INFANT FEEDING

the upper end of the parietal incision. Omentum was packed round the tube in the abdominal cavity, which itself was not drained. The abdominal wall was closed in layers in the usual manner. The gall-bladder was not interfered with, as the patient's condition was not very good at the end of the operation. During and after operation two litres of stored blood and two litres of glucose and saline solution were administered by drip transfusion. On the following day the patient's condition was much improved. The respiration was now fifteen per minute, and no cyanosis was present. The pulse rate was 100 per minute on the average, and the temperature was normal. The tube was draining a little clear fluid only. His condition continued to improve, and the tube was removed on the eighth day after operation, as it was not draining. PIe was allowed up on the eleventh day and the sutures were removed from the wound, which was healed. On the thirteenth day after operation he felt some pain in the epigastrium and vomited. His temperature rose to 100 0 F., and a swelling was noticed deep to the upper end of the wound. At the same time it was reported that his freces were pale, bulky and creamy in consistency for the first time during his hospital stay. They contained undigested meat fibres. Their fat content was 18'7% (a more or less normal figure), of which 55% was split fat and 45% unspltt fat, the normal figures being 80% and 20% respectively. The serum amylase index was not raised, being 28 units, but the urinary diastatic index was 100 units, the normal varying from 10 to 25 units. The wound then discharged copious quantities of somewhat turbid-looking fluid through the site of the drainage tube. This fluid had a diastatic index of 2000 units, and some lipase and trypsinogen were found in it. It also contained some pus cells, and some Gram-negative, lactosefermenting bacilli were grown from it on culture. From the above observations it was obvious that there was a communication between the main pancreatic duct and the remains of the Cyst, sidetracking the pancreatic juice from the bowel. This sometimes occurs in these cases, though Vecchi(8' states that it is uncommon. The discharge lasted for ten days, during which time no wound digestion occurred. On the twenty-third day after operation the fistula closed and the freces became normal in appearance and consistency; their split fat content had now risen to 69% of the total fat content. The patient was discharged from hospital thirty-one days after admission. He was feeling well, and there were no signs of the cyst. Nine months later a follow-up examination showed that the patient was physically well and had had no further symptoms referable to the cyst. He was also rid of the troublesome flatulence which he had always had prior to operation.