ON THE ACTION OF MERCURY ON THE BILIARY SECRETION. 199 
9. Introduce a portion of india-rubber tubing of the above calibre into the 
aperture in the gall-bladder, put asilk suture through it, and fasten it to the 
ligatures holding the fundus to the linea alba, in order that the tube may be 
kept from coming out. 
10. Close the wound in the abdomen by interrupted sutures, placed deeply 
in the linea alba, and then connect the edges of the skin in the same way. 
The skin should not be closed completely around the tube, but should be left 
open for an inch or so, in order that blood may be prevented from accumulating, 
11. The projecting extremity of the tube should be cut within a quarter of 
an inch from the abdominal wall, in order that when the dog lies on its face 
there may be less danger of closing the tube by its being bent upon itself. 
12. The tube should be removed at the end of forty-eight hours or so, for 
then adhesions will in most cases have taken place between the gall-bladder 
and linea alba, which the continued pressure of the tube would only tend to 
break up. The dogs operated upon by the Committee were never kept 
muzzled after the operation, and no dog ever interfered with the elastic tube. 
13. The operation should always be performed when the stomach is empty, 
for if distended it is a most serious impediment to the operator. Very soft 
sponges, perfectly freed from all sandy particles, should be used, and the 
greatest care should be taken to prevent hairs from getting inside the peri- 
toneum. 
14. In male dogs the urine is apt to be discharged into the wound during 
the operation, and against this the operator must carefully be on his guard. 
15. Great care should be taken to prevent bleeding into the peritoneal 
eayity. Any accumulation of blood inside the abdomen gives rise almost 
certainly to peritonitis. In all cases a little bile escaped into the peritoneum, 
but it seemed to produce no injurious effect. 
16. The ligatures around the common bile-duct usually become encysted. 
The wound almost always heals by first intention ; this union is very rarely 
permanent in the cutaneous wound, however; commonly pus is formed be- 
tween the skin and the wound in the linea alba. When such is the case, 
sutures must be removed from the cutaneous wound to give free exit to the 
purulent matter. No lotions or other dressings are necessary for the wound. 
The bile as it flows over it forms an excellent dressing, under which healthy 
granulation proceeds, in most cases with rapidity. 
17. For two days after the operation the animal should be fed on milk, 
given in small quantities ata time, so that the abdomen may not be distended, 
The above mode of performing the operation differs from those described 
by other operators in two particulars :—1. The mode of fixing the fundus of 
the gall-bladder to the abdominal wall. Bernard recommends a clamp to fix 
the fundus to the edges of the wound, and act as a canula also. 2. In the 
non-remoyal of any portion of the common bile-duct. Other operators re- 
commend that two ligatures be applied to the common duct, one close to the 
duodenum, the other close to the junction of the cystic with the hepatic duct, 
and that the intervening portion should be excised, The object is to prevent 
as much as possible the reestablishment of the duct, a contingency which 
appears to have been very liable to occur in the experience of other observers. 
The shock produced by cleaning and removing the whole duct is very great, 
owing to the extensive injury of the sympathetic nerves; and the danger from 
~ hemorrhage is most serious. 
Since the removal of any portion of the common bile-duct has been aban- 
doned, the success attending the operations of the Committee has been un- 
precedented. In only two out of the thirty-three dogs operated on has the 
