It not unfrequently happens that the stomach will not receive and dispose of nutrient materials, when it becomes necessary to employ nutrient rectal injections. It has been proposed to treat ulcer of the stomach by absolute rest of the organ, and the introduction of foods by the rectum. In cases of excessive irritability of the stomach the same practice is sometimes necessary. CEso-phagotomy and gastrotomy, as also wounds of the stomach, may render the use of nutrient enemata indispensable to save life. It should not be forgotten that the rectum is not an organ of digestion; hence nutrient enemata must contain the materials for artificial digestion. Furthermore, the mucus and fluids of the rectum are alkaline in reaction. To secure rapid osmosis, therefore, the enemata should have an acid reaction. The following formula is suitable for the purpose:

Beef-tea, prepared as before described, four ounces; hydrochloric acid, ten minims; glycerole of pepsin (Scheffer's), two drachms.

If the rectum is irritable, ten to twenty drops of the tincture of opium may be added to the injection. If stimulants are indicated, brandy may also be added. The rectum soon becomes intolerant of injections; hence, the greatest care should be used in practicing them, to avoid sudden distention of the bowel, and frequent introduction of nutrient materials should be avoided. Five times in the twenty-four hours should be the maximum—for artificial digestion is much slower than normal stomach digestion.

Leube recommends the following as a nutrient injection: "Take about five ounces of finely-scraped meat; chop it still finer, add to it one and a half ounce of finely-chopped pancreas free from fat, then add about three ounces of lukewarm water, and stir to the consistence of a thick pulp."

Or the following peptonized formula may be used : "A nutritive enema should be prepared in the usual way—of milk—or of milk with beef-tea or eggs—or of milk-gruel. To half a pint of the warm enema a tablespoonful of the liquor pancreaticus and thirty grains of bicarbonate of soda should be added. The enema can then be administered at once."