55 



of the excretion of acetone and diacetic acid, was 

 made on patients being " fed " by nutrient enemata 

 for haematemesis. It will be seen that the figures 

 are so little different from those obtained when no 

 food at all is given, that we are compelled to believe 

 that little if any protein or carbohydrate was ab- 

 sorbed. The carbohydrate was given in the form of 

 lactose. 



It is quite certain that dextrose can be absorbed 

 from the rectum, because it will cure acidosis when 

 given in this way, and also it will raise the respiratory 

 quotient by increasing the amount of CO 2 expired. 



It is very difficult to obtain evidence as to whether 

 fats are absorbed. In a patient who had a fistula of 

 the thoracic duct only from 3-7 to 5-5 per cent of the 

 fat given per rectum was recovered from the fistula. 



In another patient, the thoracic duct was blocked 

 and a lymphatic vessel had ruptured into the urinary 

 passages, so that most of the fat absorbed by the 

 lacteals escaped into the urine, which became milky 

 after a fatty meal (chyluria). There was no chyluria 

 when all fats were stopped by mouth, and nutrient 

 enemata containing milk administered. 



It must not be supposed that rectal feeding supplies 

 absolute rest to the stomach. It may be observed in 

 patients with a gastrostomy wound that each nutrient 

 enema excites a reflex flow of gastric juice. 



There is thus grave doubt as to whether nutrients 

 really do much good. It has been claimed that a dog 

 has been fed for many months on nutrients only, 

 but even if this be true it does not necessarily prove 

 that it would be possible in man. Patients have 



