124 Croupous Pueuinouia. 



The artificial enemas which have been reconniiended by Leube for man may 

 also be utilized; such are: peptone-milk enema (25U gm. milk, GO gm. peptone); 

 egg-milk enema (250 gm. milk, 3 eggs, 3 gm. common salt) ; starch-milk enema 

 (60 gm. starch, 25 gm. milk) ; sugar enema (60 gm. glucose, 250 gm. milk) ; 

 pancreas enema (50 to 100 gm. pancreas, 150 to 300 gm. milk, 30 to 45 gm. fat). 

 A simple meat-pancreas enema is prepared by mixing finely choppeil beef with 

 finely chopped fat-free cattle or hog pancreas (3-1) to which mixture it is well 

 to add some fat (30 to 40 gm. cod liver oil, previously emulsified with a few 

 taVdespoonfuls of 0.39^ solution of carbonate of sodium); further, 6 to 10% of 

 starch or a maximum of 2% glucose. In the treatment of valuable animals pancreatin 

 may l)e used in place of fresh pancreatic tissue and the meat may be replaced by 

 albumin preparations (peptone, meat-meal, roborat, tropon, kalodal). Ornstein's 

 experiments have shown that dogs are able to absorb milk from the rectum, and 

 also blood serum of other animals (up to 20%) ; however, serum should not 

 be used for longer periods than ten days, since it may produce hypersensitiveness 

 (anaphylaxis — see serum disease). The digestion and absorption in the rectum of 

 herl)ivora has not yet been studied experimentally with reference to the exact 

 metabolism. 



Artificial feeding by su])cutaneous injections of nutritive material must also 

 sometimes be resorted to if disease of the large intestines prohibits the administra- 

 tion of food enemas, or if these are expelled at once. The excellent investigations 

 of Ornstein in dogs have shown that 150 cc. of blood serum to which 10 to 20% 

 glucose has been added will be absorbed and assimilated, almost completely pro- 

 tecting in this way 22%. of body proteids against decomposition. It could also be 

 shown that the intestinal mucosa is in some way concerned in the assimilation of 

 proteids injected subeutaneously, and that the end-products of oxidation are different 

 from those formed normally; the urine of animals fed by the parenteral route is 

 characterized by a higher contents in calories. Liquid food is best iucor]iorated 

 in this way by an infusion apparatus, under low pressure and at body temperature. 

 Heterogenous sera should only be used for a few days, in order to prevent the 

 onset of anaphylactic symptoms. The use of homogenous serum is more to be 

 recommended particularly in horses. According to Friedenthal & Lewandowsky, 

 heterogenous sera lose their poisonous properties if heated for a considerable time 

 at 58 to 68° C. Kalodal (phosphorous albumin) is considered non-poisonous on 

 subcutaneous administration. Since fats are only absorbed in traces, their use is 

 not to be recommended unless homogenous fats are used. Fluids which are to be 

 injected subeutaneously must be sterilized ; blood serum, if used, must be collected 

 under aseptic precautions. Fats (oils, butter, lard) may be given in doses of 

 50 to 70 gm. to larger, and in doses of 10 to 15 gm. to small animals; these doses 

 are injected in several places under the skin and the procedure is repeated four 

 times so that the daily amount is equal to about 300 or 50 to 120. The amount of 

 blood serum mixed with 10 to 20% solution of glucose or of glucose solution alone 

 (10% glucose in physiologic salt solution) may be 200 gm. pro dosi in dogs, one 

 liter in larger animals. Kalodol is injected into dogs in a 1% solution; 5 gm. 

 of kalodol are dissolved in distilled water, the solution is sterilized and is then 

 diluted with 500 gm. sterile physiologic salt solution. 



For intravenous feeding, at best only grape sugar dissolved in physiologic salt 

 solution could be used, but it can only be injected in such amounts as will be 

 retained in the blood (the normal average amount of sugar in the blood is 1%). 



In considering the importance of artificial feeding it must primarily be pointed 

 out that artificial stomach feeding is the method which most nearly approaches 

 physiologic conditions and which permits of the introduction of the largest number 

 of calories. Large animals may be kept alive for weeks liy this method, provided 

 that the secretion of the digestive organs is not much below normal as is so often 

 the case in grave acute infectious diseases. Rectal and parenteral artificial feeding 

 can, at best, only diminish the disintegration of substances that are stored up in 

 the organism. It is insufficient to keep otherwise starving animals, especially 

 larger animals, alive for any length of time. With rectal artificial feeding one 

 can introduce in dogs only 100 to 150 calories, and a healthy dog, weighing about 

 20 pounds, needs about 300 calories. By a proper combination of rectal and 

 parenteral feeding smaller animals might possibly be kept in equilibrium for some 

 time. In larger animals rectal and parenteral artificial feeding can only serve 

 to retard malnutrition in diseases which do not last very long. The technical 

 difirculties are also opposed to its use in general practice. In the rectal mucosa 

 a catarrhal condition is easily produced if rectal enemas are administered daily, 

 even if easily putrefactive substances, such as eggs, are not given for more than 

 three days, and if glucose is given in a dilute, not too concentrated, solution. 

 Abscess formation and cutaneous iiecrosis ?t the site of the application may occur 

 after cutaneous injections in spi^e ot ail p'-a/^aubon.^; inrravenuiis injections cannot 



