806 HERBERT S. CARTER 



one or another method, accurate data of scientific investigation shows the 

 bettered condition is for the most part only apparent. 

 The forms of artificial feeding to be discussed are: 



1. Gavage. 



2. Duodenal feeding. 



3. Rectal feeding. 



4. . Subcutaneous feeding. 



5. Intravenous feeding. 



Gavage. By gavage is meant the introduction of food either through 

 the nose or mouth by means of a flexible rubber tube. This is an exceed- 

 ingly valuable procedure under certain conditions and gives most satis- 

 factory results because the food reaches the gastrointestinal canal through, 

 the normal route. 



Indications. The chief indications for the use of this method of 

 feeding are: First, in unconscious patients, particularly in those who 

 have lost the swallowing reflex; second, in the insane who refuse nourish- 

 ment ; third, in conditions of ulceration of mouth or pharynx with painful 

 deglutition ; fourth, in babies, at times, who have had cleft palate opera- 

 tions; fifth, in anorexia nervosa where it is necessary to feed in spite of 

 absolute anorexia ; sixth, in "hunger strikes," in prisons ; seventh, in 

 paralysis of deglutition. 



Metabolism. The metabolism in gavage is precisely that of normal 

 feeding, except that the preliminary mouth digestion is lacking. On 

 this account, foods used in gavage should be either in a liquid form 

 or so finely communicated that they will run through the tube in a 

 liquid medium. The food requirements should be calculated for each 

 patient. 



As the psychic stimulus to digestion, so far as taste goes, is not a 

 factor in gavage, it is only necessary to combine the food elements in 

 sufficient amounts and proper proportions to satisfy the nutritional re- 

 quirements cf each case, calculating the caloric value of the foods used 

 on the basis of the patient's activities, according to the well known rules. 

 Thus an insane, hyperactive patient will take many more calories per kg. 

 than one lying unconscious in bed, therefore it is unreasonable to try to 

 supply food formulae ready made. 



Foods Used in Gavage. The most convenient foods used in gavage are 

 niilk, cream, sugars, butter, oils, meat powders, eggs, cereals/ cooked 

 starch, etc. 



Method of Performing Gavage. The patient should be placed in as 

 comfortable a jM^ition as possible. If in bed, with the head slightly 

 raised ; if out of bed best in the upright position ; if insane or resisting, 

 tied in bed or to a chair. The tube should be lubricated best with some, 

 non-greasy emollient and slipped down the throat at least well beyond 



