This section is from the "A Practical Treatise On Materia Medica And Therapeutics" book, by Roberts Bartholow. Also available from Amazon: A Practical Treatise On Materia Medica And Therapeutics
A method of involuntary feeding, proposed by Debove, has accomplished so much good that it is necessary to give an account of the mode of procedure. It is entitled forced alimentation, because the nutritive material is introduced into the stomach through a flexible tube, which has sufficient capacity to conduct it, and yet is not too large to pass the oesophagus. The tubes now made for the purpose are of non-vulcanized rubber, and have a mark at the outer extremity to indicate the distance to the stomach. The outer end has, also, a funnel-shaped orifice, for the more ready introduction of the nutritive and liquid materials.
The mode of introducing the tube is simple. After being washed out with a warm antiseptic solution, it is lubricated with a little vaseline. The patient lies down on a bed or lounge, the head extended, and the mouth wide open. "With the right hand, as if holding a pen, the operator passes the tube into the pharynx, taking care to clear the epiglottis by keeping close to the posterior wall, the patient making successive efforts of deglutition. The stomach is ascertained to be entered by the mark on the tube which comes on a line with the teeth. Retching usually occurs at first, and more or less pain is experienced by the passage of the tube down the oesophagus, but after a few times these troubles cease, and neither pain nor discomfort is felt. Sometimes spasm of the oesophagus occurs, and the onward movement of the tube is arrested; no violence must be used; the tube should be slowly drawn back a little, and then by a gentle movement passed on again. If the resistance persists, the attempt should be abandoned for the time being, and another made after an interval. When the tube is duly in the stomach and the retching or nausea is ended, the funnel end is turned up vertically, and the alimentary material is poured slowly down. It sometimes happens during the first trials that portions of the aliment are returned by regurgitation, but this accident does not persist after the few trials necessary to habituate the parts to the procedure.
Debove's powder is the nutritive material now most employed ; it is desiccated fresh beef, reduced to the finest powder. This powder, mixed with water, with bouillon, with milk, etc., is readily poured into the stomach, and, in consequence of its extreme tenuity, is easily acted on by the gastric juice. The quantity first given is small, but a rapid increase can be made. From half an ounce to an ounce of the powdered beef is administered on the first day, but this quantity is soon raised to three or four ounces, which is equivalent to four times the amount of fresh beef. At the outset a single dose is given each day, but, as the tolerance increases, two, three, even four administrations are made daily. No other mode of alimentation is attempted, and all the alimentary matters are conveyed by the tube into the stomach.
A remarkable improvement in the condition of the phthisical takes place. In a week to ten days the sweats and diarrhoea cease, the cough and expectoration diminish, and a considerable gain in weight results. A corresponding improvement in the local condition is observed: the rales lessen and may even disappear, and cavities slowly contract. The method can be employed in all forms of phthisis except those accompanied by high fever; but good results are in proportion to the limited extent of the lesions. When restoration has been effected, the artificial feeding should not be abruptly stopped, but gradually, as the natural manner is slowly substituted.
The method of forced alimentation is not without its inconveniences and dangers. The patient may never acquire the tolerance necessary, and hence the method can not be persevered in. By proceeding slowly and giving a small quantity at a time, gradually the maximum amount may be reached. It is only when anorexia is complete that forced alimentation need be employed—for those who can eat sufficiently in the natural way do not require such an addition to their alimentary resources.
As a therapeutical expedient, properly speaking, forced alimentation has an important place. Associated with the process of stomach irrigation, it may be useful in a high degree in such stomachal disorders as catarrh, ulcer, cancer, dilatation, etc.
In the preparation of Debove's powder, the beef is first cut up finely or "minced" by one of the machines now used for that purpose. It is then placed in an oven, dried at a temperature of 110° C. or 230° Fahr., and when completely desiccated is reduced to the finest powder. When completed, the powder has a reddish color, and the taste of roasted meat. When mixed with milk it presents the appearance of chocolate, is very homogeneous, and passes easily through the tube. If the patient is disinclined to submit to the forced process, the powder can be mixed with malt extract, with bouillon, with soft-boiled eggs, and will in this form usually be taken readily, and as an aliment is much superior to fresh meat (Dujardin-Beaumetz, Perret, Robin, and others).
It is really doubtful that the forcing method has advantages. When food enters the stomach, the gastric juice is poured out more or less freely whether or no the salivary secretion is correspondingly increased. If the patient can swallow the necessary quantity, it would seem to be entirely indifferent how the nutritive powder got into the stomach. We learn, also, that appetite, hunger, etc., contribute no element to the process, but serve merely as a reminder that the time for taking food has come. It follows, also, from the foregoing considerations, that Debove's powder, or similar aliment, may be administered as a medicament, and that the nutrition will be as favorably affected by it as various morbid states are by an involuntary medication.