# 
<§> 
4^ 
AND 
OTHER LITERATURE 
ON THE 
SUBJEC T 
OF 
ALIMENTATION PER RECTUM 
Copied from “ The Medical Recordand from papers read 
before the New York Academy of Medicine, Thera- 
peutical Society and Gynecological Society. 
I 
1'Presented to the Medical Profession by Sr 
PARKE, DAVIS & CO., 
HVC ANUFACTUBIUG Chedveists, 
DETROIT, MICHIGAN. Gel ktirie Buppodtory CApsides. 
OLEIC ACID AND THE OLEATES OF THE ALKALOIDS, 
Suggested by F. E. Stewart, Ph.G., M. D., of New York, 
FOE EEOTAL MEDICATION. 
For the introduction of remedies into the rectum, a vehicle 
of sufficient consistency to overcome the resistance of the 
sphincter muscle is necessary. This is obtained in the Sup- 
pository as ordered by the U. S. P., by the .use of Butter of Cocoa. 
OBJECTIONS. 
1st. Suppositories, when sufficiently hard for successful insertion, frequently do 
not fuse at the temperature of the body, and are then useless. 
2d. Suppositories melting at the temperature of the body, lose consistency in hot 
weather. 
3d. Butter of Cocoa coats the bowel and greatly retards absorption, as proved 
by Ellerslie Wallace, M.D., Professor of Obstetrics at the Jefferson Medical College, 
Philadelphia. 
4th. An expensive, tedious, and difficult process, requiring costly apparatus, time, 
and skill. 
5th. Difficulty of retaining a homogeneous admixture of insoluble drug in liquid fat 
during the operation of pouring into molds. 
6th. Danger from unequally divided medicinal portion on that account. 
7th. Suppositories are disagreeable to patients. 
TO OVERCOME. 
A Rectal Capsule is a vehicle always possessing consistency, is unaffected by heat, 
and is easily dissolved by the warm secretion of the rectum. Its advantages are : 
1st. Consistency for insertion. 2d. Simplicity. 3d. Accuracy—no danger from 
unequal division of medicinal portion. 4th. Cleanliness. 5th. Fats are dispensed with ; 
also expensive manipulation. 6th. The contents of the capsules are perserved in an 
air-tight chamber. 
OLEIC ACID. 
When it is necessary to use a drug locally irritating for rectal medication, Oleic 
Acid presents an admirable diffusive agent, being perfectly bland and distinguished for 
its power of permeating the tissues. See article by John F. Marshall, F. R.S., London 
Lancet, May 25th, 1872. 
OLEATES OF THE ALKALOIDS. 
The oleates of the alkaloids are liquid salts. “ The salts of Morphia, Atropia, and 
Strychnia, in solution, are absorbed as quickly, and the last named more quickly by the 
rectum than by the stomach.”—Bart he low's Materia Medica. and Therapeutics, page 
9, ed. 1878. 
PROPERTIES OF THE RECTAL CAPSULE. 
“ In relation to other properties of the rectal capsules, they are quickly soluble in 
water at 90 0 F. In water at 6o° they swell up, become opalescent, very soft, and dis- 
solve after long immersion. Filled with cold water and placed on a plate, they lose 
consistence in about eight minutes, so that very moderate pressure robs them of their 
contents. On the tongue they dissolve and disappear altogether in about three minutes, 
usually less, depending on slight variation of thickness in their walls. In the rectum 
they melt in about four minutes; but if removed in three minutes, one side will usually 
be found dissolved, thus liberating their contents. If filled with any ingredient melting 
at the temperature of the body, the rectal capsule will not delay its fusibility, and such 
article, inserted by means of the rectal capsule, will surely produce its effect almost as 
quickly as without it. Finally, these facts have been substantiated by thorough tests in 
numerous cases in both New York and Philadelphia, in private and hospital practice.” 
—F. E. Stewart, Ph.G., M.D., in New Remedies, for December, 1879. 
We are prepared to furnish Rectal Capsules empty, or with the Oleates of Alkaloids. 
PARKE, DAVIS A CO., Detroit, Mich. STEWART’S SUPPOSITORY CAPSULES CENTRAL STOCK-YARDS AND TRANSIT COMPANY, 
JERSEY CITY, N. J. 
These Yards have a daily capacity for 8,OCX) cattle and 20,000 sheep, with ample facilities for watering and feeding. The Abattoir has a 
capacity for slaughtering 2,000 cattle and 10,000 sheep daily. All cattle and sheep not slaughtered on the premises are 
delivered by large steam cattle-boats, owned by the Company, direct to the slaughtering-pens 
of the butchers in New York City, Brooklyn, and other places. TO THE MEDICAL PROFESSION. 
The worth of Defibrinated Blood for Rectal Alimentation 
has been thoroughly demonstrated by Dr. A. II. Smith, at St. 
Luke's Hospital, and its use f ormally recognized by the New 
York Therapeutical Society. This, and the additional tes- 
timony of Prof. Flint, in his paper read before the New 
York Academy of Medicine, and of Dr. Henry F. Campbell, 
of Augusta, Georgia, reported to the Gynecological Society, 
with regard to the value of alimentation per rectum, would 
seem to fully justify our introduction of this new remedy 
to the general notice of the profession. We have therefore 
taken advantage of the recent utilization of defibrinated 
blood by the process recommended by F. E. Stewart, Ph.G., 
M.D., of New York, published in the Medical Record, Jan- 
uary 3, 1880, to supply the profession with DESICCATED 
BLOOD FOR RECTAL ALIMENTATION. .■ 
SANGUIS BOVINUS EXSICCATUS. 
xf i&w 
In the preparation of this article, great care is necessary 
both in selecting and killing the animals, to insure a perfect 
product. The process of drying, also, is one of extreme deli- 
cacy, requiring costly apparatus and the attention of a skilled 
chemist. We have, therefore, been fortunate in securing the 
unlimited facilities of the Central Stock-Yards and Transit Com- 2 
DESICCATED BLOOD FOR 
pany, of Jersey City, and the improvisory care of the well- 
known expert of the company, Dr. J. J. Craven, inventor of 
the great ship-refrigerators for preserving meat during ocean 
voyages. At these stock-yards is concentrated the immense 
live-stock traffic of the Erie and Pennsylvania Railroads, 
bringing cattle from all parts of the United States, and from 
this great variety of stock is selected the finest of the choice 
Colorado steers picked for European exportation, and killed 
for this purpose. The selection, killing, and preparation of 
the blood are conducted under the direct supervision of Dr. 
Craven ; the desiccation is performed with the greatest care in 
the most approved apparatus of his construction, and special 
attention is paid in all details to chemical and vital pheno- 
mena. We can, therefore, guarantee this article in every 
respect. 
NOTE. 
Desiccated Blood Per Orem, as a substitute for the various so-called extracts 
of beef, is now under trial at several of the New York Hospitals. The results of 
the experiments will be made public. The following formula is recommended: 
B. Sang. Bov. Exs’ct., . . . . 3 vi. 
Aqua, 3 iv. 
M. Ft. sol. et ad, 
Glycerine, 
Spts. Vin. Gal., aa, . . . . § i. 
S. Tablespoonful every three hours. 
PARKE, DAVIS & CO., 
Manufacturing Chemists, Detroit, Mich. RECTAL ALIMENTATION. 
3 
A NEW METHOD OF RECTAL ALIMENTATION. 
By F. E. STEWART, Ph.G., M.D., 
NEW YORK. 
In my article published in New Remedies, Vol. VIII., No. 
12, entitled, “A New Method of Rectal Medication,” calling 
attention to rectal (gelatin) capsules and the oleates of the 
alkaloids per rectum, the absorbent power of the intestinal 
mucous membrane was quite fully discussed. Advantage 
has long been taken of this power for the purpose of alimen- 
tation as well as medication ; and although the rectum, as an 
absorbing surface, is inferior to the stomach, and, for obvious 
reasons, not fitted to take its place as the organ of digestion, 
still this power of taking up food is of great importance when 
for any cause the stomach is incapable of performing its func- 
tion. 
For alimentation, the rectum can be resorted to as an 
auxiliary organ to the stomach, or it can be used for a time 
as a substitute for it, in supplying the system with food. It 
is to the former we wish to call attention, and to desiccated 
defibrinated blood as an agent especially adapted for rectal 
alimentation. 
But, before proceeding, an explanation is necessary. For 
more than a year past the writer has been experimenting 
with defibrinated blood as an aliment in disease. The sub- 
ject was suggested by the popular idea that warm, fresh, 
defibrinated blood, quaffed at the butcher’s shambles, is 
remedial in consumption and other wasting diseases. Inves- 
tigation of this singular practice certainly does show that 
many cases are remarkably benefited by it. This, of course, 
can be accounted for in many ways without referring it to 
the blood—the healthy outdoor exercise of a walk, or ride, 
to the abattoir, or diversion of the mind by so novel a rem- 4 
DESICCATED BLOOD FOR 
edy; but it cannot be denied that defibrinated blood is rich 
in the elements of nutrition, and the resulting benefit of its 
use is out of proportion to the novelty of the medicine or 
healthy exercise in obtaining it. 
To utilize, therefore, what appeared to be a valuable prod- 
uct, a process was devised for drying it quickly, to prevent 
decomposition, and at a low heat. After shipping a large in- 
voice of this desiccated blood to Detroit, to be used as an 
aliment, I discovered that Dr. A. H. Smith, physician to St. 
Luke’s Hospital, New York City, was also at work with 
defibrinated blood, and had proved its therapeutic worth in 
more than sixty cases. At my request, Dr. Smith substi- 
tuted the dried article at St. Luke’s, where it is now on trial, 
and appears to be of equal worth to the blood before prepa- 
ration. 
This, then, will explain the reason why desiccated blood is 
brought to the notice of the profession as a new article for 
rectal alimentation. 
There are three ways by which blood can be introduced 
into the system—per orem, by transfusion, and per rectum. 
The last-named seems, for many reasons, the least objection- 
able. Naturally enough, drinking blood is disgusting to pa- 
tients. Transfusion, even in the most careful hands, is not 
devoid of danger. But injection per rectum is an easy and 
safe operation, which can be frequently repeated without risk 
of injury. 
Blood per rectum has also the advantage possessed by 
transfusion, of not being subject to the changes incident to 
the process of digestion. 
Various articles are used for rectal alimentation—milk, al- 
bumen, and lately albuminose has been recommended. To 
be of any use to the system, they must be taken into the cir- 
culation, converted into blood, or else substituted for it. 
Blood is the product of digestion, and it is supposed that be- 
fore food can be converted into blood, the saliva, gastric, 
pancreatic, and intestinal juices and bile must perform their 
action, absorption must take place, and finally, that wonder- 
ful, vital constructive process by which the corpuscles are 
made, and the blood is fitted to perform its part in nutrition. RECTAL ALIMENTATION. 
5 
If this be all true, blood cannot be manufactured from these 
articles when injected into the rectum, and their beneficial 
effect must be accounted for in some other way. It would 
seem, therefore, that blood itself, for rectal alimentation, if 
absorbed, would be more suitable to meet the wants of the 
system. 
Blood is the food and air of the tissues. As it is the 
province of the vegetable world to convert the elements of 
surrounding nature into organic forms fitted for food, so it 
is the province of digestion to convert food into blood to feed 
the vital organs. Blood is therefore called the vital fluid or 
the life, and its presence in the vital organs is indispensable 
to their function. Only a momentary arrest from the brain 
results in syncope or fainting away, and any organ deprived 
of it soon loses functional activity. Supplies for the growth 
and repair of the whole body are in the blood. Blood is 
but the body in a liquid state. Being, therefore, per- 
fectly adapted to build and construct tissues, and indis- 
pensable to life, its administration would seem to be indi- 
cated when tissues are wasted and life is threatened by 
disease. 
Like other vital organs, the nerves depend directly on the 
blood for their functional activity, and deprivation results in 
morbid phenomena. Close physiological relations exist be- 
tween the red globules of the blood and the healthy life of 
the nerves. This relation is probably between the haemoglo- 
bin—the red coloring matter of the blood, which forms the 
principal substance of which the red globules are composed 
(about 25 to 30 per cent, of their weight, or 86 per cent, of 
their solid ingredients)—and the nerves. A morbid diminu- 
tion of the red globules is designated anaemia. As the action 
of every organ in the body depends upon the nerves, it 
naturally follows that, if they be impaired, there is a general 
deficiency of functional energy. All the vital functions are 
languidly performed. The action of the heart is feeble and 
easily disturbed. Mental energy, strength of will and pur- 
pose, are diminished. Neither can the action of impaired 
nerves on the secretory organs manufacture healthy diges- 
tive fluids for the preparation of food to be converted into 6 
DESICCATED BLOOD FOR 
healthy blood, so necessary for nerve-supply. Then, too, 
the brain sympathizes in this condition, and the mind, be- 
coming affected, in turn reacts on the nerves to increase the 
disorder. 
Nutrition is directly under nerve control. Every secreting 
cell, every absorbing villi, the inherent power of each tissue 
to select from the blood appropriate matter for its repair, 
even the muscles for respiration, are supplied by artery and 
vein with nerves to guide their action, for the purpose of 
furnishing them with blood to be used for building new tis- 
sue, and to impart nerve-force to repair that lost in the exer- 
cise of their functions. 
Desiccated blood is therefore suggested for rectal alimen- 
tation, when the life-powers are threatened by asthenia due 
either to loss of blood, loss of nerve-power, or to both. It is 
indicated in all cases where, for any reason, digestion is 
impaired, in cachectic states from special constitutional poi- 
sons, and in all cases when impaired blood, nerves, or diges- 
tion give rise to the anaemic condition, with its resulting 
general debility, hypochondriasis, or other functional dis- 
order. 
It is hardly reasonable to infer, and clinical experience 
does not justify us in believing, that blood is absorbed from 
the rectum without a breaking down of the corpuscles ; but 
there are good reasons to suppose that it enters the system 
without marked chemical change, and it has been satisfac- 
torily proved, by Dr. Smith and other scientific physicians, 
that its use is remarkably beneficial to patients. How much 
this is due to the haemoglobin and its action on the nerves, 
remains an interesting matter to determine. 
Blood for rectal alimentation must be from healthy animals. 
Inflammatory blood from diseased cattle will not do, or blood 
from animals fatigued by long journeys. None but power- 
ful, vigorous bullocks, fed and rested until the heart’s action 
regains its accustomed tone, should be selected for this 
purpose. 
Killing must be done in a manner to secure healthy blood. 
This can be accomplished only by bleeding to death. Strik- 
ing on the head, or in any other way causing death from RECTAL ALIMENTATION. 
7 
apncea, prevents a proper arterialization of the blood. Blood 
from animals killed in this manner, or the inflammatory 
blood from diseased cattle, is unfit for use in the arts, and 
therefore must be too imperfect for employment in thera- 
peutics. 
Great care also must be taken in the preparation, due 
attention being paid to all chemical and vital phenomena. 
Long exposure to the air in a fluid condition, or too high 
heat, not only decomposes, but devitalizes it, and, if the 
heat be raised to i6o° F., coagulates the albumen. No heat 
above no° F. should be used in drying the blood, and the 
process should be as instantaneous as possible, and without 
agitation. 
Desiccated blood, as thus prepared, is completely and 
readily soluble in water at all temperatures below i6o° F., 
and contains all the elements of blood, except water and 
fibrin. The loss of the latter does not seem to impair its 
nutritive value, being but a very small proportion of the 
nitrogenous constituents of the blood. 
A little more than a drachm of the dried article is neces- 
sary to represent a fluid ounce of blood of ordinary specific 
gravity ; but it is sufficient to remember, in using, to employ 
a drachm to the ounce of water. To dissolve, it should be 
thrown into water, and allowed to stand until the albumen 
becomes perfectly soft, to prevent sticking to stirring-rod or 
dish. Gentle agitation will then convert it into a perfectly 
homogeneous fluid, closely resembling fresh blood. It is a 
very difficult matter to dissolve dried blood by pouring water 
upon it, for it immediately adheres together in lumps, and 
sticks to everything brought into contact with it. 
From four to six drachms of the powder daily, or more, is 
the dose, which may be given at once, at bedtime, or in 
divided portions during the day, as circumstances seem to 
require. 
If a greater amount than can be absorbed be injected at 
once, and decomposition result therefrom, it is advised to 
wash out the rectum with tepid water before continuing the 
medication. 
For further information on this subject, the reader is re- 8 
DESICCATED BLOOD FOR 
ferred to Dr. Smith’s paper, read before the New York 
Academy of Medicine, to his paper before the Therapeutical 
Society, and to the minutes of these respective societies for 
their action in the matter. 
The Medical Record and New York Medical Journal have 
reported on these papers, and are also referred to as contain- 
ing very nearly as full information. RECTAL ALIMENTATION. 
9 
SUPPLEMENTARY RECTAL ALIMENTATION, AND 
ESPECIALLY BY DEFIBRINATED BLOOD, AS 
APPLICABLE TO A LARGE RANGE OF CASES 
IN WHICH NUTRITIVE ENEMATA FIAVE NOT 
HERETOFORE BEEN EMPLOYED.1 
By ANDREW H. SMITH, M.D., 
PHYSICIAN TO ST. LUKE’S HOSPITAL. 
In contrasting the practice of medicine of to-day with that 
which prevailed fifty, forty, or even thirty years ago, the 
salient difference which is at once apparent is in the promi- 
nence which is now given to the “supporting” instead of 
the former reducing treatment. Indeed, the period I have 
named has witnessed a complete revolution in the opinions 
and practice of the profession on this point. Forty years 
ago, inflammatory and febrile affections were very generally 
supposed to require antiphlogistic treatment—the lancet, calo- 
mel, and antimony—and to these were added the lowering 
effect of the antiphlogistic regimen, of which water-gruel 
formed a prominent factor. At the present time, the term 
antiphlogistic treatment is obsolete, and with it the antiphlo- 
gistic regimen has become a thing of the past. 
This is the result of a conviction, which, after the lapse of 
centuries of observation and study, has somewhat suddenly 
dawned upon the profession : that disease is a burden im- 
posed upon the economy, which can be sustained and ulti- 
mately thrown off only by an expenditure of vital energy ; 
and that in increasing, and not in diminishing vital force, are 
we furthering the reparative processes of nature. 
At the present day, with the exception of diseases located 
in the digestive organs themselves, and which require rest of 
1 Read before the N. Y. Academy of Medicine, February 20, 1879. 10 
DESICCATED BLOOD FOR 
these organs from functional activity, there is scarcely any 
affection in which it is considered necessary to withhold the 
amount of nourishment which the stomach craves, while in 
very many cases benefit is thought to follow the adminis- 
tration of a much larger quantity than the patient desires. 
Even in surgical cases occurring suddenly in persons previ- 
ously in perfect health, the value of generous alimentation is 
recognized, and was ably advocated by Prof. Hamilton in a 
paper read before this body two years ago. 
If, then, we considered the principle established, that the 
chances for recovery in the vast majority of cases are pro- 
moted by keeping the nutrition as nearly as possible up to 
the normal standard, the question arises : How can this ob- 
ject best be obtained ? There can be no hesitation in saying 
that the most natural means are the best, so long as they are 
adequate. If the stomach will take and digest sufficient 
food, and if the absorption and assimilation go on regularly 
and properly, there is no need for anything more, and there 
can be nothing better. 
But there may be an obstacle to the introduction of food 
into the stomach, or to its passage beyond the pylorus ; or 
there may be inflammation or ulceration of the stomach, 
causing ejection of the food ; or, from some reflex irritation, 
vomiting without actual gastric disease, may occur to an ex- 
tent to imperil life. For this class of cases, in which the 
function of the stomach is practically suspended, rectal ali- 
mentation is clearly indicated. I need only refer you to the 
able and exhaustive paper read by Prof. Flint before the 
Academy in December, 1877, for a complete discussion of 
this most interesting topic, as limited to this class of cases. 
But it is the object of this paper to inquire whether nutri- 
tive enemata may not be useful in a great many other con- 
ditions—not as a substitute for, but as an aid to, stomach 
alimentation ; and to answer this question as well as I can, 
by laying before you the experience acquired in about eighty 
cases treated in this way by myself and some of my friends, 
during the past year. 
There are a variety of conditions of the system that have 
this in common, that the stomach, though not the seat of RECTAL ALIMENTATION. 
11 
structural change, is what is termed in popular language, 
weak. There is little desire for food, and the food that is 
acceptable is not of a nourishing character. If a larger 
amount of food is forced down, or if something more solid 
is taken, the result is either vomiting, or the flatulence, or 
diarrhoea, which depend upon the passage of undigested food 
into the intestinal canal. But often these effects are not ob- 
served, for the want of appetite removes from the patient all 
temptation to go beyond his digestive power, and he is satis- 
fied to abstain from the food for which he has so little relish. 
Thus he lives in a state of semi-starvation, and the ill-nour- 
ished tissues, from lack of vitality, too often fall a prey to 
structural degeneration. 
This condition, when standing by itself, is recognized as 
atonic dyspepsia; but it is the accompaniment or result of 
a wide range of affections by which it is overshadowed, and 
which sometimes cause its importance to be overlooked. 
Now, if poverty of blood is not the original occasion of 
the weak stomach, it very speedily becomes its result. In- 
deed, these two conditions necessarily act reciprocally as 
cause and effect. And the reason of this is plain. Weakness 
of the stomach—-(and by the word stomach in this connec- 
tion I mean the whole alimentary apparatus), depriving the 
system of a portion of its necessary supply of nutritive 
material, must result in impoverishment of the blood ; while 
a stomach whose nerves, muscular fibres and glands, are sup- 
plied with thin and watery blood must be irritable, must 
perform its muscular movements languidly, and must afford 
a weak and inefficient secretion for the solution of food—in 
other words, must become weak. Thus we have a circle es- 
tablished, atonic dyspepsia producing poverty of the blood, 
poverty of the blood producing atonic dyspepsia. 
I have lately read in one of our journals of a case in 
which, without any obvious cause, the heart’s action was 
found to be growing weak. From hour to hour the pulse 
became feebler, and the ear applied to the chest heard the 
heart-beats fainter and fainter. There was no evidence of 
any internal hemorrhage; there was no brain-lesion to par- 
alyze the heart, no cardiac poison had been taken. The 12 
DESICCATED BLOOD FOR 
entire symptomatology was summed up in the one expression 
—failure of the heart. All the stimulants given produced 
no effect, and the doctors could only stand by with finger on 
the pulse and note that life was fast going out. Why, they 
could not tell. The autopsy solved the riddle. In one of 
the coronary arteries was lodged an embolus, and the heart, 
upon which the whole frame depended for blood, was itself 
left bloodless. 
How often is the stomach in like case ? The whole sys- 
tem looks to it for nourishment; yet it is itself often nour- 
ished with such a beggarly quality of blood that, like the 
heart in the case I have cited, it has no longer strength to 
carry on its work. 
This condition may, as I have remarked, stand by itself; 
but it is much more frequently the result of some other dis- 
order, past or present. In these cases the blood may first 
be affected, and through it the stomach ; or the stomach may 
suffer first, and through it the blood. 
The blood is first affected in hemorrhages, protracted sup- 
puration, in scrofula, phthisis, renal disease, etc., while the 
first attack is upon the stomach in diseases which are located 
in the organ itself, or which affect the nerves supplying it, 
or cause irritation in other organs which stand in intimate 
reflex relations to it, such as the uterus, the liver, and the 
brain. 
The treatment of this condition as a complication is, of 
course, involved in that of the disease with which it is asso- 
ciated. But inasmuch as these diseases, when not actually 
incurable, are much more manageable if the nutrition can 
be maintained, it often becomes necessary to regard the de- 
fective action of the stomach as the principal feature in the 
case. In these cases, as well as when the condition is pri- 
mary, the treatment has heretofore been narrowed down to 
three lines of procedure. We have endeavored to furnish 
to the debilitated stomach an aliment which would require 
the least possible digestion ; or we have attempted to sup- 
ply artificially the necessary digestive fluids ; or we have 
tried, by means of tonics, stimulants, haematics, etc., so to 
work upon the nervous and vascular supply of the stomach RECTAL ALIMENTATION. 
13 
as to force a more vigorous action. The first of these at- 
tempts has resulted in the multitude of patent foods with 
which the market is flooded, in the use of cod-liver oil, in 
the consumption of alcohol as a food, and last, but not least, 
in that most pitiful of all delusions, beef-extract. 
To the second we owe pepsin in its myriad forms, pancre- 
atin, and lastly ingluvin, prepared from the gizzard of the 
domestic fowl, and five times as strong as pepsin ; and we 
may prophesy with confidence that ere long we shall find 
upon our tables illuminated circulars, in the highest style of 
decorative art, announcing a new preparation fifty times as 
strong as ingluvin, made from the gizzard of the ostrich. In 
the third, we employ, in short, the whole materia medica. 
And there can be no doubt that by a judicious use of these 
agencies, together with suitable hygienic measures, a vast 
amount of good can be, and is, accomplished. Still we 
must all confess that there is yet much to be desired, and 
that any plan which promises to help us out of even a part 
of the difficulties which we meet in treating these constantly 
recurring cases will be a welcome addition to our resources. 
For the condition of insufficient nutrition forms an impor- 
tant factor in almost all chronic diseases, and in many that 
are acute. Nay, it is the broad avenue by which death en- 
ters in those cases which terminate by exhaustion, and it aids 
also indirectly in the other modes of dissolution. 
Such an addition to our resources as I have referred to is 
afforded, as I believe, by what I propose to call Supplement- 
ary Rectal Alimentation, that is to say, the use of rectal in- 
jections to supplement alimentation by the stomach. 
The power of the rectum to absorb aliment has been so 
often demonstrated, and the demonstration has been so fully 
set forth before this body in the paper to which I have already 
referred, that time would be wasted in further argument to 
prove it. It remains only to consider whether the fact of 
such absorption can be turned to account in the class of cases 
now under discussion. 
But here we are met at once by the question : If the 
stomach is in a great degree incapacitated for absorbing by 
the influence of some general condition of the system, will 14 
DESICCATED BLOOD FOR 
not that incapacity necessarily extend to the rectum also ? 
To this I answer, without hesitation, No. The fallacy that 
lies in this question is in assuming that the conditions for 
simple absorption in the stomach and in the rectum are 
alike, while, in fact, they are as different as possible. The 
stomach is an exceedingly complex organ, not designed 
merely to afford a surface for absorption, nor yet simply to 
reduce solid aliment to a fluid form, but which has for a part 
of its function to create, in many cases, new substances 
from the food presented to it. Thus, for example, albumi- 
nose is not a mere solution of the several nitrogenous prin- 
ciples of the food by the gastric juice, but a distinct prin- 
ciple in itself, the result of a recomposition of elements. It 
is only after the reactions have taken place, of which the 
above is an example, that stomach absorption begins, and if 
digestion in this sense is interrupted, absorption is also sus- 
pended. Moreover, the stomach is the centre to which re- 
flex influences tend from many other organs and parts of 
the body, and as such is liable to derangement in sympathy 
with them. But with the rectum all this is different. It is 
scarcely more than a passive pouch, whose mucous surface 
absorbs fluids much as the serous surface and the subcu- 
taneous connective tissues do. It suffers but little reflex 
disturbance from excitement elsewhere, and is comparatively 
insensitive to irritation within itself. 
Theoretically, then, we might anticipate what has been 
practically demonstrated—that the rectum will continue to 
absorb aliment long after the stomach has refused to perform 
its office. 
But then another question arises : Does the absorption of 
a certain amount of aliment by the rectum do anything more 
than to add so much nutritive material to the blood ? Does 
it help at all toward restoring a natural condition of nutrition, 
and shall we not, in any given case of a chronic character, 
stand just as much in need of such aid next week or next 
year as we do to-day ? The answer is : In some cases, yes ; 
in many cases, no. If the innutrition depends upon a cause 
which cannot be removed, a cause which might exist in a 
well-nourished body, doubtless the need for aid to the RECTAL ALIMENTATION. 
15 
stomach will continue. But if the condition be one simply 
of weak stomach, and the stomach is weak only because its 
muscle and glands and nerves are supplied with an impover- 
ished blood, then every particle of aliment taken up from the 
rectum is absolutely curative. It helps to improve the con- 
dition of the blood, and its influence will be felt sooner in the 
stomach than anywhere else. The result will be improved 
appetite and better digestion, and the stomach will be brought 
nearer to the condition in which it can provide for its own 
necessities and for those of the system at large. 
The result of a considerable number of cases in which 
transfusion of blood has been resorted to, to correct a con- 
dition of extreme innutrition, shows that a little extraneous 
aid is often all that is required to reverse the tendency of the 
system, and to give it an upward instead of a downward 
direction. How little is the strength of the engineer com- 
pared to the power of the mighty engine under his charge ; 
yet that little strength exerted to carry the balance-wheel 
beyond the “centre” may prevent'a stoppage of the whole 
machinery. 
At the same time, the direct support to the system to be 
attained through nutritive enemata, independently of any 
improvement of stomach digestion, is not to be despised as 
a temporary resource in acute cases. There are many times 
when the stomach suddenly gives out, or when its fullest 
powers are not equal to the unusual demand upon them, and 
in such cases nourishing injections may render invaluable 
aid. 
If, then, the value of this method of alimentation be con- 
ceded, the question arises : What is the best material to be 
employed ? Milk, raw eggs, animal broths, etc., are usually 
employed. Since the publication of Prof. Leube’s paper on 
rectal alimentation in 1872, the preparation which he recom- 
mended has come largely into use, and to this Dr. Flint 
gives the preference. It consists of the muscle of beef, partly 
digested by an artificial process, and brought to a sufficiently 
fluid condition to be administered by means of a syringe. 
Life has been sustained for periods of two or three weeks or 
longer with this preparation alone, and there can be no doubt 16 
DESICCATED BLOOD FOR 
that a considerable proportion of it is absorbed. Yet it is 
only imperfectly dissolved and semi-liquid flesh, containing a 
great deal of innutritious fibre, and, as such, appears to me to 
be greatly inferior to the perfectly fluid and wholly absorb- 
able flesh which nature has prepared in the form of blood. 
It was while listening to Dr. Flint’s paper that it occurred to 
me that in no other substance could we be so certain of find- 
ing all the elements of blood as in blood itself, and that it 
would be better to make use of it before it had become solidi- 
fied into the form of flesh than to take the flesh and try to 
reduce it again to a liquid state. A few experiments con- 
vinced me that the blood was very readily absorbed by the 
rectum, the corpuscles being taken up as well as the serum.. 
In experiments of this kind, blood presents the advantage of 
distinguishing itself by its color from the faecal matters in the 
dejections, and it is thus easy to form an idea of the amount 
voided. I soon found that in many persons an enema of 90 
to 120 grams (3-4 ounces) of blood administered at night 
would be so completely absorbed in the course of eight or 
ten hours that no trace of it could be found in the morning 
evacuation ; while larger quantities, such as 180, 240, or even, 
in a few cases, 300 grams, were retained, and the evacuation 
showed simply a small quantity of a dark red material of a 
tarry consistence mingled with the faeces. 
In order to retain blood in a fluid state, it is necessary to 
have it defibrinated at the moment it is drawn. The propor- 
tion of solid matter lost in this wray is not great, and if, as 
Virchow asserts, the fibrin of the blood is an excrementitious 
product, only waiting to be removed, the loss is in reality a 
gain. 
The process of defibrinating is understood at all the 
slaughter-houses, where the blood so prepared is known as 
“stirred blood.” 
Seeing how readily the corpuscles as well as the serous 
elements of blood are taken up from the rectum, it appears 
to me self-evident that the material thus added to the cir- 
culation, either directly by capillary absorption, or indirectly 
by way of the lacteals, the receptaculum chyli and the tho- 
racic duct must be more nearly homologous with the blood RECTAL ALIMENTATION. 
17 
than would be the case if any other alimentary substance 
were employed. Nay, we may go farther, and state that it 
is more nearly homologous than some of the products of 
stomach digestion. Chyle, for example, as we all know, is 
a white, milky fluid, widely different in its sensible qualities 
from blood, and very different in its chemical constitution. 
To convert it into living, active blood, requires a process of 
elaboration, the steps of which have never been traced. 
How or where the transformation takes place we do not 
know. But it requires no argument to prove that a slight 
change must be more readily effected than a greater one, and 
that blood which has merely had its corpuscles dissolved 
presents the elements for the formation of living blood in a 
more readily available shape than a fluid so dissimilar as 
chyle, and a fortiori, as milk, eggs, or a solution of meat. 
And here we are brought to the border of an unknown, 
unexplored territory. Libraries have been written on im- 
perfect solution and absorption of nutritive material, but 
what do we know about imperfect conversion of what is 
absorbed into blood ? Under what conditions may it arise, 
what relation may it have with fever, and to what extent 
may it not complicate the diseases which we are called upon 
every day to treat ? As yet we can only conjecture, but 
into the void which exists in our knowledge, we may at 
least project this thought: that the nearer the substances 
absorbed approach to the character of blood, the less chance 
there will be of imperfect conversion into the blood. And 
I fully believe that blood absorbed from the rectum nour- 
ishes the system more directly and more efficiently than if 
the same blood were swallowed and digested in the stomach ; 
for, in the first case, it enters the circulation but little differ- 
ent from the blood with which it mingles, while in the second 
case it becomes chyme—the same as any other chyme, and 
subject to the same conditions of absorption. 
In urgent cases, and especially when the stomach cannot 
be called upon to perform its office, defibrinated blood may 
be injected into the rectum in quantities of from 30 to 90 
grams every two or three hours. For chronic cases, in which 
it is designed merely to aid stomach nutrition, from 90 to 18 
DESICCATED BLOOD FOR 
180 grams may be given once or twice a day. Given at 
bedtime it usually causes no discomfort during the night, 
and there is only the customary evacuation after breakfast 
the next morning. If thought desirable, another injection 
may then be given, the recumbent position being maintained 
for a few minutes, after which, as a rule, there is no con- 
sciousness of anything unusual in the bowel, and the patient 
may go about his daily occupation. Any ordinary syringe 
may be employed, care being taken to cleanse it thoroughly 
each time without delay, lest the valves become adherent 
and fail to act. It is not necessary that the blood should be 
warmed in all cases. Many patients can bear it perfectly well 
without. But if the rectum is at all irritable, it is best to put 
the quantity of blood required into a small tin vessel, and 
set it into warm water until it has acquired about the tem- 
perature of the body. Warming the injection also promotes 
rapidity of absorption, and is therefore important when the 
supporting effect is required with as little delay as possible. 
As bearing upon this point, the following experiments made 
last summer are of interest. I found that 8 grams of fl. ext. 
of rhubarb, in 20 grams of water at a temperature of 22.8° 
C. (73° F.), gave, in sixteen minutes after being taken into 
the stomach, the characteristic red color to the urine on the 
addition of caustic potash. Two trials of the same quantity 
at the same temperature, injected into the rectum, gave 
sixty-five and seventy minutes respectively, as the time 
required to produce the same effect. When the temperature 
of the injection was raised to 42.2° C. (108° F.), the red 
color was obtained in forty minutes, while at a temperature 
of 36.6° C. (98° F.), forty-two minutes were required. 
An important observation bearing upon the absorption of 
enemata was made recently in my service at St. Luke’s 
Hospital. A man with phthisis in the last stage, who was 
receiving every evening an injection of 120 grams of blood, 
died suddenly at 5 A.M., eight or nine hours after the last 
enema had been given. The amount of the injection was 
not sufficient to half fill the rectum, yet at the autopsy Dr. 
Satterthwaite found that the large intestine was very evenly 
lined with a coating of thickened blood, for a distance of RECTAL ALIMENTATION. 
19 
nearly three feet. Since then a case has come under my 
observation in which there is always a gurgling in the de- 
scending colon within a few minutes after the injection is 
received, indicating that the fluid is working its way upward. 
This is important as showing that even a small bulk of fluid 
thrown into the rectum spreads itself over a considerable 
absorbing surface. I am not aware that any other post- 
mortem observation of the character above mentioned has 
been made ; indeed, with the substances usually employed for 
injections, it would be difficult to tell how far up they ex- 
tended, since they could not be readily distinguished by 
their appearance from faecal matter. 
The observation, perhaps, explains a fact mentioned by 
the late Dr. Peaslee, in the discussion upon Dr. Flint’s 
paper, that he had often used the long tube in giving nutri- 
tive enemata, but never found that any advantage resulted 
from carrying the injection into the colon. Of course, it 
would be superfluous to do so if the fluid finds its way there 
of itself within a short time after it is thrown into the rectum. 
As might be expected, there are occasionally inconveni- 
ences attending this treatment, and which may be so serious 
as to compel its abandonment. In the first place, the rectum 
may be so irritable that the injections will be immediately 
returned. This has happened only two or three times out 
of eighty cases, of which I have notes. Again, the injections 
may be retained for a while, but may produce severe colicky 
pains. Both these difficulties may sometimes be met success- 
fully by giving the blood at first in very small quantities, 
warmed, and with the addition of a little tincture of opium. 
The bowel usually becomes more tolerant by habit. 
More or less constipation occurs in perhaps one-third of 
the cases. In a case related to me by Dr. Seguin, he was 
obliged to give up the treatment on account of a very fetid 
odor emanating from the person. This was also noticed in 
one of my cases, but it continued only a few hours. 
In another case, in the practice of Dr. A. E. M. Purdy, the 
patient refused to go on wdth the treatment because, as she 
averred, she tasted the blood. 
In two cases the discharges were so very offensive as to 20 
DESICCATED BLOOD FOR 
cause serious annoyance in the house. One of the patients 
was taking, on his own responsibility, 270 grams (9 ozs.) of 
blood every night. When the quantity was divided and 
half of it given in the morning, the difficulty nearly ceased. 
In one case of ovarian neuralgia, not attended by anaemia, 
nervous irritability and insomnia were produced. 
With these exceptions no cases have come to my knowl- 
edge in which the use of the blood has been attended by any 
ill effects. 
The cases which I have treated, or of which I have notes 
furnished by my friends, cover a pretty wide range of affec- 
tions, in all of which asthenia was a prominent condition, 
and presented the leading indication for treatment. 
Naturally a considerable number of cases (about forty) 
were of pulmonary phthisis. This disease, perhaps more 
than any other, illustrates the reciprocal influence of an en- 
feebled stomach and impoverished blood. Whichever of 
these we regard as the cause, entails the other as its simul- 
taneous effect. The tendency, therefore, must inevitably be 
from bad to worse, unless in some way the stomach can be 
strengthened so that it may afford an increased amount of 
pabulum to the blood, or the blood be enriched so that it 
may impart greater vigor to the stomach. The latter, we 
may hope to do in some measure by calling in the aid of the 
rectum, by which we may effect daily, or more frequently, a 
modified transfusion of rich blood into the circulation. 
But there is also, perhaps, no other disease in which it is 
so difficult to determine the effect of treatment. Under any 
plan the condition of the patient is liable to sudden changes. 
The occurrence of even a moderate haemorrhage will cause a 
considerable loss of weight, which may be speedily regained 
under favorable conditions afterward. The same is true of 
intercurrent attacks of bronchitis, or of circumscribed pneu- 
monia or pleurisy. An unfavorable change in the weather 
will aggravate the cough and wear down the strength and 
flesh, while an interval of warm, dry weather will cause a 
general feeling of improvement and encouragement, and tip 
the scale again the other way. 
Besides, nearly all hospital patients with phthisis improve RECTAL ALIMENTATION. 
21 
during the first few weeks after admission, owing to the 
better hygienic and dietetic conditions by which they are 
surrounded. From all these considerations it is extremely 
unsafe to ascribe to a change of treatment either the falling 
off or the improvement which may follow, unless the relation 
of cause and effect is evident. Still, if the inauguration of a 
new treatment is seen to be promptly followed in some by a 
diminution of night-sweats, in others by an improved appe- 
tite and a gain in weight, in others by lessened cough and 
refreshing sleep, and in others still by a better color and 
reviving strength, we cannot resist the inference that the 
treatment is upon the whole beneficial, although in some 
other cases it appeared to be without result. 
Excluding as carefully as possible the effect of other favor- 
able influences, it seems to me that the use of defibrinated 
blood has resulted in marked benefit in about one-half of the 
cases of phthisis in which it has been tried, while in the re- 
mainder there has either been no improvement whatever, or 
none that could be confidently ascribed to the enemata. The 
test has been a severe one, inasmuch as in nearly every case 
the patient was already upon careful treatment with cod-liver 
oil, stimulants, tonics, quinine, etc., and the use of the blood 
was simply added to these. If, under these conditions, a 
prompt improvement has followed in a considerable number 
of cases, it would seem that a positive step in advance has 
been secured. I should hesitate, perhaps, to claim such re- 
sults on my own unsupported testimony. But they have 
been observed in the practice of others as well as myself, and 
even my cases were for the most part under the observation 
of the House Staff at St. Luke’s. 
Of these, one man in the third stage of phthisis, who had 
been in hospital several weeks, and was constantly losing 
ground, suffered much less from sweating the night following 
his first injection, was entirely dry the third night, had gained 
a pound and a quarter at the end of the first week, and dur- 
ing the month which has elapsed since, has continued steadily 
improving. 
Another, also in the third stage, who had been seven 
weeks in hospital, confined all the time to his bed, gained 22 
DESICCATED BLOOD FOR 
six pounds in weight during the first fortnight after com- 
mencing the treatment, and a pound a week for the three 
succeeding weeks. In this case an extraordinary improve- 
ment of the appetite took place. 
Another patient in the second stage maintained his weight 
while using the blood, but fell off a pound a week for the 
next three weeks after giving it up. 
Another, a female patient, aged 28, entered hospital Sep- 
tember 26th; first seen by me November 1st. Phthisis in 
first stage involving only right apex, but producing extreme 
constitutional irritation. Pulse 120, temperature high, cough 
very wearing, appetite entirely gone. Early in November 
she took to her bed and rapidly lost flesh, color, and strength. 
Her treatment was arranged with great care to meet as far 
as possible every indication, but she steadily grew worse. 
About the first of December she began the injection of de- 
fibrinated blood, daily at bedtime. Within a week there 
was marked improvement. She began to gain flesh, her 
cheeks regained some color, her appetite returned, and her 
strength improved so that she sat up a little each day. The 
improvement continued steadily, and in six weeks she left 
the hospital, still coughing a great deal and with the physical 
signs not greatly changed, but much stouter and with a good 
color, and a fair amount of strength. 
In a case reported by Dr. Bayles to the Therapeutical 
Society, a girl, twelve years of age, with phthisis, used the 
enemata of blood for a period of six weeks, at the end of 
which time the night-sweats had ceased, the patient had 
begun to relish food, the cough had abated, and there had 
been a gain of four pounds in weight. She then went south, 
where she continues to improve in strength and spirits. 
Case reported by Dr. A. E. M. Purdy. A young gentleman, suffering phthisis in 
the second stage, came to this city from his home in Chicago, intending to go from 
here to San Antonio, Texas, for change of climate. He had a diarrhoea supposed 
to be tubercular, which had resisted all treatment in Chicago, and which became 
so much worse while here that he was unable to resume his journey. All the 
means usually employed in such cases were tried by Dr. P. without success. An 
injection of 45 grams of blood was then ordered twice a day, increased the second 
day to 120 grams three times a day. In twenty-four hours from that time the RECTAL ALIMENTATION. 
23 
diarrhoea had ceased and constipation was produced. In five days the patient 
was so much stronger that he started again on his journey. 
Case reported by Dr. O. B. Douglas. Patient, a lady 22 years of age. Tu- 
bercular deposit in upper lobe of right lung. She coughed badly, was greatly 
emaciated, had no appetite, vomited frequently, slept but poorly, and had ex- 
hausting night-sweats. Pulse 132 ; axillary morning temperature 38.7° C.; respira- 
tion 36. December 8, 1878, ordered 90 grams of blood by enema twice a day. 
She coughed less and slept better the night following. December nth, a marked 
improvement in every particular, especially in her relish for food. Increased the 
injections gradually to 150 grams twice, and subsequently three times a day. 
January 13th, the following is noted : 
“ From a state of great nervous debility and mental depression, without a hope 
of recovery, the patient has become hopeful and cheerful, coughs less, sleeps and 
eats better, weight increased five pounds. The discharges seldom show traces of 
blood, and the odor is never more than ordinarily offensive.” 
I have treated quite a number of cases of simple anaemia 
by enemata of blood, and have had excellent results in all 
but one. In this case I suspect that congenital arterial hy- 
perplasia exists, as the patient has been remarkable from her 
childhood for her extraordinary pallor. No treatment seems 
ever to have been of real service to her. 
The other cases were, without exception, strikingly bene- 
fited, and indeed these are precisely the cases to which the 
treatment is, theoretically at least, most applicable. 
In one of my cases, the patient, aged 23, had had a siege 
of ague, lasting several months, which had completely broken 
him down. Anaemic bruit and venous hum were present to 
a typical degree. Chalybeates were purposely withheld, and 
enemata of blood administered twice a day. His color 
rapidly improved, and in a fortnight the bruit and hum had 
entirely disappeared. 
Two other cases in females, both exceedingly well marked, 
were treated by the injections alone, with only an occasional 
dose of medicine to meet some passing indication, and made 
satisfactory recoveries, one of them remaining in hospital only 
thirty-four days. 
The following case is taken from the Transactions of the 
Therapeutical Society, April, 1878 : 
Mrs. S., aged 26, was confined three months ago, and suffered from protracted 
haemorrhage, extending through several weeks. Came under my care March 16, 
187S. Is anaemic to the last degree; face tallowy white, lips almost bloodless; 24 
DESICCATED BLOOD FOR 
pulse ninety-six and very small; can walk but a few steps at a time; has not been 
down-stairs since her confinement; complains of shortness of breath, giddiness, 
and mental confusion; is very despondent; has an absolute disgust for solid food, 
and vomits it if taken; has been living principally upon beef-tea, milk, and lime- 
water. 
Pepsin and simple bitter tonics were prescribed, with little if any benefit. On 
the 19th of March began the use of enemata of blood: 120 grams were taken 
three times a day. Patient retained the injection, the bowels on one occasion not 
being moved for forty-eight hours. 
There was very prompt improvement in strength; within a week she was able 
to go out-of-doors and walk several blocks. The lips and conjunctive regained 
their color, the stomach became less irritable, the vertigo disappeared, and, in less 
than three weeks, the only traces of her illness remaining were some shortness of 
breath when going upstairs and occasional nausea after a full meal. 
On several occasions the use of the blood was omitted for a short time, and she 
immediately felt a decline of strength and spirits. 
This patient had been under the care of a very intelligent practitioner for three 
months before I saw her, and it is fair to presume that the usual means for cor- 
recting anaemia had been employed. While under my care she had very little 
treatment except the enemata, and it seems to me that her improvement is to be 
attributed chiefly to their use. 
A gentleman, aged 68, a Doctor of Divinity, was sent to me in November last 
by Dr. Webster, for a tormenting cough and dyspnoea, for which he had had a 
great deal of throat treatment. I found almost complete obliteration of the right 
pleural cavity, and on inquiry elicited the history of a pleurisy with effusion two 
years ago. 
The lung had been compressed, and was bound by firm adhesion to the spine, 
so that it could not expand when the effusion was absorbed. The chest was 
greatly contracted, and the diaphragm so drawn up that the lower border of the 
liver was nearly on a level with the nipple. The breathing was almost wholly 
with the left lung. The shortness of breath, due to this cause, was increased by 
a profound anaemia, the result of the general derangement of health, so that the 
breathing was between sixty and seventy per minute. The lips and conjunctivoe 
of the lids were white, and there was oedema of the feet and legs. The appetite 
was completely gone, and the patient was in about as wretched a plight as pos- 
sible. Realizing that medicine would do very little toward re-expanding the lung, 
and that the shortness of breath, which constituted the principal discomfort, was 
greatly increased by the watery condition of the blood, I recommended no medi- 
cine whatever, but only a simple and nutritious diet, and an injection of a tea- 
cupful of blood every night. This course he pursued, except that instead of about 
150 grams (5 ozs.), which I meant him to take, he divided the very liberal pint 
which the butcher sent him every second day into two parts, and took in reality 
each night about 270 grams. This quantity was perfectly well retained, but there 
was some fluid blood in the evacuation next morning, and the odor from the de- 
jections pervaded the whole house. He improved, however, and in two weeks 
wrote me that the swelling of the feet and legs was gone, and that the appetite 
was better. A few days later I saw him, and on learning the quantity of the in- 
jections, directed that half the amount should be taken at night and the remainder RECTAL ALIMENTATION. 
25 
in the morning. This did away with the nuisance referred to, and at the next 
report the breathing was better. He gained decidedly in strength for some time, 
and finally determined to stop the injections for a week, and see what the effect 
would be. His last enema was taken Saturday evening, but by the Thursday 
following he was obliged to renew the treatment. His appetite had left him en- 
tirely, and a little food forced down on Tuesday was vomited. He could not 
sleep, his breathing became again very rapid, and the oedema about the ankles 
returned. Wednesday and Thursday he ate nothing but a little gruel. His son 
then interposed, and went himself for the blood, and Thursday evening the 
treatment was resumed. That night the patient slept comfortably, and when I 
saw him on Fxuday morning he had taken with appetite a light breakfast. This 
was four days ago, and I received a card from him to-day, the 18th, saying that he 
slept well last night, and was feeling encouraged. 
Supplemental rectal alimentation ought, theoretically, to 
be useful in dyspepsia, whether atonic or depending upon 
gastritis; in the first case, for the reasons already dwelt upon 
at length, and in the second, as giving to the inflamed organ 
partial rest. A case of atonic dyspepsia treated in this way 
very successfully occurred in my private practice within the 
past few months. The patient, a young man about 22 years 
of age, of rigidly temperate habits, began last spring to run 
down, and soon lost the power of digesting solid food. The 
smallest quantity taken into the stomach brought on vomit- 
ing. He rapidly lost flesh and strength, and his appearance 
was that of a person far advanced in consumption. There 
was a good deal of epigastric pain and tenderness, but the 
pain did not run through to the back, and he had never 
vomited blood. The tongue was pale and but little furred. 
This was his condition when I first saw him in December. 
No medicine was ordered, but he was directed to take a 
teacupful of blood by the rectum twice a day, and to apply 
a belladonna plaster over the stomach. The epigastric pain 
and the vomiting ceased within two or three days, and solid 
food was taken without inconvenience. In seventeen days 
he gained eleven and a half pounds in weight. 
Dr. George Bayles reported recently to the Therapeutical 
Society a case of dyspepsia, in which the vomiting was so 
constant and severe that disease of the pylorus was suspected. 
For nearly nine weeks he was nourished wholly by injections 
of bullock’s blood, only a little claret and water, toast-water, 26 
DESICCATED BLOOD FOR 
or tea with milk, being taken by the mouth. At the end of 
this time it was found that he gained in weight, and he has 
had no trouble since from dyspepsia. 
The following case of dyspeptic asthma occurred in my 
private practice. 
Mr. R., 30 years of age, partner in a coffee-importing house, of weakly frame, 
but possessed of intense nervous energy and a ceaselessly active temperament, his 
attention closely devoted to business, has been for some years subject to frequent 
and severe attacks of dyspeptic asthma, which leave him greatly prostrated. He 
often scarcely recovers from one attack before another comes on. This was his 
condition in the early part of last summer. Whatever good effects drugs may 
have produced seemed to be exhausted. I had tried every possible line of treat- 
ment, and in his frequent business trips he had consulted many other physicians in 
other cities. But with the demands which his business made upon him, it was 
scarcely possible that permanent good could result from any medication. Still, 
with the hope of enabling him better to withstand the wear and tear during the 
hot season which was approaching, I ordered for him injections of blood twice 
daily. He gradually increased the quantity until he had used 480 grms. (1 pint) 
a day. The treatment resulted in a prompt and decided improvement in all his 
symptoms. His appetite, which before was capricious and irregular, became ex- 
cellent, and although he continued at his business through all the hot weather, 
sleeping in town, and taking his meals at restaurants, he gained about eight 
pounds in weight, and enjoyed complete immunity from asthma. Finally, how- 
ever, he got to be troubled with severe constipation, notwithstanding the amount 
of fluid thrown into the bowel daily, and the annoyance from this induced him to 
give up the treatment. Since then he has held his vantage ground in part, but he 
is slowly slipping back into his former condition. 
The following is one of my cases transcribed from the 
records of St. Luke’s Hospital: 
Patient, William T., four and a half years of age, was admitted October 21, 
1878. For five or six months had been running down without assignable cause. 
Examination shows extreme emaciation, ancemia, enlarged liver, veins of abdo- 
men injected, and stomach distended. Ordered : syr. ferri iodid.; ext. of malt. 
November 1st.—Improving in general appearance. 
January 1st.—For some days patient has been vomiting nearly everything taken 
into the stomach. Ordered milk diet. 
January 23d.—Not materially improving, though vomits less frequently. Pa- 
tient weighs 8.5 kilos. (23 lbs.) without clothes. Ordered, enemata of defibri- 
nated beef blood, 60 grms. (1 ij.) t. i. d. 
January 31st.—Weighs 9.1 kilos. lbs.); looking much better; running 
about the ward. 
February 8th.—Weighs 9.44 kilos. (25I- lbs.). Lips red; cheeks filled out and 
rosy; abdomen less distended; and in every way patient looks a healthy child. RECTAL ALIMENTATION. 
27 
If neuralgia is, as Romberg has elegantly expressed it, 
“ the prayer of a nerve for healthy blood,” it should offer a 
promising field for the treatment in question. 
My own experience on the subject is very small and incon- 
clusive. Dr. Bayles, however, has reported to the Therapeu- 
tical Society two cases of inveterate neuralgia, apparently 
inherited, which were greatly relieved in this way. The 
paroxysms were rendered much shorter and less severe. 
Both patients increased in weight, one 1.85 kilos. (5 lbs.) in 
six weeks, and the other 1 kilo, in the same time. 
The following case of nervous exhaustion is from my pri- 
vate practice : 
Patient, a lady aged about forty years. Constitution broken six years ago by 
prolonged ulceration of the rectum and fistula in ano. Has had frequent attacks of 
dysentery since. Last winter was sick for three months with a low nervous fever, 
which left her in a state of extreme debility. She had pain and tenderness in the 
epigastrium, no appetite, insomnia, giddiness, palpitation, tinnitus, and spectral il- 
lusions. Ordered 150 grams (5 ozs») of blood by enema twice daily. This pro- 
duced an immediate effect. The epigastric pain and tenderness disappeared within 
a few days, and sleep and appetite returned. The giddiness and palpitation soon 
ceased, but the tinnitus and spectral illusions continued for several weeks. In a 
month she had recovered so much strength that she could row for a short time 
each day. No medicine was taken. She returned to town in October much im- 
proved in flesh and better than she had been for years. She was then subjected 
to a great drain upon her strength in settling a new house, and in the midst of it 
had one of her attacks of dysentery. This was promptly checked, but it left her 
with many of her former symptoms. She resorted again to the enemata, with im- 
mediate and marked benefit, and in three or four weeks, although surrounded by 
very unfavorable influences, she regained all she had lost. 
The following case can scarcely be called one of supple- 
mentary alimentation by the rectum, since the stomach did 
almost nothing ; but it is introduced here to show the nu- 
tritive value of blood as a material for injections, and what 
may be accomplished with it, with almost no aid from the 
stomach. 
Paulina S., about 18 years of age, patient at St. Luke’s Hospital, entered 
July 22, 1878, with some pulmonary trouble. Soon after developed symptoms 
of gastric ulcer, and was kept for a long time on milk diet. Finally, even this 
was rejected, and for two weeks previous to the first of November she had been 
nourished entirely by enemata of defibrinated blood, ordered by Dr. Wheelock. 28 
DESICCATED BLOOD FOR 
At first she did well, but after a few days began to fail, and when I saw her she 
was apparently moribund. She was in a state of semi-consciousness, lying with 
the eyes half open, the corneoe glazed and the conjunctive injected, the tongue 
dry and the teeth covered with sordes, presenting the appearance of a person in 
the last stage of typhoid fever. The pulse was barely perceptible. She was then 
receiving by injection 90 grams (3 ozs.) of blood every three hours, and 30 
grams (1 oz.) of brandy. On inquiry, it was ascertained that the blood and 
brandy were mixed and injected together, thus causing coagulation of the albu- 
men, and unfitting the blood for absorption. This was corrected, the blood being 
given alone, and an occasional teaspoonful of brandy and milk being administered 
by the mouth. 1 he following day I found an astonishing improvement. Com- 
plete consciousness was restored, the countenance was bright, and there was a 
pulse which, though very frequent, could be easily counted. From this time re- 
covery progressed rapidly. Brandy and milk were allowed in small quantities by 
the mouth, and gradually other things were added, until at the end of two weeks 
she was placed on full diet, and on Dec. nth was discharged cured. 
Case reported by Dr. Hanks. 
Patient, Mrs. B., U. S., age 33 years, mother of two children. Has never 
been rugged, but has generally been able to superintend her household. Has 
always been of a pale complexion, but has had a good appetite, and slept well. 
July 29, 1878—I was called to prescribe for her on account of a profuse and 
long-continued menstrual flow. I found her extremely weak, and apparently 
nearly exsanguinated, with a rapid, feeble pulse of no; temperature, 37.70 C. 
(99°); respiration, 24. A constant flow of thin red blood from vagina. This 
has continued for one week. Her last menstrual flow was also of long dura- 
tion. 
The uterus was found retroverted in the second degree. The displacement was 
corrected, and warm salt-water injections per vaginam were ordered. On the 
following day the flow still continued, and the patient was hardly able to raise her 
head from the pillow without fainting. 
Pulse still rapid and feeble, temperature normal. A liberal allowance of 
brandy was ordered, and aromatic sulph. acid and morphine in small doses. 
August 1st.—Same condition; pulse, 120; temperature, 38.3° C. (101°); 
vomits all food taken; ordered 120 to 180 grams (4 to 6 ozs.) of fluid beef’s 
blood per rectum, three times per day. 
August 2d.—Pulse and temperature the same. Patient looks and feels better. 
Injections have caused no pain or uneasiness. Same treatment to be continued. 
August 5th.—Patient improving, same treatment. 
August 13th.—Has continued the injections of blood until to-day. Has taken 
some food via naturalis, during the week. Has improved steadily during the 
use of the injections. 
I might add many other cases in which the success of this 
method of alimentation has been more or less striking, but 
I will not occupy more of the time of the meeting. I cannot RECTAL ALIMENTATION. 
29 
close better than by quoting from a recent report of the 
Committee on Restoratives of the Therapeutical Society. 
The report concludes as follows : 
“ From the facts before them the Committee feel warranted 
in the following conclusions : 
“I. That defibrinated blood is admirably adapted for use 
for rectal alimentation. 
“2. That in doses of 60 to 180 grams (2 to 6 ozs.) it is 
usually retained without any inconvenience, and is frequently 
so completely absorbed that very little trace of it can be 
discovered in the dejections. 
“ 3. That, administered in this way once or twice a day, it 
produces, in about one-third of the cases, for the first few 
days, more or less constipation of the bowels. 
“4. That, in a small proportion of cases, the constipation 
persists, and even becomes more decided the longer the 
enemata are continued. 
“ 5. That in a very small percentage of cases irritability of 
the bowels attends its protracted use. 
“ 6. That it is a valuable aid to the stomach, whenever the 
latter is inadequate to a complete nutrition of the system. 
“ 7- That its use is indicated in all cases not involving the 
large intestines, and requiring a tonic influence which cannot 
readily be obtained by remedies employed in the usual way. 
“8. That in favorable cases it is capable of giving an im- 
pulse to nutrition, which is rarely, if ever, obtained from the 
employment of other remedies. 
“ 9. That its use is wholly unattended by danger.” 30 
DESICCATED BLOOD FOR 
RECTAL ALIMENTATION IN THE NAUSEA AND 
INANITION OF PREGNANCY—INTESTINAL IN- 
HAUSTION AN IMPORTANT P'ACTOR AND THE 
TRUE SOLUTION OF ITS EFFICIENCY.1 
By HENRY F. CAMPBELL, M.D., 
AUGUSTA, GA. 
The introduction of nutrient materials by the rectum, in 
various conditions of obstruction or of other disability in 
the upper portions of the alimentary canal, has of late been 
somewhat widely discussed. In the present paper, I pro- 
pose to consider it briefly in one of its most obvious ap- 
plications, which, it appears to me, considering the com- 
paratively frequent demand for it, has received but slight 
attention. Neither in recent disquisitions, nor in the refer- 
ences made to it in standard works, do we find more than a 
secondary importance given to rectal alimentation as a re- 
liable means of sustaining life in the dangerous condition 
to which women are brought by the persistent and uncon- 
trollable vomiting of the earlier months of gestation. The 
condition of the patient, in the severer cases, has ever been 
regarded as one for grave consideration. We scarcely ever 
encounter in books, however, any representation which por- 
trays the hopeless suffering of the patient, as it will be found 
in the recollections of any one who may have had the mis- 
fortune to see death by starvation threatening his patient 
and her unborn offspring, while he, with futile efforts, tries 
to stay the progress of the hunger and emaciation which 
seem steadily, day by day and hour by hour, to be taking 
them to the grave. 
I will not delay this meeting with the detail of authorities. 
It is sufficient here to remind the Fellows present that a 
state so hopeless is often enough arrived at, from the nausea 
1 Reprint from the Transactions of the Gynecological Society for 1879. RECTAL ALIMENTATION. 
31 
and inanition of pregnancy, to constitute it, in the minds of 
a large proportion of our profession, one of the very few 
conditions which authorize—nay, which make it the impera- 
tive duty of the obstetrician, to sacrifice the foetus by induced 
abortion, as the only means of saving the life of the mother.1 
My single purpose now is to present “ Rectal Alimenta- 
tion,” as it has been aptly designated, as finding in the 
nausea and inanition of pregnancy a fuller and more frequent 
application than in any of those conditions of stomachic dis- 
ability so frequently discussed, or than has heretofore been dis- 
tinctly recognized by the profession even when treating of the 
measure as an expedient of nutrition ;2 and further, to call 
attention, by an illustrative case, to the efficiency of the 
measure, and to the rationale of its success. In the recent 
discussions of the subject, such as occurred in the New York 
Academy of Medicine last year, most valuable information 
in regard to rectal nutrition in its general application was 
elicited ; and in the communication made by Dr. Austin 
Flint will be found perhaps the largest collection of cases 
to be seen in any one paper. The perfect efficiency of the 
method is there shown. Nutrition was maintained in a 
number of patients, ranging in time from three weeks to five 
years—the majority of them by rectal diet alone ; while in 
others, buccal ingestion constituted so inconsiderable a part 
of the supply as in no way to vitiate the assumption that 
“ life may be sustained indefinitely solely by rectal introduc- 
1 “ The subject of excessive vomiting in pregnancy, involving the life of the 
mother, has recently attracted much attention. In 1852 there was a remarkable 
discussion in the French Academy of Medicine, embracing more particularly the 
question—Is it ever justifiable to induce abortion in cases of excessive vomiting? 
The discussion grew out of a report submitted to the Academy by M. Cazeaux, 
and there was much conflict of opinion on the subject, the ultimate decision being 
of a mixed character. It is conceded that pregnant women have occasionally died 
from the effects of vomiting; there are some striking instances recorded, and I 
am quite sure the unrecorded experience of practitioners could furnish many more 
examples.”—Principles and Practice of Obstetrics, by Gunning S. Bedford, A.M., 
M.D., New York, 1866, p. 671. 
2 Dr. Austin Flint, in a most instructive communication on Rectal Alimenta- 
tion (see American Practitioner, January, 1878), though presenting a list of the 
conditions in which it may be applicable, does not once refer to the nausea and 
inanition of pregnancy. 32 
DESICCATED BLOOD FOR 
tion of aliments.” Suggestions as to its applicability to the 
nausea and persistent vomiting of pregnancy were incident- 
ally made by distinguished Fellows of the Society.1 
In a hasty review of the subject, I find that many authors 
who regard excessive nausea and vomiting as very serious, 
still do not even mention rectal nutriment, while some who 
do refer to it attach little importance to it. Dr. Davis, of 
London,5 says : “It has been attempted to convey nutriment 
to patients incapable of receiving any through the stomach, 
in consequence of its being instantly rejected, by the absorb- 
ents of the skin, by means of rubbing milk, etc. ; more nutri- 
ment, however,” he continues, “ may be introduced into the 
system by clysters.” Its association here with “ rubbing 
milk into the skin ” certainly gives us no very high idea of 
his estimate of the value of “ nutriment by clysters.” 
Moreau says : “ If vomiting be very frequent, it occasions 
pain and an agitation which, in some instances, may oppose 
the progress of pregnancy and produce abortion ; at other 
times it interferes with the nutrition of the woman, and gives 
rise to emaciation and consequent irritability which, in some 
rare cases, may prove fatal.” He gives elaborate directions con- 
cerning medication and nutriment, but does not mention the 
rectal administration of either among his expedients. In his 
discussion of the severer cases, M. Cazeaux devotes an unu- 
sual number of pages to the subject; he dwells at length 
upon the apparent extreme danger of some cases, suggests 
every expedient by which stomachic nutrition may be main- 
tained, and his especial horror—induced abortion3—avoided, 
and yet he does not mention nutrient injections among 
them. Dr. Hodge4 also abounds in remedies and devices to 
arrest the exhausting and distressing symptoms of this com- 
plication of pregnancy, but makes no reference to rectal ali- 
1 Dr. Fordyce Barker and the late Dr. E. R. Peaslee. 
2 Obstetric Medicine, London, 1836, p. 860. 
3 According to his estimate, one in seven is the average of escapes from death 
after the operation. He thinks the most desperate case, as he cites several to 
show, has a better chance on the expectant plan, with such nutriments as can be 
retained, than in the resort to induced abortion. Op. cit., p. 277. 
4 Principles and Practice of Obstetrics, 1866. RECTAL ALIMENTATION. 
33 
mentation. Dr. Elliott,1 however, in the report of a fatal 
case in which the induction of premature labor was practised, 
says: “ Supporting treatment was resorted to by the mouth 
and rectum ; but she steadily lost ground from the date of 
her admission.” 
Leishman2 expresses himself as follows: “In some cases 
where the irritability of the stomach seems merely to be in- 
creased by food and drink, it will be proper for us to sustain 
the powers of nature by nutritive enemata; ” but he, like 
Davis, again lessens our idea of his confidence in the measure 
by adding, “ and, availing ourselves of the probability of 
ingestion by the skin, we may give warm baths to which 
gelatinous matter in any form may be added; or inunction, 
by means of cod-liver or other oil, may be practised.” 
Neither time nor the scope of these remarks will allow of 
further rehearsal of the estimate put by authorities upon this 
expedient. 
I have for many years regarded nutrient enemata as a 
valuable stand-by in all cases in which the ability to take 
food naturally was, from any cause, long delayed, and among 
these have recommended the measure for short periods, in 
the severer cases of gravid nausea.3 In many of these cases 
there was no particular danger of inanition, but the expedient 
was suggested by me to relieve the stomach, and to supple- 
ment for a while the deficiency in its supply of nutriment to 
the system. Among common cases, I can refer to one of 
paralysis in the muscles of deglutition, from diphtheria, where 
rectal nutrition had to be exclusively relied upon for many 
weeks, until the disability subsided ; and another of constric- 
tion of the fauces from traumatic tetanus, in which, though 
fatal, the patient himself (the late George M. Newton, Pro- 
fessor of Anatomy in the Medical College of Georgia) pro- 
posed the operation of cesophagotomy, but was for many days 
relieved of the pangs of hunger and thirst by the ingestion of 
beef-tea and water by the rectum. Another case, which I 
1 Obst. Clinic, 1868, p. 167. 
2 System of Midwifery, 1875, P- 222- 
3 The term “ gravid nausea ” is here adopted for its brevity. 34 
DESICCATED BLOOD FOR 
have not seen referred to in any recent discussion, is that of 
Dr. Marshall Hall, of London. Though suffering from an 
obstructive cancerous affection of the oesophagus, he yet, with 
a noble zeal, continued his labors during many months, in 
which he was physically sustained almost entirely by nutrient 
enemata. 
In my own experience, as I have just said, rectal alimenta- 
tion has not been by any means always applied as a dernier 
ressort in hopeless cases, but as an expedient for supple- 
menting inadequate nutrition by the stomach. An injection 
of beef-tea once daily has been in many cases a preventive 
of that exhaustion and extreme emaciation which I am cer- 
tain would otherwise have resulted. 
But few extreme cases of gravid nausea and vomiting can 
be expected to occur in the experience of any one physician, 
and still more rarely does it happen that the opportunity for 
daily personal observation is afforded throughout the con- 
tinuance of a case. The following somewhat prolonged case 
—over six weeks—is the occasion of the present communica- 
tion, and I shall therefore present in detail the result of my 
observations—more especially such as relate to the suste- 
nance of the patient by rectal alimentation : 
Gravid Nausea—Nutrition maintained for Fifty-two Days by Rectal 
Alimentation alone. 
August 24, 1875.—Mrs. C. M. H., aged about twenty-nine years, had been for 
some time irregularly under my treatment. She had expressed apprehensions 
that conception had occurred. She greatly dreaded the condition, on account of 
the suffering she had endured in a previous pregnancy, which had been marked by 
considerable nausea; but especially did she fear it because her life had been de- 
spaired of from anasarca, at about the fifth or sixth month. At the present time 
she had lost her appetite, vomited nearly everything she ate or drank, and was 
feeble and emaciated, though she had not as yet confined herself to the house. 
On the 28th of August I wras called to see her, and found that she had eaten 
nothing for several days, and that her suffering from nausea was very distressing. 
The pulse was feeble and irritable; though she had taken neither food nor drink, 
I found her vomiting large quantities of a glairy fluid from the stomach. Owing to 
her utter incapacity to take food, and her rapid emaciation, I regarded the case 
with unusual apprehension, and saw at once that I had no ordinary “ morning 
sickness” to deal with, but a case of the most intractable character. Nutritive 
enemata of ordinary beef-tea, with the addition of Borden’s condensed beef, were 
systematically administered from this time. RECTAL ALIMENTATION. 
35 
Her stomach showed such irritability that medicines by the mouth, no less than 
food, were plainly out of the question. Soda-water, champagne, “Potion de 
Riviere,” and oxalate of cerium, had all been tried in vain. I had also applied 
a blister to the epigastrium, without in any degree modifying the symptoms. 
Morphine and atropia were given subcutaneously to quiet nervousness. Sus- 
pecting gravid displacement of the uterus to be the cause, postural pneumatic 
replacement of a moderate degree of retroversion was readily and repeatedly 
accomplished, but no relief afforded. Finding that leucorrhea was profuse, I 
decided on a specular examination, hoping to discover in the condition of the 
cervix some adequate excitor of the exaggerated hystero-neurosis of the stomach.1 
From some circumstance this lady’s husband and his family had acquired some 
vague knowledge of induced abortion as a “sure and safe expedient for the relief 
of the nausea of pregnancy,” and before I had myself admitted so despairing an 
idea, it was urged upon me by them with much persistency. I now requested 
considtation with Professor Joseph A. Eve, for, though she retained all the rectal 
nutriment, and also water administered two or three times a day in the same way, 
the nausea was but little abated. Small lumps of ice or teaspoonfuls of water, 
when taken to relieve the unpleasant taste in the mouth, often caused her to 
vomit half a basinful of the glairy fluid secreted by the stomach, sometimes mixed 
with bile and often with bluish flocculi. I desired that Dr. Eve should be present 
at the specular examination, so that in case abortion were determined on—which 
I did not favor—the process might be begun at that time. 
September 20.—Examination detected general redness and tumefaction of the 
vagina and cervix. There was a large collection of leucorrhoeal fluid in the specu- 
lum. We at once discovered a considerable superficial but well-defined ulceration 
near the os. The edges of the ulcer were somewhat ragged, and the surface was 
covered with a whitish curd-like deposit, through which red bleeding granulations 
could be seen. This erosion encroached somewhat upon the external os, occupy- 
ing one side of the canal to a slight extent. Dr. Eve and I both abandoned even 
the slight idea we had entertained of induced abortion, feeling assured that in this 
angry and irritable erosion we had discovered the cause of the nausea and vomit- 
ing, as confidently asserted by Dr. Henry Bennett to be the invariable provocative 
in nearly all cases. 
This surface was freely cauterized with the solid nitrate of silver; but, I am 
sorry to say, with no perceptible immediate effect upon the reflex gastric pheno- 
mena. 
Besides the repetition of the blister over the epigastrium, the expectant plan, 
with, if possible, a more regular and systematic application of the rectal nutri- 
ment, was the result of our conference. The failure of cauterization and the 
continuance of the gastric distress, though I felt confident of her pretty satis- 
factory well-doing upon rectal alimentation alone, caused the family again to urge 
1 “ I am persuaded,” says Dr. Bennett, “that those gastric disorders and ob- 
stinate vomitings which so often bring women to the portals of the tomb are 
almost always caused by inflammatory ulcerations of the neck of the womb.” 
“For my own part,” he adds, “since my attention has been directed to the 
subject, I have almost invariably found ulceration of the neck in cases of this 
kind.” 36 
DESICCATED BLOOD FOR 
the measure of induced abortion. Prof. L. A. Dugas was now added to the con- 
sultation. 
September 26.—The patient had for some few days past vomited less of the 
fluid secretion—she had not pretended to take either food or drink—and appeared 
more comfortable. She had always retained the rectal nutriment without difficulty 
—seldom requiring the addition of any opiate, as at first. She was somewhat 
more cheerful than heretofore, though she could not sit up a moment without 
retching. On examination with the speculum, the erosion was found in a healing 
condition, and it was decided not to repeat the application of nitrate of silver. 
Tepid injections of water were daily applied per vaginam. The measure of in- 
duced abortion was fairly considered, but there was no disagreement as to its re- 
jection—especially as we had some reason, though there was neither motion nor 
foetal heart-sounds perceptible, to believe the foetus to be alive. The very large 
percentage of fatal results from the measure under the circumstances of our case 
was, of course, the more cogent reason determining us to adhere to the expec- 
tant plan and to depend upon rectal alimentation. We all agreed that the 
evidences of an adequate nutrition by the rectal introduction of food were amply 
sufficient to warrant us in relying upon it to secure her from any danger of fatal 
inanition. 
October 4, 10 a.m.—From August 25th to the present time, Mrs. H., though 
frequently distressed with nausea and unwilling, and, I believe, unable to take the 
smallest amount of nutriment or drink without provoking immediate vomiting, 
improved in color, increased apparently in flesh and strength, slept well, being 
scarcely ever awakened by the gastric disturbance. She was also more cheerful, 
but said she feared she should always be obliged to take her food in this unnatural 
way. “She never expected to eat again.” 
October 4, 4 o’clock, r.M.—At this hour Mrs. H. began to complain of lumbar 
and uterine pains. Being sent for, I found abortion in progress, though at my 
morning visit there had been no such indication; the os uteri was well dilated ; 
there was no sanguineous flow. A dead foetus of three and one-half months was 
soon easily expelled. The womb apparently contracted well. 
Contrary to all our expectations and hopes, we found that the nausea was in no 
degree abated by the evacuation of the uterus. In reflecting upon this case sub- 
sequently and from the appearance of the foetus, I have concluded the latter must 
have been dead for some time previous to expulsion. The continuance of nausea 
before the abortion w'as one of our grounds for supposing the foetus to be alive; 
but all the circumstances, as developed subsequently, rather militate against this 
supposition. 
According to memoranda carefully kept by her husband, Mrs. H. continued to 
be distressed with nausea and to be nourished solely by the enemata for fourteen 
days after the expulsion of the fetus, and for a much longer period this had to be 
continued as supplementary to her very gradually returning power to take and 
retain food by gastric ingestion. 
During this time she improved rapidly in flesh and in color. We at this time 
added a solution of tartrate of iron and potassa five grains, quinine five grains, 
and sometimes stimulants to the nutrient injections. RECTAL ALIMENTATION. 
37 
Method of Rectal Alimentation in the above case. 
By reference to the note recording the beginning of rectal 
nutrition in this case, it will be seen that on the 27th of 
August, in order to inaugurate properly this method of nu- 
trition, I began by administering the first enema in the 
presence of the attendant. This consisted of beef-tea or 
beef-essence. For gastric ingestion this fluid is skimmed 
and decanted, so as not to offend the taste of the patient by 
the oil or the sediment, the clear fluid only being given. In 
my use of it for rectal administration, the settlings and also 
the oily particles are retained, in order to render the inges- 
tion more nutritious. In addition to the beef-essence, I 
added to each injection of eight ounces one teaspoonful of 
Borden’s, or Liebig’s, or sometimes Valentine’s, condensed 
preparation of meat. 
There are various opinions as to the nutrient properties of 
ordinary beef-tea, and therefore the condensed preparation in 
some of the above forms was always added to insure a double 
chance that our rectal food should possess adequate nutrient 
elements. Other articles were at times added, such as rice- 
water, arrow-root, jelly, gruel, etc., blanc-mange, custard, 
whipped cream, etc., and used as found convenient, but al- 
ways with the beef-tea strongly made. 
On the application of the first injection—an ordinary tum- 
blerful of beef-tea—there was some tendency to evacuation, 
continuing but a short time, when the bowel was rendered 
tolerant by a pressure against the levator ani. 
Notes on the Process of Administration. 
The mixture above described was that ordinarily used in 
the case. A large gobletful—at least half a pint—perhaps 
ten ounces, was injected twice daily. The propulsion of the 
fluid was very slowly and gently made till the vessel was 
entirely exhausted. By care in excluding the air, there was 
seldom any danger of losing an enema, large as they were, 
and I cannot remember a single occasion during the treat- 38 
DESICCATED BLOOD FOR 
ment in which an entire injection was lost. In addition 
to the nutriment thus given, the drink of the patient was 
represented in the rectal administration of water with or 
without the addition of wine or brandy, as appeared suit- 
able to the condition and feelings of the patient. During 
the interval of the morning and evening injections a full 
goblet of water, not quite cold, was twice given, some hours 
apart. 
In addition to the records above presented, such as the 
generally beneficial effect of the rectal ingestion of food, etc., 
there are certain observations which I have reserved for 
separate mention, intending to discuss but one of them at 
any length. 
First.—That the rectal aliment seemed always, as has been 
observed in other reports of cases, to relieve the patient of 
the feeling of hunger and “ sinking ” in the epigastrium which 
often marks prolonged abstinence, and from which she some- 
times suffered when the injection was delayed. The injec- 
tion of the water, often called for by the patient on account 
of the dryness of the mouth and fauces—increased, I sup- 
pose, by the atropia and morphine—also relieved her thirst 
promptly, as well as the dryness in the mouth, for hours at a 
time. 
Secondly. — The alvine discharges were quite natural—“ fig- 
ured passages,” though by no means regular; they generally 
occurred once, or at most twice, during the week. In no in- 
stance that they were examined was there found any trace of 
the articles used for nourishment. The discharges were, 
when iron was not used, properly colored with bile, and al- 
ways solid. The amount of faecal matter passed was much 
less than the average of health. 
Thirdly.—The urine, which was not tested, either as to its 
specific gravity or its constituents, was somewhat less, I 
should think, than that of health, generally of rather a pale 
amber color, but sometimes dark and reddish. There was 
no irritability of the bladder or vesical mucus. The large 
quantity of fluid sometimes vomited may possibly have caused 
a diminution in the amount of urine. 
Fourthly—Intestinal movements.—For a very large portion RECTAL ALIMENTATION. 
39 
of the time during which this patient was under treatment, 
emaciation was extreme, and the abdominal wall very thin, 
thus affording the best possible opportunity for observing the 
effect of the introduction of aliments upon the intestinal 
canal. On the completion of the injection, more or less 
gurgling within the abdomen, and some obscure movements 
of the intestines, were often perceptible. At first this was 
regarded as an indication that the nutritive enema was pro- 
voking peristaltic action, which might cause it to be expelled. 
On several occasions I inquired of the patient if she felt any 
uneasiness indicating the loss of the injection. Her answer 
at first surprised, but also satisfied me as to the perfect safety 
of the retention : “No, doctor; that sound and movement al- 
ways follow the enema; they are sometimes perceived at once, 
and sometimes later, but I always feel easier after that rum- 
bling takes place. I think it is the beef-tea going up into 
my bowels, for, after that, I never feel any disposition to pass 
it off.” Daily personal observation fully convinced me of 
the fact that the movement was an upward one. It continued 
sometimes for more than an hour in a less obvious manner, 
as was noted by the patient and an intelligent relative in 
constant attendance. “ Upon this hint I speak,” for upon 
this observation, and the interpretation I hope legitimately to 
give it, mostly depends the principal value of the case, in the 
discussion of the rationale of rectal alimentation. I shall 
refer again to it as the evidence of reverse peristalsis, or, as 
I would prefer, retro-stalsis, which, as will be seen hereafter, 
I can but regard as a most important, though heretofore un- 
recognized factor in the efficiency of all the devices for rectal 
feeding. 
Mr. President—It has been neither for the purpose of 
reporting a case of but moderately prolonged sustenance by 
rectal nutrition, that I have presented this paper to the So- 
ciety ; nor as a mere novelty have I detailed the phenomena 
as observed by me for over seven weeks. There are on 
record, as we have seen, many cases affording equal, and 
some of them much more striking proofs of the adequacy of 
rectal alimentation to sustain life over protracted periods of 
time. Three months, twelve months, three years, and even 40 
DESICCATED BLOOD FOR 
five years,1 have passed during which persons have been 
nourished by food introduced solely from this direction. 
These were cases in which, as in my own, there was no other 
possible avenue by which pabulum could find access to the 
blood. My object has been far different, and my endeavor 
more comprehensive. I have desired to present certain rela- 
tions in which, in this case, I have been afforded the oppor- 
tunity of studying phenomena that might transpire unob- 
served and uninterrupted during years of successful rectal 
feeding. I desire to awaken the interest of others—to elicit 
impartial discussion upon the obscure and heretofore little 
explored field of research that pertains to the physiology or 
rationale of rectal nutrition. 
The little importance attached to this method of ingestion 
until a very recent date, has, I think, been principally due to 
two prominent causes, or rather methods of reasoning upon 
the subject: , 
First.—As the rectum and even the colon are comparatively 
devoid of lacteal vessels, much incredulity exists as to their 
power of absorbing and carrying to the blood aliment in any 
degree adequate to the sustenance of life. 
Secondly.—Even were the rectum abundantly possessed of 
lacteals, and endowed with the most active powers of lacteal 
as well as of venous absorption, neither of these modes of in- 
gress could be utilized, on account of that thorough disinte- 
gration and solution, so indispensable to nutrient absorption 
and assimilation, being entirely deficient in the absence of 
those chemico-vital “ digestive fluids''—the gastric juice, the 
bile, the pancreatic juice, and, perhaps, the secretions of the 
small intestine, so necessary to the solution, attenuation, and 
proper elaboration of alimentary matters preparatory to their 
absorption into and admixture with the blood. 
I have thus enumerated but two of the more common and 
obvious objections that have been made (though I do not 
know that they have been anywhere formulated) to rectal 
1 Most of these will be found referred to in the discussion before the New York 
Academy of Medicine, and given more fully, perhaps, in Dr. Flint’s paper, 
“Cases Illustrative of Rectal Alimentation, with Remarks,” in the American 
Practitioner for January, 1878. RECTAL ALIMENTATION. 
41 
assimilation and absorption. I fear, however, a more ex- 
tended examination of the intimate structure of the lacteal 
absorbent apparatus—of the essentials to, and modus of, 
lacteal and venous absorption as they are effected in the 
villi, showing each one to be a highly organized and elabo- 
rately constructed absorbent gland, so to speak, with a portal 
radicle and lacteal ramus in its centre ; these also thickly 
studding the mucous membrane down to the ileo-csecal valve, 
where they abruptly disappear; and finally, the extent of 
this mucous membrane greatly increased by valvulae conni- 
ventes to retard the progress of the chyle, and to offer sur- 
face and facility for the double absorption of the prepared 
fluid. I repeat, I fear that such a study would rather in- 
crease than relieve the difficulties of faith in regard to rectal 
assimilation and absorption. Such considerations would be 
calculated to cause the direct entry from the rectum into the 
blood of composite and unelaborated aliments, to be re- 
garded by many as a physical impossibility and a physiologi- 
cal absurdity. This is the apparatus, however, and such as 
briefly sketched are the conditions upon which intestinal di- 
gestion and absorption depend.1 Now, in nearly all of these 
requirements the large intestine is totally deficient, though 
it has a most abundant supply of portal radicles. By these, 
water and thin solutions of nutriment are most undoubtedly 
absorbed and carried into the portal circulation for hepatic 
digestion, and for distribution thence to the system.2 “So 
long ago as 1824,” says Murchison, “it was shown by 
1 F. W. Pavy: Treatise on the Functions of Digestion: its Disorders and 
their Treatment, p. 170. From Second London Edition. Philadelphia, 1869. 
2 In some experiments on a case of large artificial anus, by Dr. William Hunt, 
it was found that bits of meat placed in the colon or caecum had no digestive effect 
produced upon them. Medicines placed in the caecum and colon were inert. It 
was concluded that neither the caecum nor colon had any digestive power whatever. 
—Pennsylvania Hospital Reports, vol. ii., 1868. 
In a paper by Prof. Joseph Jones, of New Orleans, published by the Smith- 
sonian Institution, that distinguished physiologist gave his experiments on various 
animals to determine the influence of starvation upon sanguification. In the 
American a gopher,” large masses of grass and other crude nutritious matters, in 
the colon of this chelonian, seemed to keep up nutrition and sanguification, the 
colonic deposit serving as a store of nutrition to prevent emaciation. 42 
DESICCATED BLOOD FOR 
Magendie and Tiedemann that the absorption of nutritive 
matters from the bowels was not limited to the lacteals, 
but that part was taken up into the blood by the portal 
vein,” 1 etc. 
Then, notwithstanding the simplicity of its structure as 
compared with that of the mucous membrane of the small 
intestine, there can be little doubt of the capacity of the 
rectum to absorb a considerable variety of substances—as 
medicines and also aliments—and to furnish, it may be, a 
moderate supply to support nutrition through vascular and 
membranous absorption. A method of food-ingress, by 
which the entire vegetable kingdom and the invertebrate 
department of the animal kingdom 2 are supplied from the 
external world, must, with logical certainty—as it has been 
by experiment demonstrated—be retained by man and the 
higher vertebrata, notwithstanding their additional endow- 
ment with lacteals and an elaborate special apparatus for the 
absorption of external aliments. I think we may believe, 
then, that a very considerable portion of the aliments enter- 
ing the system from food placed in the rectum is quite often 
taken in by venous absorption through the portal radicles, 
whence it is carried to the liver for digestion,3 blood-mixture, 
and blood-making. But that this is the tinly avenue, or 
that it is through this channel of the rectal blood-vessels 
that the most abundant supply of rectal pabulum is carried 
to the blood, I think may be denied with the most positive 
confidence, and its converse established by irrefutable dem- 
onstration, as it will in time be by actual experiment. 
1 Op. cit., p. 8. 
2 “ The proper absorbent system is exhibited in its most simple and diffuse 
form in fishes, the lowest class in which its existence has been demonstrated.” 
—Principles of General and Comparative Physiology, by W. 'B. Carpenter, 
p. 661. 
3 Dr. Murchison, in his Croonian Lectures, says that “in the first half of the 
seventeenth century the liver was the centre of sanguification,” and he strongly 
advocates its reinstatement to that position, now that the modern advances in 
physiology confirm that view. RECTAL ALIMENTATION. 
43 
Intestinal Inhaustion. 
There is, in my opinion, as I have already intimated, 
another, which is by far the most important method by 
which the solution, elaboration, assimilation, absorption, and 
final introduction of rectal food into the body is vastly pro- 
moted. It is the one first suggested to me by the observa- 
tion and study of the case, the report of which I have made 
to-day ; but the force of the conviction, at that time im- 
pressed, has been strengthened by reflection, and more 
especially by innumerable observations of daily experience 
which have borne directly upon it. This valuable adjunct 
and promoter of rectal alimentation, the existence and value 
of which I hope plainly to show, depends upon what has 
been variously termed by different writers “ reversed peri- 
staltic action ”—“ inverted peristalsis”—and by Copeland and 
Pavy, and perhaps many others, “anti-peristaltic action” of 
the muscular coat of the intestine. I prefer to change these 
terms to one more directly indicating the result, more sig- 
nificant of the part it plays as auxiliary to rectal feeding—I 
shall define this well-known action as “ Retro-stalsis.'" 1 I 
hope to show that by it the nutrient materials injected into 
the bowels are, in a shorter or longer time, carried up out of 
the rectum, and made to reach the portions of the digestive 
canal, where all the conditions of normal intestinal digestion 
may be fully met, and where, on account of it, the process 
can be as effectually accomplished as though the aliment 
had arrived there by buccal instead of by rectal ingestion. 
This process, or function, or vital action of co-ordinated and 
continuous retro-stalsis, is to the rectum and small intestines 
what deglutition is to the oesophagus and stomach. For the 
want of a more appropriate designation, I propose that it 
shall be called “ INTESTINAL Inhaustion.” 
No physiologist of the present day, however fully im- 
pressed with the wonderful capabilities of venous and mem- 
1 From retro, “backward,” and (tteAAco, “I send.” “ Prostalsis,” from irpi, 
“ forward,” and <rreXKoo, “ I send,” is also proposed as another term briefly indicat- 
ing the direction of intestinal action. 44 
DESICCATED BLOOD FOR 
branous absorption, can feel perfectly satisfied that these 
alone and without the intervention of some other factor 
wanting in the rectum, can rationally and adequately ac- 
count for the success and apparent perfect efficiency of rec- 
tal alimentation as reported in journals, and here and there 
in some works on practice.1 Especially is our ingenuity 
taxed in the presence of such cases as those discussed before 
the New York Academy of Medicine, and in the recent col- 
lection by Dr. Flint.9 If absorption could account for the 
disappearance of the injected pabulum from the rectum, and 
the sustained nutrition of the patient, how are those indis- 
pensable prerequisites to the introduction of food into the 
blood, viz., digestion, solution, homo-genification, peptonifi- 
cation, to be accounted for in a cavity devoid of every one 
of the digestive principles requisite to accomplish these 
acts, and also unprovided with the secretory apparatus by 
which only they could be supplied ? In a question of 
such perplexity, as it is both interesting and instructive, 
I will quote, without much comment, the language of Dr. 
Flint (who, of course, recognizes no digestion as taking 
place, per se, in the large intestine) in dealing with this 
dilemma : 
“ With reference to this inquiry (about articles of rectal 
diet), I cannot pass by the physiological question, How is 
digestion in the large intestine effected ? From its failure 
to procure from the mucous membrane of the colon and 
rectum a digestive juice, and from experiments on lower 
animals, physiologists have been led to doubt the ability of 
these portions of the alimentary canal to perform the func- 
tion of digestion. Yet secreting glands analogous to those 
of Lieberkuhn are found in considerable numbers in the 
large intestine, and it is not difficult to understand that they 
may take on a vicarious activity when the glands of the 
stomach and small intestine are not excited by the presence 
1 Leube denies the possibility of rectal nutrition, unless the food has been first 
artificially digested. Pancreatic emulsion, prepared by him for the use of dis- 
abled stomachs, has been used by Flint and others as rectal food.—Ziemssen's 
Cyclop., vol. vii. 
2 Loc. cit. RECTAL ALIMENTATION. 
45 
of ingesta. This supposition is not inconsistent with the 
absence of digestive juice in the large intestine when di- 
gestion in the stomach and small intestine is not inter- 
rupted.” 
So indispensable does the admixture and modifying influ- 
ence of the digestive fluids of the small intestine very pro- 
perly appear to Dr. Flint,1 that, in addition to the ingenious 
though scarcely admissible suggestion of their supply by 
vicarious secretion in certain minute glands of the large in- 
testine, he advances still another possible method by which 
the digestive chemistry (which by these fluids can alone be 
effected) is to be secured to the alimentary mass to be 
assimilated in the large intestines. He thus clearly enun- 
ciates his second proposition : “ Another supposition which 
I will venture to make is, that food introduced into the 
rectum excites secretion by the gastric and intestinal glands, 
and, in the absence of ingesta in the stomach and small 
intestine, the fluids secreted by these glands pass into the 
large intestine in sufficient quantity to effect digestion within 
the latter.” 
I have already defined the method by which I account for 
the digestion, absorption, and assimilation of food when 
placed in the rectum. It is this—differing from all others 
with which I am acquainted—that digestion in either rectum 
or colon is not at all contemplated : neither by direct absorp- 
tion on the part of the walls and vessels of these cavities; nor by 
the means of artificial digestive principles added to the food, 
after the manner of Leube ; nor by the glands of the large in- 
testine vicariously secreting the digestive fluids of the small 
intestine ; nor, lastly, by the alimentary mass in the large 
intestine exciting the secretions of the stomach and small 
intestine, and then attracting or in some way acquiring them 
in order that rectal digestion may take place. My pro- 
position is distinctly the reverse of this last, and asserts that, 
1 A Fellow of this Society—Dr. J. R. Chadwick, of Boston—proposes, in des- 
perate cases, to inject with the aspirator through the abdominal walls nutrient 
fluids and stimulants into the small intestine, “ that part of the alimentary canal 
from which they will be most readily absorbed.”—Am. Jour. Obst., viii., 399, 
November, 1875. 46 
DESICCATED BLOOD FOR 
instead of the digestive principles descending to the food to 
digest it, the food ascends to these fluids in the small intes- 
tine, and that it is there digested and prepared for absorption 
by the proper organs in precisely the same manner as after 
buccal ingestion. 
Facts of Observation. 
In substantiation of the important proposition thus enun- 
ciated, there are many facts both of observation and experi- 
ence which will give support to my belief. Let us examine 
some of these facts. 
ist. By the investigations of the majority of the physiolo- 
gists (see Flint’s 11 Text-book of Physiology” and others) the 
rectum is not a receptacle for the faecal mass, but an avenue 
of transmission. It is intolerant of the presence of faeces, 
expelling them downward naturally when convenient, but 
contracting, and returning them into the colon if their exit is 
prevented. Gynecologists, by their daily examinations in 
the vagina, are familiar with the fact that the rectums, even 
of women of torpid habits, are comparatively seldom found 
loaded with fasces, but empty, and flattened between the 
vagina and sacrum. 
2d. Faeces descend and reascend easily from the rectum to 
above the sigmoid flexure of the colon. In persons of regu- 
lar habits the desire for defecation indicates the presence of 
fasces in the rectum. If the opportunity is lost, they reascend 
to the colon, remaining perhaps for many hours, or even a 
day, before descending to the rectum to provoke again the 
desire for evacuation. Unquestionably, food, such as beef- 
tea, injected into the rectum, even by the shortest pipe of a 
syringe that can be used, must soon disappear like the faeces, 
by ascent above the sigmoid flexure of the colon. “ I will 
give one caution,” says Allingham—“ Diseases of the Rec- 
tum,” 1873 : “ if you wish to let the bougie remain in the 
rectum all night, take care to secure it by a tape. I have 
seen a short bougie pass up into the bowel above the stricture 
out of reach, and considerable difficulty was experienced in 
removing it.” RECTAL ALIMENTATION. 
47 
3d. Injections of a quart or more (as are often given) 
certainly more than fill the rectum, and, therefore, must 
ascend by the muscular contractility of the rectum quite 
easily into the colon, thus showing that food can be pro- 
pelled upward in the same manner; we can seldom recover 
more than a small part of any injection (even one far short 
of distending the rectum), from the fact that it passes up- 
ward into the colon. Large injections often excite the 
passage of faeces, and yet the fluid used remains, none at all 
passing away. 
Mrs. S. W., aged about 40 years, under the care of Dr. I. L. Harris, of 
Milledgeville, Ga., was the subject of a large ovarian tumor. Ovariotomy was 
performed by the late Dr. W. L. Atlee, of Philadelphia. Excessive vomiting 
succeeded. Rectal alimentation was diligently attempted. “None of the beef- 
tea escaped per anum, but it was constantly, for several days, vomited from the 
mouth. The vomiting of the nourishment was pi-eceded by stercoraceous vomit- 
ing, but afterward the beef-tea came up almost clear and entirely unmistakable, 
as satisfactorily proved by chemical tests.” Dr. Atlee, in his reply to the letter 
of Dr. PI arris, reporting this feature of the case, wrote that he had observed a 
similar occurrence “ from inverted peristaltic action,” in one or more of his former 
ovariotomies. 
4th. In an extreme case of non-gravid nausea, under the 
care of Dr. J. B. Ficklen, of Washington, Ga., I found it 
impossible to prevail upon the patient to continue nutritious 
enemata. She complained that in vomiting she invariably 
tasted the beef-tea that had been injected, in the matters 
discharged from the stomach. 
5th. It is known that fluids have been forcibly injected 
through the colon, “ and even made to gravitate slowly 
through the ileo-caecal valve along the whole track of the 
small intestine into and through the stomach, and even out 
of the mouth The feasibility of this was long ago,” 
says the recent author,1 “demonstrated by the illustrious 
Haller,”—“ Prime Lineae Physiologic,” 1767. We are 
aware that a distinguished Fellow of this Society, Dr. Robert 
Battey, of Georgia, has accomplished the same feat, but can- 
not now lay hands upon his valuable paper. 
1 Essay on Rectal Medication, by W. Bodenhamer. New York, 1878. 48 
DESICCATED BLOOD FOR 
Some of the above instances will show that, under efforts 
made by mechanical means forcibly applied, in all instances 
the way is clear for the gradual passage upward—less natu- 
rally and with less facility than downward, of course—for 
the ascent of liquids from the rectum and large intestine 
even to the upper termination of the alimentary tract. Of 
course, in the propulsion onward and upward of the fluid 
in these cases, reverse or retro-staltic action, and not in 
all of them the first mechanical force of the instrument 
used, will be recognized as an agent in the progression of 
the fluid. 
But, as I am discussing retro-stalsis as a dynamic act in its 
agency in the upward movement of the injected food, upon 
which movement I have claimed that its digestion and 
absorption depends, and, therefore, upon it also the success 
of rectal alimentation, I will briefly refer to a few more 
facts of common observation sufficiently analogous in char- 
acter to show the possibility of intestinal inhaustion. There 
is no section of the alimentary tract which may not be 
shown in certain conditions, and under certain influences, to 
perform retro-staltic acts capable of propelling upward its 
contents. 
1st. “ Gagging ” is an action of the faucial muscles which 
reverses that part of the act of deglutition in which they are 
concerned. 
2d. Vomiting, regurgitation, rumination (Copeland—Pavy), 
and several acts of this class, concern both the oesophagus and 
the stomach. The contents, both solid and fluid, ascend, be- 
ing forced up into the mouth and out of it. 
3d. The familiar phenomenon of the ascent of bile into the 
stomach indicates inhaustion between these two portions of 
the alimentary canal. ; 
4th. Chylous vomiting (Pavy) is inhaustion from the small 
intestine, the result of a reversal of peristalsis. 
5th. The stercoraceous vomiting in ileus and in strangu- 
lated hernia, and in a few other conditions of serious intestinal 
disturbances, in which the matters are fluid, semi-fluid, and 
solid, tells its own history, and we know the journey it has 
taken, and that it must have passed through the ileo-caecal RECTAL ALIMENTATION. 
49 
valve.1 Here is intestinal inhaustion, the very inhaustion we 
claim as the indispensable factor in all effectual rectal ali- 
mentation. It must invariably occur when rectal nutrition is 
accomplished. The remaining portions of the canal have 
already been referred to. 
6th. The ascent of the faeces under restraint of the sphincter 
ani, in which the solid mass, as before stated, ascends above 
the sigmoid flexure ; the ascent of enemata filling the colon 
when injected only within the sphincter. 
We have seen, then, that every section of the intestinal canal 
is at times subject, under circumstances generally of irritation 
or disturbance of various kinds, to inhaust or receive from 
below the contents of the section continuous with it. That 
which is so familiarly and demonstrably true as pertaining to 
one and all of the parts of this alimentary canal may certainly, 
under similar circumstances, be predicated as pertaining to 
the whole. Then this upward movement, continuously main- 
tained from the rectum to the small intestine, is what I would 
designate as the intestinal inhaustion subservient to rectal 
alimentation. 
Experimental Research. 
Although, in the foregoing enumeration of observed phe- 
nomena, a logical demonstration of the existence of intestinal 
inhaustion, convincing to most minds, may have been arrived 
at, I have yet sought to give to it the confirmation of actual 
experiment. Experiments in rectal feeding on the lower ani- 
mals have been made, I think, by Leube, and perhaps others, 
but simply to test its efficacy, and also the nutritive power 
of certain rectal aliments. My present effort had no such 
object in view. It was made solely to establish the fact of 
the upward progression of injected aliments, from the rectum 
to the small intestines, by retro-staltic action. By the sug- 
11 am aware that Bointon (see Pavy) has denied that there is any such thing as 
a reversal of peristaltic action. He describes a downward current that always 
exists and that is never reversed, while the phenomena of stercoraceous vomiting 
depend upon a central current. Well, then, the rectal food ascends by way of 
this “central current.” 50 
DESICCATED BLOOD FOR 
gestion of intestinal inhaustion and its experimental demon- 
stration, I hope to “cut the Gordian knot ” of rectal alimenta- 
tion. 
Some carnivorous animal, as the dog, with a short alimen- 
tary canal, would certainly have been more suitable as a sub- 
ject for an experiment in intestinal inhaustion. I could not, 
it appears to me, have made a more unfortunate selection 
than that of a ruminant. 
Rectal Feeding of Kidfor Eighteen Days with Colored Aliment. 
September 2, 1878, 2 o’clock, p.m.—Subject, a suckling kid, six weeks or two 
months old. Injection after twenty-four hours’ privation of food. Instrument, 
a piece of No. 8 gum-elastic catheter, five inches in length, attached to an India- 
rubber bulb of Mattson’s syringe. I injected three ounces of rich milk, deeply 
colored with a decoction of madder and solution of cochineal. Result : nearly all 
of the milk was immediately expelled, together with a large dejection of the faecal 
scybalae peculiar to the defecations of the sheep, goat, and some other animals. 
Nine o’clock, p.m.—The injection was repeated after the same manner, and 
retained. 
September 3, 10 o’clock, a.m.—I injected three ounces of colored milk. De- 
fecation immediately; nearly all of the fluid lost. Injection of two ounces was 
repeated in thirty minutes, and retained. 
Three o’clock, p.m.—Injection of two ounces of colored milk; no defecation; 
enema retained. 
Ten o’clock, p.m.—Injection repeated—two ounces; retained. 
A detail of the processes and occurrences of our prolonged experiment would be 
but tedious and without interest. The process, as detailed for the first two days, 
was continued for eighteen days, till the 20th of September, when the kid was 
killed by prussic acid dropped upon the tongue. The intervals of administration 
of the colored fluid were from three to five hours. The defecations became less and 
less frequent, and when a single bulbful was injected the fluid was generally retained. 
A small amount of corn-meal was mixed with the milk for the last five days. The 
kid was also given, two or three times during the experiment, a small handful of 
apple-peelings and some bread, to lessen hunger. The experiment was not in- 
tended or conducted in a manner to test the efficiency of rectal feeding to sup- 
port the kid’s nutrition. It retained its activity and strength, however, in a sur- 
prising degree. As to the effect of the injections in relieving hunger or thirst, it 
was difficult to decide. The animal certainly made less noise by its bleating for 
some time after receiving the injection. 
No observations were made in regard to the urine. The bladder was collapsed 
at the time of the autopsy. 
The faeces were somewhat carefully observed. At first the scybalae passed at 
the time of giving the injections were found to be reddened on the surface, from 
being bathed in the milk and gruel; but, on being broken, they were of a dark 
color interiorly. Later in the course of the investigation, the balls became lighter RECTAL ALIMENTATION. 
51 
in color, and when broken were found to be colored throughout by the cochineal. 
Those found in the intestine at the post-mortem were all of this character— 
colored. 
Autopsy.—In this examination I was kindly assisted by Dr. John S. Coleman 
and Dr. A. Sibley Campbell. 
September 20, 1868, 5 o’clock, p.m.—The injections had been applied from 7 
a.m. to 3 p.m. four times, to insure the presence of the fluid in the intestine. 
Emaciation not extreme, but no subcutaneous fat,—no fat above the viscera. 
The intestines and gastric cavities were somewhat distended with inodorous gas. 
The very long intestine was carefully examined at intervals, from the anal ter- 
mination to the last stomach. 
On opening the abdomen, and previous to slitting open the intestinal wall, 
dark red discolorations were seen occupying many inches of the tube, though not 
continuous throughout. These were found in all parts of the tract from the anus 
to the maws. On slitting the tube, these parts of the intestine were found to 
contain the coloring matter of the injected aliment. The fluid was carefully ex- 
amined, though no test was applied. In none of the physical appearances did 
there seem to be any occasion for doubt. In addition to the colored fluid, large 
numbers of the faecal scybalae or “balls” were scattered throughout the whole 
length of the tube. The larger proportion of them consisted of matter which was 
colored by the stain of the cochineal and madder. I have retained the viscera of 
the kid used in the above experiment, preserved in a solution of chloral. Whether 
an examination of sections of the intestinal wall and of the mesentery will detect 
the coloring matter in the lacteals, I have as yet had no proper opportunity to 
determine. 
Thus, so far as the above single and somewhat imperfect 
experiment goes, we may be said to have added actual 
demonstration to our rational deductions, in regard to the 
retro-staltic action of the intestinal canal. The analogy be- 
tween the goat and the human subject is perhaps too remote 
to found upon it any very important deductions, but I think 
a deeper study of the subject of intestinal inhaustion will de- 
velop the fact that retro-stalsis is by no means an action of 
the intestinal canal, which is to be considered only in its rela- 
tions to rectal alimentation. I am most confident in the 
opinion that “ the progression of the chyle,” as it was formerly 
called, is by no means a progression always in one direction, 
downward, as is the present opinion, by peristalsis, but that 
there are alternations of prostalsis and retro-stalsis—progres- 
sion and retrogression — during which, in ordinary normal 
intestinal digestion, the alimentary mass or fluid is presented 
again and again to the villi and lacteals and mucous surfaces, 
for elaboration and absorption. But our consideration of 52 
DESICCATED BLOOD FOR 
intestinal action now must be limited to the relations of our 
present discussion. 
I have heretofore remarked that “ under certain condi- 
tions ” the above described retro-peristalsis, or inverted 
vermicular action, in the several portions or in the entire 
length of the alimentary canal, may reverse the direction 
in which it ordinarily acts ; that prostalsis, by which all its 
contents progress downward, may become retro-stalsis, in 
which by intestinal inhaustion, the as yet unrecognized 
function, it will be drunk in from one lower portion of the 
intestine to an upper, until the mass finally reaches the small 
intestine. It but remains now, and the investigation is of 
the utmost importance to us, considering the character of the 
cases in relation to which I am discussing rectal alimentation, 
to inquire whether or not the pregnant woman, laboring under 
the uncontrollable nausea and vomiting and impending inani- 
tion incident to her state, can be said to present conditions 
in which intestinal inhaustion is likely to be excited. Is hers 
not par excellence the very condition ? 
Gravid Nausea and Inanition. 
Terms descriptive of the long recognized relation (of some 
kind) between the pregnant uterus and the almost invariable 
concomitant gastric disturbances are not very numerous, and 
some of them indefinite and awkward. I have heretofore fre- 
quently used the term “ gravid nausea,” and here suggest it 
as the most convenient for this form of hystero-neurosis. 
For the term hystero-neurosis I am glad to render acknowl- 
edgment to a Fellow of this Society, Dr. George J. Engel- 
mann, of Missouri.1 It at once indicates the origin and the 
complex pathology of a large variety of reflex manifestations. 
The most frequent, the most inevitable, often the most dis- 
tressing, and frequently for the time being the most uncon- 
trollable of these hystero-neuroses, is the nausea and vomiting 
of pregnancy. 
One of the oldest authors by whom anti-peristalsis as such 
1 Tr. Am. Gynec. Soc., vol. ii., p, 483. RECTAL ALIMENTATION. 
53 
is discussed in connection with pregnancy, is Moreau. It will 
be recollected that the term “ sympathy ” is but expressive 
of the phenomena of the then unknown function of reflex 
action, not enunciated by Marshall Hall until 1837. 
In remarking upon “ the sympathetic signs of pregnancy,” 
he says : “ All these gastric phenomena do not depend upon 
the same cause ; the vomiting in the last period seems to be 
owing to a sympathetic action, or rather a sort of nervous 
irradiation which extends from the uterus to the adjacent 
organs, an action which we can understand and explain in the 
following manner : the uterus, being a centre of attraction 
during pregnancy, and constantly changing in size during the 
first three months, is impeded in its development by the re- 
sistance of the bones of the pelvis, and incarcerated, as it 
were, in the pelvic cavity. It reacts forcibly on all the abdo- 
minal viscera by means of the numerous ramifications of the 
great sympathetic, from the hypogastric plexus of which its 
nerves chiefly originate. The nervous irradiation, the con- 
sequence of the compression and exaltation of the sensibility 
of the uterine nerves, extends to the solar plexus, reaches 
the epigastric centre, causes anti-peristaltic contractions of 
the stomach, and consequently vomiting.”1 
The above is valuable as stating in the most terse and 
pertinent manner one of the means by which the pregnant 
uterus is converted into a sensitive excitor to the reflex 
phenomena presented by the digestive organs, namely, its 
compression and exalted sensibility. To this the gynecolo- 
gist of the present day knows full well may be added the 
irritation of inflammatory states of the cervix, as abrasion 
(Sims), ulceration (Bennett), but more frequently than all, 
gravid malpositions, which greatly add to the compression 
and consequent exaltation of sensibility in the uterine 
nerves. 
It is important to the object of our present discussion to 
call attention to the fact that in reflex disturbances of the 
alimentary canal, from whatever direction they may have 
originated, there is more frequently a reversal of the ordi- 
1 Practical Treatise on Midwifery, by J. F. Moreau, p. 116. 54 
DESICCATED BLOOD FOR 
nary direction of its muscular action than any mere exagger- 
ation of normal peristalsis: intense pain and syncope, when 
they affect the digestive organs, produce nausea ; the in- 
jured mamma, the inflamed ovary, the bruised testicle, the 
irritable uterus, all exemplify this ; nephritic colic is at- 
tended with nausea, but strangulated hernia and ileus with 
stercoraceous vomiting. The habitual and long-continued 
local irritation in the uterus, consequent upon gestation and 
the nutritive processes of which it is the centre, establishes 
it, for the time being, as the common excitor and disturber 
of many organs, to the functional activity of which its rela- 
tions ordinarily are by no means obvious. Among these, 
none appears more prominently affected than the stomach 
and intestinal canal. The effect of a large number of preg- 
nancies—it will be admitted the majority—is to establish an 
abiding and habitual irritability of the gastro-intestinal canal, 
the stomach especially; but every portion of the tube is in 
ready response to irritation. That this response is, as a rule, 
by inverted rather than direct action, common observation 
will substantiate—the habit is retro-staltic ; borborygmi in 
the colon, eructations, regurgitations, nausea, and vomiting 
in the stomach, with a constipated habit, far more frequently 
characterize the gastric and intestinal action of pregnant 
women than diarrhoea and other manifestations of downward 
action. 
From the above consideration of the effect of gravid 
uterine irritation upon the gastro-intestinal canal, namely, 
its predominant predisposition and tendency to retro-stalsis, 
the conclusion would seem inevitable that, of all the conditions 
of gastric disability in which rectal alimentation could be de- 
manded, that of the nausea and inanition of pregnancy is the 
most favorable. 
Not only is the great practicability of rectal alimentation 
in the majority of severe cases highly probable, but injury 
in such cases is reasonably to be apprehended as a result 
of buccal ingestion. That the long-continued influence of 
reflected irritation upon any organ, whether through reflex- 
motor or reflex-secretory action through the ganglionic sys- 
tem, is capable of dynamically altering its structural condition, RECTAL ALIMENTATION. 
55 
has for some time been known. It was long since shown1 
that the reflected dental irritation of the fifth nerve in infants 
is capable not only of modifying the secretions of the stomach 
and alimentary canal, but also of influencing their vascularity, 
giving rise to the gastritis and enteritis of the cholera infan- 
tum at the period of the first dentition, as also to the various 
cutaneous eruptions of that disastrous phase of infantile ex- 
istence. In the remarks accompanying the report of a highly 
interesting case of gravid nausea, successfully treated for five 
weeks by rectal aliments, by Dr. A. Y. P. Garnett, of Wash- 
ington, the opinion is expressed that “ uterine irritation re- 
flected for a protracted period upon the stomach often 
establishes a true gastritis, which may constitute one of the 
conditions imperatively demanding rest.”2 Though many 
deny that there is organic change in the mucous membrane 
of the stomach, it is highly probable that in some extreme 
cases this hyperaemic condition is evoked. Such a condition 
could only be aggravated by the gastric ingestion of aliments. 
Conclusions. 
The following principles may legitimately be deduced from 
the foregoing discussion : 
1st. That the exhaustion resulting from gravid nausea not 
infrequently demands a supply of food over and above that 
which can be retained by the stomach. Death has resulted 
from the inanition thus produced. 
2d. That the number of well-authenticated cases on record 
—ranging from three months to five years—fully demonstrate 
the adequacy of rectal alimentation to sustain nutrition un- 
assisted by other means of ingestion. 
3d. That rectal nutrition requires rather an explanation of 
its rationale than a demonstration of its truth. 
4th. That water and tenuous, nutritious, and medicinal 
1 Southern Med. and Surg. Journal, June, 1850. 
2 The report of this valuable case came to hand too late for introduction in the 
present paper. The notes of a most painful case of gravid nausea—death without 
delivery in the eighth month of gestation—have recently been furnished to me by 
my distinguished friend, Prof. L. A. Dugan, of this city. 56 
DESICCATED BLOOD FOR 
solutions are probably absorbed directly into the blood, or 
by the portal radicles and mucous membrane of the rectum 
and colon, for digestion in the liver. 
5th. That the digestion of composite aliments is never 
effected in the rectum or colon, on account of the absence 
of the “ digestive fluids ” universally recognized as indispensa- 
ble to their disintegration and solution. Their undissolved 
condition and the absence of absorbent vessels in the rectum 
and colon prevents their entrance into the blood from these 
portions of the alimentary canal. 
6th. That the admixture artificially (Leube) of digestive 
principles, pancreatic juice, etc., with the injected food, is 
not necessary or important to the efficiency of rectal nutrition. 
7th. That the “vicarious secretion” (Flint) of the elements 
of the gastric juice, pancreatic juice, and other digestive 
fluids by the glandular structures of the rectum, for the pre- 
paration of the rectal aliments, is highly improbable, and cer- 
tainly not necessary to accomplish their ultimate digestion 
and absorption into the blood. 
8th. That the secretion of these fluids from their proper 
surfaces and glands (Flint), as the stomach, pancreas, liver, 
etc., and their descent into the rectum, may also be denied 
as one of the conditions to success in rectal nutrition. 
9th. That the true explanation of the almost uniform effi- 
ciency of rectal alimentation and its physiology is to be found 
in the reversal of normal peristaltic action : first in the rec- 
tum, sending the injected aliment above the sigmoid flexure, 
and then past the colon and ileo-caecal valve into the small 
intestine. Here digestive fluids for their disintegration, 
solution, and chylifaction are abundant, and here also lac- 
teals abound for chylous absorption. This retro-staltic action, 
when continuous, as in rectal alimentation, accomplishes the 
ascent of the nutriment from the rectum into the small in- 
testine. As here considered, I believe “ Intestinal Inhaus- 
tion ” to be a newly recognized function of the alimentary 
canal. It is to the intestines what deglutition is to the 
stomach. Through its instrumentality, rectal and buccal 
ingestion are as nearly as possible equalized in both their 
rationale and their results. RECTAL ALIMENTATION. 
57 
Ioth. That the nutrition of the body by rectal aliments 
can be accounted for solely on the recognition of intestinal 
inhaustion. Without it the digestion and absorption of such 
solids or semi-solids as boiled eggs (Flint), meat-broths, and 
pulps, could not be explained. 
nth. That the present view in regard to the movement 
of the contents of the alimentary canal is probably incom- 
plete ; and that aliments, whether from buccal or rectal 
ingestion, while undergoing digestion and absorption, are 
not subjected solely to a downward movement, but to al- 
ternations of progression (prostalsis) and retrogression (re- 
tro-stalsis), passing and repassing the absorbent surfaces of 
the intestine repeatedly, till deprived of nutritive elements. 
12th. That the rectal ingestion of food is a valuable sub- 
stitute for gastric ingestion in all cases of disability of the 
upper portions of the alimentary canal. 
13th. That in the early months of gestation reflected ute- 
rine irritation establishes a habit or abiding tendency to 
retro-staltic action in the muscular tunic of the entire ali- 
mentary canal, and that it is from this retro-staltic irritability 
that the nausea and vomiting of pregnancy originate. 
14th. That, on account of this retro-staltic irritability, so 
manifest in early gestation, the intestinal inhaustion of rec- 
tal ingesta is greatly facilitated ; and that this circumstance 
renders gravid nausea, above all others, the condition most 
favorable for efficient rectal alimentation. 
15th. That, under the careful and systematic application of 
rectal alimentation, artificial abortion for the relief of gravid 
nausea can be banished from practice, even as a last resort. PARKE, DAVIS & CO.’S 
Gelatine Suppository Capsules, 
EMPTY AND FILLED. 
In presenting to the consideration of Physicians and Druggists our new 
Suppository Capsules, we believe it will require no argument in 
order to gain an acknowledgment of their superiority in many important respects 
over the old form in which suppositories were presented. 
To the practical pharmacist at least, who has experienced the annoyance and 
tediousness of the manufacture of suppositories in moulds, the advantages of 
these Capsules will appear at once. 
An explanation of the method of their use will quickly make these advantages 
apparent. The mass may be made as usual, of cocoa butter, which will allow of 
two methods of introduction into the Capsule; the first of these being to allow 
the melted composition of cocoa butter and other ingredients to cool and harden, 
and afterwards rolling it out on a pill machine with division as required—the 
sections being then introduced into the Capsules. The second method consists in 
making the Capsules serve as molds. To accomplish this, moisten with the 
tongue the lower end of the Capsule; by a slight pressure the latter may then be 
made to adhere in an upright position to a clean board or a sheet of paper. 
Place as many as are desired in a row, melt the composition as usual, and 
pour into the upright half of the Capsule, allow to harden, and then cover with 
the cap. 
It will be seen that the latter method permits of the use of any suitable 
composition besides cocoa butter; for instance, such a compound as simple 
ointment, which melts at the temperature of the body. 
The Capsules will each hold 14 grains of melted composition of any ordinary 
formula. In making the mass, therefore, the amount of medicinal ingredients and 
excipient together should be adjusted to equal this weight. 
To physicians we are enabled to give an assurance of their ready solubility 
based on the results of an extensive experimental use. They will dissolve in the 
fluids of the rectum in from 15 to 20 minutes. 
We have a full line of filled rectal capsules, for which we claim advantages 
not possessed by any other kind of suppositories. The composition with which 
they are filled being a mass of which glycerine forms the largest part, is entirely 
soluble in the fluids of the rectum and offers nothing which might obstruct 
absorption of the medicinal ingredient as is the case with cocoa butter and other 
fats. Solid extracts, salts of the alkaloids, tannin, and other agents usually 
prescribed in this form, are almost without exception soluble in glycerine; and this 
fact enables us to present the medicinal ingredient in a dissolved condition instead 
of being merely suspended in the excipient, as is the case with cocoa butter 
suppositories. 
PARKE, DAVIS & CO., 
Detroit, Mich. NEW REMEDIES 
FLUID EXTRACTS. 
RAR1? From Bolivia. Almost a specific in acute and chronic diarrhoea, 
DAIVIx. cholera, cholera morbus, etc. 
\ 
C A A T? A Q A fVF? A T'l A (Rhamnus Purshiana.) From the Pacific Slope. 
XvA OAvJi.VnA. Highly recommended for habitual constipation; 
and very useful in all cases where a laxative or cathartic is indicated. Beware of the fluid 
extracts of spurious varieties of this bark. 
p Q T T A p A D /"A 13 Zp F’rom Brazil. A powerful alterative, which exerts a marked 
vrllXvlJ/ly, curative action in syphilis, scrofula, and kindred disorders. 
RHUS AROMATICA.- A remedy in diabetes, and other diseases of the 
1") A lVIT A N A (Turnera Aphrodisiaca.) From Mexico. The well known aphrodisiac. 
Of great value in impotence, spermatorrhoea, and loss of sexual appetite. 
ROT DO (Peumus Boldo.) From Chili. The new tonic. Very useful in dyspepsia, 
* hepatic torpor, yellow fever, etc.- 
BERBERIS AQUIFOLIUM.— 
been used with extraordinary success in salt rheum, psoriasis, eczema, scrofula, and syphilis. 
■DT AOTC (Viburnum Prunifolium.) From the United States. Employed 
u i—/xi. 1 A xx VV . to prevent abortion and miscarriage. 
I? T M Ti TT T T A T? O R T T QT A From California. A valuable curative agent 
VJIVlIN KU0U0I A. in asthma and diseases of the air passages. 
• ,—, w « y -■ ,—« y t a ,—, y t a y—t , „ 1 r o m California. An 11—m al ar 1 al. 
GRINDELIA SQTJA.R.R.OSA, Used in enlarged spleen and other 
malarial diseases. 
CEREUS BONPLANDXI. — 
sedatives. Very useful in controlling functional and organic disturbances of the heart. 
V AVI (Dyospyros Kaki.) From Japan. Peculiar action on the mucous surfaces. Useful 
• in mucous dyspepsia, typhoid fever, etc. 
CERCIS CANADENSIS. I"cE°0U,d«*hJU4*n*ttry?elc'."''dy in 
M AN APA (Fransiscea Uniflora.) From Brazil. Officinal in both Brazilian 
. Dispensaries. They describe it as being a powerful anti-syphilitic, purgative, 
diuretic, and emmenagogue. 
FLUID EXTRACT 
JAMAICA DOGWOOD 
CpiscidzcL IOvytTurtn,CL. 
PROPERTIES.—This new remedy, lately introduced by us from the West 
Indies, is said to be a substitute for opium in its indication as an anodyne. Dr. Wm. 
Hamilton, of Plymouth, England, in an article in the Pharmaceutical Journal (iv. 76, 
August, 1844), speaks of the plant as a powerful narcotic, capable of producing sleep 
and relieving pain in an extraordinary manner. 
Prof. Fernando Altamarino, of Mexico, has found it useful in the following 
complaints: Writer’s cramp, functional muscular spasms, chorea, tetanus, etc. 
i4BIB» lAfli &. 
Manufacturing Chemists, 
DETROIT, MICHIGAN. Our line now embraces the following subdivisions, of several of which we are the largest manufacturers in 
the United States. 
E-1111H Fvtl'QPtO Our fluid extracts well deserve the commendations be- 
I IUIU LAI! ClUlO. stowed upon them by physicians throughout the United 
States. No trouble or expense has been spared to make them perfect in all the char- 
acteristics of this class of preparations. We pay particular attention to the following 
points: ist Selection of the best drugs, as regards condition and quality, which the 
market affords. Our extensive correspondence gives us great advantage in this direc- 
tion. 2d. Superiority of apparatus and process of manufacture. 3d. Skill and care- 
ful attention throughout the manipulation. 4th. Absence of heat in our process. 
Qliaar-PnGtoH 0 i 11 o ®ur caP f°r the manufacture of sugar-coated 
OUqCiI OUcUCU ill ld« pills is unsurpassed. Great care and skill, based 
on long experience, is exercised to secure accuracy in the mixing of materials and the 
division of the pills. Having made many improvements in the manipulation through- 
out the process, we can, with confidence, guarantee in our finished pills uniformity, 
solubility, smoothness and permanent and immaculate whiteness. We keep over 400 
different formulae constantly on hand as our regular stock line, all of which have been 
selected either from officinal or other standard authorities, or from the prescriptions of 
able physicians. 
Dinlf Pronnloo The granules are intended to supply the needs of physicians 
I 111 lx UlallUICO. in such cases as require minute doses, or frequent repetition, 
for adults, or in complaints of children. For the sake of beauty of appearance, and 
to distinguish them from our regular line of pills, we have applied a pink coating. 
Specify P., D. & Co.’s Pink Granules on your orders and prescriptions. 
EMlf'ito Cnmilllo Dillo °ur Pills are Put UP for market in bottles 
I lIVCllu I U I 111 U I Ct I HID. containing 100 and 500 each. The Postal 
Laius forbid the transmission of glassware or liquid by mail; but we will send pills 
in tin boxes, free of postage, to any address, 011 receipt of price. Please observe 
that our pills are coated whileithe mass is yet soft, and will remain in same conditions 
for years. To convince yourselves of this fact, and of their extraordinary solubility, 
please cut open a few of them (for instance, quinine, cinchonidia or blue), all of 
which are usually found on the market hard and insoluble. Note also the rapidity 
with which the sugar-coating is dissolved in the saliva. 
Solid Extracts & Powdered Solid Extracts.., 
cal and pharmacal friends to critically examine our Solid Extracts, as we claim for 
them the first rank as regards medicinal value and physical characteristics. Analysis 
has demonstrated the alkaloidal strength of our narcotic extracts as compared with the 
English and other American manufacturers.—See Amer. Journal Pharmacy, April, 
1876. Handsomely put up for market in flint glass jars (stained dark green), of a 
pattern convenient for general pharmacal purposes. 
Pnnnonfratinno This list comprises the proximate medicinal principles of 
UUI IllCl III dllullo. the several plants named, either combined in the form of 
powder, consisting of two or more constituents, or isolated in the form of a powdered 
alkaloid or resinoid. Owing to the liability of these articles to absorb moisture, they 
should be kept securely corked, and in a cool place. Put up in ounce bottles and bulk. 
MoHipQtQri 8 n7anffDO Lozenges are of use in pharyngeal troubles 
ITlCUIuCtlDU SLU&.OI IqUU1. that yield to ordinary medication. By being 
slowly dissolved, the medicament they contain is brought into contact with the diseased 
mucous membranes, and hence a beneficial influence, local as well as general, is exerted. 
In this respect they are of inestimable value to public speakers, teachers, singers, etc., as 
they can be kept in the pocket ready for immediate use. In certain diseases of chil- 
dren, in worms, dyspepsia, and in cases where it is desirable to carry the remedy about 
the person (as with travelers), too, the lozenge is a useful form for a medicament. 
Among the fifty varieties named in our Price List will be found many admirable and 
useful formulae. Special Formula made to order of any desired size, shape, color or 
flavor, when ordered in quantities of 3 lbs. or more. 
Send for Sample of any Formula, shape or color you desire. 
Send stamp for price list and descriptive circulars giving the botanical history and therapeutical applica- 
tion of fifty new remedies with doses of same. Correspondence solicited from druggists and physicians. 
PARKE, DAVIS & CO., Detroit, Mich. 
If you desire to procure any of these New Remedies, send for same to LEHN & FINK, and 
WALTER ADAMS, New York City ; SMITH, DOOLITTLE & SMITH, Boston ; W. B. 
BLANDING, Providence ; L. BURTON & CO., Troy; and D. H. FONDA, Albany, specifying 
“ p. D. & Co.’s ” in all cases ; by so doing you will insure reliable preparations of the TRUE DRUGS. 
SPECIALTIES.