DIGESTION IN THE SMALL INTESTINE. 



401 



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

 oi Leuret and Lassaigne on the horse. nanas 



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

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

 when permanent fistulse are established, although they serve a useftd 1 Tn 

 permitting .the study of various conditions which may modify the secre on o? 

 pancreatic mice, yet the fluid poured out by the glands under Lse circumstances 

 cannot at all be regarded as Us normal secretion" For the purpose of Slight 

 a permanent pancreatic fistu a a small dog may be selected si^ce L smal anh mis 

 the pancreas is nearer the middle line than in large dogs, and hence the wts ire 

 not as much disturbed by the operation. The dig halving been kept ft Ungfor 

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

 possible, shou d be narcotized by a subcutaneous injection of morphine and he ,b 

 domen opened by an incision about two centimeters long made in the lfcea all a ,■ nd 

 about midway between the xyphoid cartilage and umbilicus . The Zodenunr amUne 



Fig. 159.— Pancreatic Fistula in the Dos. {Bernard.) 



A, cannula on which ia fastened the ruhber bulb, B ; C, 8top-cock. 



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

 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 X -shaped 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. Pine 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 



