The Therapeutic Value of the Stomach Tube

By W. YOUNG, M.D., F.R.C.S.E.

(Read at British Medical Association Meeting, Wellington, 4th July, 1924).

Washing out the stomach is an old method of treatment of stomach ailments, but the use of the stomach tube for this purpose is quite modern. Apparently Cullen did not know of it, for in his “Practice of Physic,” published in 1791, he recommends the washing of the stomach “by throwing in a large quantity of warm and mild liquids, and by exciting vomiting.”

According to Osler the stomach tube was introduced by Kussmald in 1867. It is such a simple appartus that one finds it difficult to believe that it is of such recent origin. Used with a funnel, as a syphon, it has now almost superseded the stomach pump,

Lavage with the tube has of recent years become with many a favourite method of treatment for stomach ailments, and one can agree with Osler “that, while perhaps in some hands the measure has been carried to extremes, it is one of such extraordinary value in certain cases that it should be more widely employed by practitioners.” It is because I have only in the last few years begun to appreciate this that I thought it worth while opening a discussion on the subject to-night.

It sometimes takes a good deal of pluck to recommend to a patient the use of a stomach tube, especially if the patient is very ill, or if of a very nervous temperament. Often the difficulties are great in pursuing treatment by lavage owing to the almost insuperable objections of the individual for, although doubt it causes little or no discomfort when once the habit is acquired, it is distinctly unpleasant to most people at first, and this is especially so if the patient is very ill. Sometimes, I am sorry to say, I have had to do it by force, but I have always found the ends justified the means. Frequently the patients get so used to the tube that they pass it themselves. To give the patient confidence, as well as to judge for himself the effect on the patient, a doctor should, as far as possible, do the operation himself, certainly on the first occasion. In a few cases laryngeal spasm is set up, and one has to desist. In some patients lavage causes a considerable amount of shock, which must be provided for.

THE TUBE.—If the contents of the stomach are fluid, a small-sized tube should be used, for the small the tube the less the discomfort of the patient. It is necessary to always measure the tube, for one was sold to me recently as a child’s size, but I found the white mark was 24 inches from the end. When one remembers that in the average adult the cardiac orifice of the stomach is about 16 inches from the incisor teeth, one can imagine the result of passing a tube 24 inches long down a child’s gullet. It is well to mark off 16 inches on the tube.

While considering the nature of the tube used, I should like to say that the best kind of tube, and one difficult to get, is blind at the end and has two lateral openings. The ordinary tube, patent at end, with one lateral opening, is too easily blocked by particles of food: this latter would be improved by making a second lateral opening higher up.

LOTIONS.—The best solutions to use are, in most cases, either plain warm water or warm water with the addition of bi-carbonate of soda (one teaspoonful to the pint).

CONTRA-INDICATIONS.—Apart from aneurism of the aorta there are few contra-indications to the use of lavage. Even hæmatemesis is not a contra-indication. In a recent discussion (March 5th) at the Royal Society of Medicine, Dr. Hurst recommended the treatment of severe hæmatemesis by lavage. I should like to quote his own words: “When the hæmorrhage was severe and continuous after hæmorrhage had occurred, or when in spite of its severity it was not sufficiently rapid to cause the sudden distension which resulted in its ejection by mouth,  death might result unless steps were taken to empty the stomach. A stomach tube should be passed just far enough to reach beyond the cardia; in this way the bleeding surface could not directly be disturbed, and the stomach emptied. . . . The stomach was washed out with about four ounces of ice cold water, which was repeated until the water came back no longer blood-stained. Instead of water 1 in 1000 ferric chloride, also iced, might be used. When the last trace of water had been evacuated a drachm of 1 in 1000 adrenalin chloride should be poured into the stomach before withdrawing the tube.”

INDICATIONS.—In most cases of poisoning and of alcoholic gastritis, lavage has long been used by most practitioners. In eclampsia it is now used by some obstetricians, but as I have had no experience in this treatment for eclampsia, I hope other members will relate their experiences with it in these cases. In the indigestion of infants, and in pyloric obstruction in infants, it is now considered an invaluable means of treatment, but as I have had of late little to do with these cases I should like to hear the opinion of other members on the value of lavage in pedriatics. I notice that Still reports (Medical Annual, 1924), that of 78 cases of pyloric obstruction, 48 recovered after treatment by lavage.