pre- 

 venting it from falling either out of the abdomen or into the stomach. 

 It is closed externally by a cork, which may be removed at pleasure, 

 allowing the contents of the stomach to be withdrawn for examination. 



Mode of Secretion of the Gastric Juice. As a rule, the gastric 

 juice is not a constant but an occasional secretion, being poured out 

 only when food is taken into the stomach. Beaumont found it entirely 

 absent during the intervals of digestion, the stomach containing at that 

 time only a little neutral or alkaline mucus. He could obtain a small 

 quantity by gently irritating the mucous membrane with a gum-elastic 

 catheter, or a glass rod ; but on the introduction of food the mucous 

 membrane became turgid and reddened, a clear acid fluid collected in 

 drops beneath the mucus lining the walls of the stomach, and was soon 

 poured out abundantly into its cavity. Prof. F. G. Smith, in his sub- 

 sequent observations on Alexis St. Martin, also found the fluids obtained 

 from the empty stomach invariably neutral in reaction ; while during 

 digestion they w r ere always acid. Other observers, in experimenting 

 on the dog, have found more or less acid reaction always present at the 



* Annalen der Chemie und Pharmacie. Heidelberg, 1854, p. 42. 



f Comptes Rendus de F Academic des Sciences. Paris, 1877, tome Ixxxiv., p. 450. 



