ARTIFICIAL METHODS OF FEEDING 807 



the epiglottis although not necessarily into the stomach. An ordinary 

 stomach tuhe may he used or any convenient sized catheter to which is 

 attached a glass funnel. If the tuhe is passed through the nose, a small 

 sized catheter must he used and the end passed to a point well heyond the 

 epiglottis. Before pouring food into the funnel, one should listen to he 

 sure that the patient is not breathing through the tuhe, showing it to he 

 in the trachea a not unusual occurrence, particularly in unconscious 

 patients. 



The number of feedings given during the day will depend on circum- 

 stances; but three or four feedings in the twenty-four hours should be 

 enough, too frequent passage of the tube being irritating to the mucous 

 membrane. At times it is necessary to insert a mouth gag before passing 

 the tube, and in restless patients who bite the tube it is well to use a spool 

 gag with a good flange, passing the tube through the hole. 



Duodenal Feeding. This method of feeding was devised by Einhorn 

 some years ago, and has found a field of usefulness in certain cases. 

 It has been recommended especially for use in peptic ulcer, chronic gastric 

 dilatation to prevent weight on the gastric walls, allowing them gradually 

 to recover their tonus and contract, provided, of course, the dilatation is 

 not secondary to pyloric obstruction; in cases of difficult nutrition on 

 account of absolute anorexia, nervous vomiting, or asthenia also in severe 

 hepatic disease when it is supposed to reduce the congestion of that 

 organ although this is a questionable result; in carcinoma of the stomach 

 where the ingest ion of food is painful; in some, forms of chronic 

 indigestion. 



The metabolism of duodenal feeding is, of course, essentially normal, 

 and follows the same lines as in gavage. 



Method of Introducing the Duodenal Tube. The bulb of the tube is 

 placed in the patient's mouth and a swallow or two of water is given to 

 help in its deglutition care being taken not to have it swallowed too 

 rapidly as it might curl up in the pharynx. When the tube is in the 

 stomach the patient is placed on the right side, and the tube fed in its 

 entire length, gradually working its way into the duodenum by gravity. 

 The length of time necessary for it to reach the duodenum depends on 

 several factors, on the degree of gastric acidity, the motor power of the 

 stomach muscle and pylorospasm ; entering the duodenum most rapidly in 

 hypoacidity when this is associated with good muscle tone and no pyloric 

 contraction either functional or organic. In favorable circumstances, it 

 may enter the duodenum in ten to twenty minutes possibly two or three 

 hours for normal persons up to twelve or thirty-six hours in less favor- 

 able cases. When the end of the tube has passed the pylorus it is diffi- 

 cult to obtain any fluid and what few drops can be aspirated with a syringe 

 are alkaline and usually contain bile. If the tube is still in the stomach 

 the fluid will probably be acid. If there is an achylia present (and this 



