CLINICAL
ADULT TUBE FEEDING THEN, NOW AND IN THE FUTURE Ever wondered what were the beginnings of enteral tube feeding? How did it emerge? What were tubes made of? How was nutritional formula made? This article presents the development of adult tube feeding throughout history. The earliest description of tube feeding was found on 3500-year-old papyrus, although it was not tube feeding as we know it. Due to issues with accessing the upper gastrointestinal tract, ancient Egyptians and Greeks, including Hippocrates, are reported to have performed rectal feeding. From then on, rectal alimentation was commonly used throughout history. Although nasogastric feeding was introduced in the 16th century, rectal feeding still gained popularity in the 19th century.1-3
Currently, in some wellness companies, the rectal route is used to provide colonic irrigation, also known as hydrotherapy. Its purpose? To flush waste materials out of the body using water, in order to ‘cleanse’ yourself. However, according to the NHS, there is no scientific evidence to suggest any health benefits of hydrotherapy, and the list of side effects remains extensive from irritation and dehydration to infection and bowel puncture.4
FOOD ENEMAS
The humble beginnings of nasogastric feeding date back to the 16th century, when nasogastric tubes were made out of silver or leather. An animal bladder served as an equivalent of the 20th century ‘formula bottle’. The 18th century brought major advances when John Hunter used a catheter and syringe approach to deliver nasogastric feeding. Later, investment in device developments led to inventions including a tube made of spiral wire covered with gut and another consisting of an eel skin drawn over flexible whalebone for orogastric feeding. However, these tubes were very large in diameter, not flexible and difficult to insert.1,3,5,7,8 The early 19th century brought major advances in psychiatry, with tubes being widely used for forcibly feeding patients with mental health issues. It wasn’t until the late 19th century when medics started using softer rubber tubing. Only then did tube feeding stop being an extremely traumatic experience for patients.3,5,7,8
In 1878, food enemas pushed into the rectum twice daily with a wooden syringe were claimed to provide an adequate provision of fluids and nutrients. One of the most famous reports of rectal alimentation was following President Garfield’s gunshot wound. For 79 days, every four hours he was rectally infused with peptonised beef broth, several drops of opium and whisky!1-3 Until 1940, the rectal route was still used to provide water, saline and glucose solutions. In 1941, it was a recommended form of nutrition in US military hospitals and infamously used as a method of torture by the Central Intelligence Agency (CIA). Solutions contained a combination of wheat or barley broth, milk, eggs, wine, brandy, tobacco and meat mixed with wax and starch. Defibrinated blood was also considered for that purpose but dismissed after reports of causing rectal irritation.1-3
Bogna Nicinska RD Dietitian by day, writer by night, Bogna has experience in research, community and acute care. Prior to Oviva, Bogna worked at Imperial College Healthcare NHS Trust as a Nutrition Support Dietitian.
NASOGASTRIC BEGINNINGS
www.NHDmag.com March 2021 - Issue 161
REFERENCES Please visit: nhdmag.com/ references.html
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