808 HEEBEKT S. CARTER 



acid test of no use) a little milk can be given by mouth or some colored 

 fluid and aspirating at once; if the tube has gone beyond the pylorus no 

 colored fluid or milk will be obtained. The tube's location can also be 

 determined, if necessary, by fluoroscopy after filling it with a solution of 

 barium. The length of time that the tube is left in situ depends on the 

 condition for which it is used, but it can remain for from twelve to fif- 

 teen days without detriment, keeping the mouth clean by washes and 

 brush. 



Duodenal Feedings. The feedings recommended by Einhorn consist 

 of milk 210-240 c.c. (1 to 8 ounces), one egg, a tablespoonful of lactose 

 (15 gm. 1/2 ounce). If the bowels are made too loose, reduce the lactose, 

 and when it is necessary to increase weight, 4 to 8 gm. (1 to 2 drams) of 

 butter may be added to each of the eight feedings given at two-hour inter- 

 vals. For those patients who cannot take milk, cereal gruels may be sub- 

 stituted, made thin and smooth enough to pass through the tube readily. 

 It will then be necessary to give the protein of the diet in the form of 

 meat powders egg albumin or some one of the artificially prepared 

 protein foods, e. g., plasmon, 70 per cent protein; nutrose, 90 per cent 

 protein; beef meal, 77 per cent protein; peptones, e. g., panopeptones, 

 Witte's peptones, Armour's or Cranick's, all of which vary from 1.5 to 10 

 per cent nitrogen. These latter peptones may easily upset the digestion, 

 causing diarrhea, and are therefore suitable only for short periods. Aleu- 

 ronat, a vegetable protein, contains 80 to 90 per cent protein, 7 per cent 

 carbohydrate. All these preparations are good as well for reenforcing 

 the milk formulae. 



The food should be given at about 100 F., slowly either by the 

 drop method or by a syringe directly into the tube, or by using a three- 

 way stopcock drawing the food up from a glass. If the food is given 

 rapidly, it distends the duodenum and causes pain. After each feeding 

 saline is run through the tube to cleanse it, followed by air. This is very 

 essential or the tube shortly becomes blocked and has to be removed for 

 further cleaning. Einhorn (&) reports 95 per cent of ulcer cases healed 

 at once, and 90 per cent after two years in 132 cases, and other favorable 

 results. 



Buckstein(c) reports experiences with this method of feeding, using an 

 average mixture of peptonized milk 150 c.c. (5 oz.), glucose 70 gm. (2 1 /} 

 oz.), 2 eggs, butter 40 gm. (li/^ oz.). 



DUODENAL FEEDING ROUTINE EINHORN FEEDING 



7:30 a. m. Oatmeal gruel ................... 180 c.c. (6 oz.) 



One egg 



Butter .......................... 15 gm. (l/ 2 oz/ 



Lactose ......................... 15 gm. (l/ 2 oz. 



