810 HERBERT S. CARTER 



ulcer,, cancer, pyloric stenosis, protracted vomiting, etc. 4. Increasing 

 emaciation. 



Physiology of Rectal Feeding. The large bowel is ordinarily thought 

 of as a reservoir whore the liquid of the chyle, including the salts, is ab- 

 sorbed, where the bacteria continue to break down cellulose, and the feces 

 are compacted. Little if any enzyme action on the foods is carried out 

 except in the ascending colon, where the small intestine digestion is 

 continued for a short time, the large bowel secreting no digestive juices. 

 The substances absorbed are those which travel easiest by osmosis and in 

 the case of rectal enemata reverse peristalsis carries any food solution the 

 whole length of the bowel and into the small intestine if the ileocecal 

 valve is incompetent. It is more than probable in the cases of rectal 

 feeding that have been kept alive for months the success of the procedure 

 has depended on this factor to a large extent, the small intestine being 

 responsible for the greater part of the absorption. 



In 1002 Cannon showed by bismuth enemata with food that if small 

 in amount they were carried only to the cecum, but if large ami thick, 

 were carried into the small intestine, segmentation taking place following 

 antiperistalsis, particularly if considerable pressure was used in their 

 introduction. 



Metabolism of Rectal Alimentation. As rectal feeding has been sub- 

 jected to more accurate laboratory methods, the clinical observations indi- 

 cating almost complete nutrition by this method, have of necessity been 

 modified, and at best it has been found that only about 30 per cent of the 

 total caloric needs of the body can be supplied, save in exceptional cases. 



Of the different food elements introduced by enema, it is necessary 

 to speak more in detail concerning the fate of protein, carbohydrate, fat, 

 alcohol, salts and water. 



Protein. Almost every conceivable form of protein has been used at 

 one time or another in rectal feeding, and Bauer and Voh(d) in 1869 

 proved by the increase in urinary nitrogen that protein, when properly 

 prepared, was absorbed to some extent. 



Edsall and JMiller(e) found in two patients 3.04 gm. X (10 gm. P) and 

 3.8 gm. X (23.8 P) absorbed; Boyd in six patients receiving an average 

 of 44.6 gm. protein (7.16 X) there was absorbed 8.87 gm. protein (1.42 

 X) i. e., 20 per cent of the intake, and the nitrogen balance was in every 

 instance a negative one. Adler, using peptonized milk per rectum, gave 

 3.0 gm. X, 2 grn. being found in the feces, proving that approximately 

 one-third of the protein was absorbed. 



Short and By waters (/) analyzed reports of cases fed by rectal enema 

 together with weight charts and urinary findings and concluded that: 1. 

 The daily output of urinary nitrogen from patients given enemata of 

 peptonized milk and eggs (peptonized twenty to thirty minutes) showed 

 that almost no nitrogen was absorbed, and the total nitrogen in the urine 



