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Samuel McLanahan, M.D.
JAMA. 1937;108(5):385. doi:10.1001/jama.1937.92780050001012.
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The striking differentiations between various epithelial surfaces are well illustrated when intestinal contents are permitted to drain on the skin of the abdominal wall. Substances that are innocuous to the epithelium of the intestinal tract and that are even produced by it may prove most irritating and destructive to the cutaneous epithelium. This physiologic fact produces at once a clinical problem, and this problem has already been dealt with in many practical ways.

Ingenious methods of managing high intestinal fistulas have been devised, depending for their success on the twofold principle of neutralizing the alkaline secretion and of supplying some sort of protein from without the body on which the enzymes may act, thereby preserving the patient's own tissues from digestion.1 In addition, suction and the application of dry kaolin have been used with great success.2

The more common problem, however, is the


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