A NEW METHOD 
OF 
RECTAL MEDICATION. 
BY 
F. E. STEWART, PH G., M.D. 
[.Reprinted from New Remedies for December, 1879.J 
NEW YORK: 
WILLIAM WOOD & CO , 27 GREAT JONES STREET. 
1880. A NEW METHOD 
OF 
RECTAL MEDICATION. 
BY 
F. E. STEWART, PH.G., M.D. 
[Reprinted from New Remedies for December, 1879.] 
Advantage has long been taken of the 
absorbent power of the rectum as a means of 
obtaining the peculiar effect of a remedial agent 
upon the system ; and, although the rectum, as 
an absorbing surface, is inferior to the stomach, 
medicines are frequently introduced by this 
organ with great benefit in cases of inability to 
swallow, irritable stomach, and in children’s 
maladies. Unfortunately the rectum soon be- 
comes intolerant, the mucous membrane irritable, 
and the medicament may be at once rejected or 
absorption delayed. This, and the difficulty 
attending the introduction of the substance 
through the anal aperture, guarded as it is by a 
tightly-closing sphincter, have always presented 
serious obstacles to rectal medication. Any plan, 
therefore, which shall to any extent remove these 
obstacles, and add to the utility of this important 4 
branch of therapeutics, must be of value, and it 
is with this purpose in view that the new method 
which forms the subject of this article has been 
devised. 
For the • introduction of remedies into the 
rectum a vehicle of sufficient consistence to over- 
come the resistance of the sphincter muscle is 
necessary. This is obtained, in the use of solids, 
by mixing them with some form of hardened 
fat, or with soap, and such a mass moulded into 
convenient form for insertion is called a sup- 
pository. Medicines in the liquid state are 
introduced by means of the syringe, and are 
technically known as enemata or clysters. The 
chief objection to the enema is that the amount 
necessary for injection stimulates the natural 
irritability of the rectum, often causing its 
expulsion; to the suppository, that the fat coats 
the bowel and greatly retards absorption. This 
latter fact has been satisfactorily proven by 
Ellerslie Wallace, M.D., Prof, of Obstetrics in 
the Jefferson Medical College of Philadelphia. 
Another very serious objection obtains with 
regard to fats as a vehicle: it is that, when suf- 
ficiently hardened for successful insertion, their 
fusion point is often raised higher than the 
temperature of the body. Such suppositories 
melt so slowly in the rectum as to be compara- 
tively worthless; they may fail altogether to 5 
soften down, and thus pass from the body 
unchanged; another is, that during summer in 
these latitudes the temperature of the weather 
is often above that of the body; suppositories, 
therefore, melting at the temperature of the body 
in such weather, lose consistence and turn into 
liquid fat. 
Solutions of medicinal agents for rectal ad- 
ministration must be perfectly bland, a point 
often difficult to secure if they are injected in a 
condition permitting ready absorption, or they 
will not long be tolerated. 
Consistence for insertion, concentration and 
blandness to prevent irritation, the use of a 
remedy in a condition to be readily absorbed, 
and the employment of a vehicle which shall not 
prevent absorption, are, therefore, the require- 
ments for rectal medication. With these re- 
quirements in consideration, I have devised and 
beg leave to introduce the oleates for rectal 
medication, and the rectal capsule, a cylindro- 
conical case of gelatin, suppository-shaped, as 
a vehicle. 
The great advantages claimed for the rectal 
capsule are: ist. It does away completely with 
other vehicles for conveying the medicinal 
agent into the rectum, be it powder, extract, or 
fluid, provided that fluid is not a solvent for 
gelatin, the capsule itself giving the consistence, 6 
not its contents; the vehicle being entirely 
unaffected by the heat of any climate, yet still 
very soluble in the secretion of the rectum. 2d. 
It enables the employment of the oleates—liquid 
salts already famed for their power of perme- 
ating the tissues. 
Much attention was drawn to the oleates by 
a paper on the treatment of persistent inflamma- 
tion by the local applications of solution of oxide 
of mercury and of morphia in oleic acid, by Mr. 
John F. Marshall, F.R.S., Prof, of Surgery in 
University College, London, published in the 
London Lancet for May 25th, 1872. The facility 
and rapidity with which oleates are absorbed 
from the skin was then something quite new 
in therapeutics, and subsequent research has 
proven his suggestion relative to the substitution 
of the oleates for some of the older ointments, 
as being cleaner, more elegant, much more effica- 
cious, and of practical value. The oleates of the 
alkaloids injected beneath the skin are also 
easily absorbed, presenting an admirable mode 
for hypodermic use, and the oleates, per rectum, 
only need some means to convey them to the 
mucous surface of the bowel, where they will be 
far more easily absorbed than by the epidermis, 
and free from the objections attending the 
hypodermic method of medication. 
In proof that some medicines enter the blood 7 
more quickly by the rectum than by the stomach, 
J. Roberts Bartholow, Prof, of Materia Medica 
at the Jefferson Medical College, states in his 
work on Materia Medica and Therapeutics, 
that “ The salts of morphia, atropia, and strych- 
nia, in solution, are absorbed as quickly, and 
the last-named more quickly, by the rectum 
than by the stomach.”* 
Rectal capsules abolish the necessity for a 
suppository mould and a long and difficult 
process, thus materially cheapening the product 
and increasing its utility, enabling the pharmacist 
to manufacture to order, with the same dispatch 
as in making pills, or to keep a stock on hand, 
securely sealed from exposure to the air, thus pre- 
venting mould or rancidity. Oleic acid is a per- 
fect substitute for butter of cacao, or other fat, 
for equal diffusion of the medicinal portion, if 
locally irritating, without danger of retarding 
absorption, or, if the drug be mild and in the 
form of powder, soluble, or with an active princi- 
ple soluble in the rectum, it may be placed dry 
in the rectal capsule for immediate insertion. 
In relation to other properties of the rectal 
capsules, they are quickly soluble in water at 
90° F. In water at 6o° they swell up, become 
opalescent, very soft, and dissolve after long 
immersion. Filled with cold water and placed 
* Page 9, ed. 1878. 8 
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 vari- 
ation 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 with 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.