Barr Justin, Gulrajani Natalie B, Hurst Alison, Pappas Theodore N
From the Department of Surgery, Duke University, DUMC 3443, Durham, NC.
Trinity College of Arts and Sciences, Duke University, Durham, NC.
Ann Surg Open. 2021 Feb 10;2(1):e039. doi: 10.1097/AS9.0000000000000039. eCollection 2021 Mar.
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.
从19世纪70年代到20世纪初，医生们经常依靠营养灌肠剂来救助患有肠梗阻和其他胃肠系统疾病的患者。这种疗法并非非同寻常或古怪离奇，无论是穷人还是总统都曾使用过，包括加菲尔德和麦金莱在遇刺后也接受过这种治疗。19世纪末的医学环境为这种疗法的应用提供了特别有利的条件，随着对抗疗法医学的兴起，尤其是外科手术的兴起，同时营养学的生理学研究也蓬勃发展。尽管关于不同方法和各种成分的优缺点的讨论一直在进行，但在美国或欧洲，很少有人怀疑直肠营养的功效。然而，在20世纪初，利用生物化学进行的新研究表明，这种灌肠剂无法提供足够的热量或蛋白质，于是这种干预措施逐渐失宠。直肠滴注法，即直肠补液，在接下来的20年里一直是标准的治疗方法，得到了约翰·B·墨菲和其他外科医生的大力支持。最终，静脉补液以及更晚出现的全胃肠外营养取代了直肠途径。
