Nasal Feeding

In nasal feeding a nasal tube is employed or in case of infant a catheter. Have either well oiled and passed gently through the nose into the oesophagus and then into the stomach. Before pouring in the food wait a moment to see that the tube has not entered the larynx.

Use Of The Stomach Tube

The jaws must be kept open. In children without teeth, the finger may be employed; in grown persons a mouth gag or a roller bandage may be held between the teeth. The tube should be moistened, passed into the pharynx and thence rapidly into the stomach. If these two precautions are not observed, contraction of the muscles may occur, preventing the tube from entering the oesophagus. In passing the tube into the oesophagus, hold it well back from the end. When the tube is satisfactorily introduced, place a funnel in the free end and pour liquid nourishment slowly down the side of the funnel until the tube is filled, and the air in tube is expelled; this care prevents the air in tube entering the stomach. In removing the tube, it should be withdrawn rapidly in order not to excite vomiting. In some cases the physician orders the stomach washed out before introducing the food. When it is necessary to take special precautions to prevent regurgitation of the food, the ribs may be tickled to prevent contraction of the diaphragm.

Rectal Feeding

This form of alimentation is necessary when the stomach cannot retain food. It is based on the fact that the rectal mucous membrane, while it possesses no digestive faculty, is able to absorb certain classes of nutriment. These include among the carbohydrates, sugars; among proteins, the native albumin as well as the end products of protein digestion. The latter are believed to be much more absorbable than the first products (albumoses and peptones).

Soluble starch (dextrin) is doubtless absorbable, but unchanged starch and fats can hardly be taken up. It is probable that finely emulsified fats if thrown well up into the colon are absorbable to some extent. Although we cannot understand why certain substances nourish the patient, since they are theoretically not absorbable, they seem in some manner to be utilized, even when merely thrown into the rectum. As far as possible we should employ substances which we know positively to be capable of absorption; but in rectal feeding for a long period it is sometimes necessary to use a great variety of formulas, making it out of the question to confine ourselves to the few articles which are theoretically best suited for the purpose.

The rectum may be intolerant to almost any form of enema; even if retained for some time, it may be rejected without apparent change. Under the most favorable circumstances, at least three-fourths of the quantity injected will come away with the regular evacuation of the bowels. The amount of energy actually supplied must be far below the theoretical demands of the body. In some cases, it is of course possible to nourish the patient partly by the mouth and partly by rubbing a small amount of fatty matter into the skin. Some of the most available substances, such as solutions of sugar, are naturally irritating to the rectum.

It is possible to keep a patient alive for weeks and even months by rectal feeding, but in many cases this resource for one reason or another fails outright to do what is expected of it. Hence we cannot be too careful as to technique and choice of material used. Of natural substances, milk and eggs have been very freely used. The albumin and sugar in the milk are probably utilized. In an emulsion of eggs, the native albumin is doubtless the constituent which nourishes the patient. We cannot be sure of the absorption of the fatty matter of the milk and eggs. Both these substances are relatively non-irritating. Peptonized milk answers well in some cases. It is best to carry on the peptonization for a long period, until the end products of digestion form, peptones themselves being often irritating. Solutions of glucose and dextrin are useful, alone or combined with other ingredients. For example, eggs may be combined with glucose, or plain milk with dextrin. For variety, any of the pre-digested foods, whether these come in solution or dried, and even bouillon and beef-tea may be tried. Starch emulsion is soothing in the rectum and may be utilized if first mixed with diastase.