DIGESTION IN THE SMALL INTESTINE. 



401 



•was first employed by de Graff on the dog, and has proved successful in the hands 

 of Leuret and Lassaigne on the horse. 



As before stated, the operation as performed as above described does not 

 render the permanent collection of this secretion possible. It lias been found that 

 when permanent fistula: are established, although they serve a useful purpose in 

 permitting the study of various conditions which may modify the secretion of 

 pancreatic juice, yet the fluid poured out by the glands under these circumstances 

 cannot at all be regarded as its normal secretion. For the purpose of establishing 

 a permanent pancreatic fistula, a small clog may be selected, since in small animals 

 the pancreas is nearer the middle line than in large dogs, and hence the parts are 

 not as much disturbed by the operation. The dog having been kept fasting for 

 twenty-four hours, so that the pancreatic vessels should contain as little blood as 

 possible, should be narcotized by a subcutaneous injection of morphine, and the ab- 

 domen opened by an incision about two centimeters long made in the linea alba and 

 about midway between the xyphoid cartilage and umbilicus. The duodenum and the 



Fig. 1.59.— Pancreatic Fistula in the Doo. (Bernard.) 



A, cannula on which is fastened the rubber bulb. E ; C, stop-cock. 



pancreas are then to be drawn out of the wound and the pancreatic duct isolated and 

 opened by a little cut in one side; instead then of inserting a cannula, two pieces 

 of lead wire bent at an angle are to be introduced, one wire being passed toward 

 the gland and the other into the intestine ; the remaining halves of each wire are 

 then to be twisted together so as to form a T- sna P ec l piece, the middle limb of 

 which projects through the wound. Owing to the shape, the wires cannot fall out 

 and cannot move around in the duct. Fine wire should be selected somewhat 

 smaller than the calibre of the duct, so that the flow of the secretion will not be 

 interfered with. The duodenum and pancreas are then returned to the abdominal 

 cavity, care being taking to retain the wires in the wound, the duodenum is to be 

 stitched to the abdominal peritoneum, and the wound then closed. Inflammatory 

 adhesions take place around the wound and the wires cause the formation of a 

 fistulous tract which communicates with the ducts and through which, after a week 

 or so, the juice may be collected. 



26 



