Bottoms Up: A History of Rectal Nutrition From 1870 to 1920

Abstract

From the 1870s through the early 20th century, physicians frequently relied upon nutritive enemata to succor patients suffering from bowel obstructions and other disorders of the gastrointestinal system. Far from extraordinary or outlandish, this therapy was used on paupers and presidents alike, including on Garfield and McKinley after their assassination attempts. The medical milieu of the late 19th century provided particularly promising circumstances for its practice, with the rise of allopathic medicine generally—and surgery especially—coinciding with flourishing research on the physiology of nutrition. Although ongoing discussions debated the merits of different methods and various ingredients, few in the United States or Europe doubted the efficacy of rectal alimentation. However, in the early 20th century, new studies utilizing biochemistry demonstrated the inability of such instillations to provide significant calories or protein, and the intervention fell from favor. Proctoclysis—or rectal hydration—remained standard of care for the next 20 years, strongly supported by John B. Murphy and other surgeons. Ultimately, intravenous hydration and, much later, total parenteral nutrition replaced the rectal route.

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“…7 In the early 20th century, scientific advances in nutrition physiology concluded that nutrients (specifically fats and proteins) are not absorbed to any significant extent through the rectal mucosa, and the practice largely vanished by 1915. 7 Although fluids (water, saline) can be absorbed through the rectal mucosa, intravenous administration of fluids replaced hydration via the rectal route by the mid-20th century. Rectal administration of fluids can be attempted for fluid resuscitation in emergency situations in remote settings when it is the only treatment available.…”

“…“Nutritive enemata” is of historic interest only, having been used in US medicine for patients with bowel disorders dating back to the 1870s and up through the early 20th century. This method of feeding was attempted on Presidents Garfield and McKinley prior to their deaths from gunshot injuries inflicted by assassins . In the early 20th century, scientific advances in nutrition physiology concluded that nutrients (specifically fats and proteins) are not absorbed to any significant extent through the rectal mucosa, and the practice largely vanished by 1915 …”

“…This method of feeding was attempted on Presidents Garfield and McKinley prior to their deaths from gunshot injuries inflicted by assassins. 7 In the early 20th century, scientific advances in nutrition physiology concluded that nutrients (specifically fats and proteins) are not absorbed to any significant extent through the rectal mucosa, and the practice largely vanished by 1915. 7 Although fluids (water, saline) can be absorbed through the rectal mucosa, intravenous administration of fluids replaced hydration via the rectal route by the mid-20th century.…”