812 



HERBERT S. CARTER 



use in milk enemata by its action in reducing fermentation. The mono- 

 saccharids are all well absorbed by the colon in considerable quantities, 

 and of them dextrose is the best for general use. Boyd and Robertson 

 found that 9/10 of a 10 to 20 per cent solution of dextrose was absorbed 

 up to 40-50 gm., but decided that a total of 30 gin. was less apt to irri- 

 tate the colon. Goodall found with a 10 per cent solution 157 to 163 gm. 

 was absorbed and with a 15 per cent solution a total of 14 A to 193 gm., 

 not more than 0.5 to 1 per cent being lost by bacterial action. Boyd gave 

 patients an average of 55 gm. dextrose with an average absorption of 53 

 gm. Gompertz, using a 3 per cent solution gave 60 gm. dextrose and 

 found 52 gm. absorbed in 24 hours, 8 gm. being recovered from the stools; 

 using a 10 per cent solution 200 gm. were given, 163 gm. absorbed; of a 

 15 per cent solution, 300 gm. were given, 144 gm. absorbed; and ali- 

 mentary glycosuria did not occur. 



For the most part, therefore, it has been found that solutions of 

 dextrose up to 5 per cent were best tolerated and can be used over con- 

 siderable periods without irritation. If fermentation is a factor it can 

 be controlled by adding 1 part of thymol in 4,000 parts of the solution. 



Salts and Water. It has been abundantly proven that these substances 

 are rapidly absorbed by the rectum and really largely account for the 

 success of rectal feeding. Gompertz (A) did experiments with both potas- 

 sium iodid and sodium chlorid and found both well absorbed. Apparent 

 gains in weight are no doubt due in some instances, as Coleman points out, 

 to water retention. 



Formulae for Rectal Feeding 



Among the most easily prepared and satisfactory foods for rectal feed- 

 ing is milk, preferably skimmed, and pancreatized from 8 to 24 hours, 

 after which enough dextrose is added to make a 5 to 10 per cent solution 

 and salt 5 gm. to the liter. The milk should be scalded after peptoniza- 

 tion to sterilize it, and then kept on ice. Of this solution, 6-8 ounces (180- 

 240 c.c.) may be given by rectum every four to six or eight hours, de- 

 pending on the ability of the patient to take it. This may also be given 

 advantageously by the Murphy drip, thirty-five drops to the minute, three 

 pints or more being given this way in twenty-four hours. 



The following combination of dextrose, alcohol and pancreatized 

 milk represents a fair sample formula, although in some patients the 

 alcohol has to be omitted and the lower percentage of dextrose used. 



Dextrose 20 to 50 gm. 80 to 205 calories 



Alcohol . ... 20 to 50 gm. 140 to 350 " 



Pancreatized milk 1,000 c.c. 650 650 " 



Salt 5 to 9 gm. 



870 to 1,205 



