Whilst you’re probably vaguely familiar with nose and stomach feeding tubes, it hasn’t always been that way… rectal feeds were once the only way… and up until the 1940s the rectum was used for water, saline and glucose solutions.
The first recorded attempt dates back to ancient Egypt when reeds were used to give rectal feedings of chicken broth, wine and eggs. Rectal feeding was used as there was no way to reach the upper GI tract without killing the patient.
There is a long period before any known, recorded developments in artificial feeding. In Spain, in the 12th century Ibn Zuhr attempted parenteral nutrition, supplying nourishment intravenously to a human with the aid of a hollow silver needle. It is unknown how successful it was.
A few centuries later, in 1598, Capivacceus used a hollow tube with a bladder attached to one end to reach as far as the oesophagus. This thinking was developed and in 1617 Fabricius ab Aquapendente used a silver type of NG (nasal gastric – nose to stomach) tube that went as far as the pharynx for patients with tetanus.
In 1646 Von Helmont used leather to create a flexible, hollow tube that patients would swallow and it would feed into the top of the oesophagus. A syringe was used to deliver blended food.
By the mid 17th century, thinking was focused back on parenteral feeding:
“The idea of providing nutrients intravenously in humans was first realised when Sir Christopher Wren injected wine and ale in dogs way back in the middle of the 17th century.”
– Ahmad Fuad Shamsuddin
Wren had invented an IV made of goose quills and porcine bladders and was also able to give opiates to dogs through this. There were issues and in 1710 Courten concluded that fats needed to be manipulated before being administered through an IV. Despite these developments, IV feeding is a fairly new therapeutic tool.
In the 1700s physicians experimented with blends of wine, eggs, jellies and milk and in 1710 it was suggested that the leather tube could be used to reach down into the stomach.
Another stepping stone in the history of feeding tubes saw John Hunter, in 1790, using whalebone covered in eel skin attached to a bladder pump to feed a mix of jellies, beaten eggs, sugar, milk and wine. In the early 1800s, food blends included thick custards, mashed potatoes and pre-digested milk, whatever delightful thing that is…
During the first half of 19th century stomach pumps were used to feed severely mentally ill patients in England but it wasn’t a straightforward technique with complications including stomach lacerations and drowning in beef broth…
Apparently it was in 1837 that the first gastronomy was suggested. That is a tube which goes into the stomach through the tummy. It was attempted around 1845 but there were many complications including infections which couldn’t be dealt with as antibiotics hadn’t yet been created.
In 1867 Kussmaul introduced a flexible orogastric tube – a tube that goes from mouth to stomach rather than nose to stomach. Three years later, in 1870, Dr Staton was the first surgeon in the US to perform a gastrostomy with long term survival. The patient was an 8 year old boy. Another four years and Ewald and Oser would introduce a soft rubber tube.
It would be 1878 before the first jujunostomy was attempted – that’s a gastrostomy which goes into the duodenum instead of the stomach. But rectal feeding was still about and in 1881 the US president James Garfield was kept alive after being shot by being rectally fed beef broth and whisky.
Moving into the 20th century, we the early days of the central line which would lead to IV feeding and parenteral feeding as well as soft flexible tubes introduced to make artificial feeding more comfortable and more successful.
Unfortunately, paralleling this was the forced feeding of suffragettes. This was a torturous affair made up of brutal attacks. A primitive method of feeding was used that was painful – the tube through the nose was often too large and any resistance from the prisoner lead to further pushing, if the nasal tube failed, a throat tube was used which involved a metal spring gag.
Around 1910, Einhorn began experimenting with NJ tubes and shortly after, in 1916 continuous and controlled delivery of liquid nutrition was suggested when it became clear bolus feeding was not always tolerated. The Levin tube, introduced in 1921 was very stiff and thicker than the tubes used today which are made of soft polymers such as silicone and polyurethane but was presumably progress then. Another development came in the 1930s with feeding via a pump.
The literally life changing discovery of modern antibiotics in the 1940s changed the landscape of artificial feeding dramatically. Many of the surgeries that had failed because of infection were now viable. This was developed further in the late 1940s when polyethylene tubing began to be used and the first enteral feeding pump was developed.
In the 1960s, with the focus on space travel, work was carried out on nutrition to help astronauts get the right food and prevent malnutrition. This information would later be used to create the formulas used today in tube feeding. These were further developed in the 1970s.
In 1979, the PEG insertion technique was developed and performed on a 6 month old in the US. This is a common method still used today which uses a cut in the stomach and an endoscopic tube – hence percutaneous endoscopic gastrostomy. It’s this kind of insertion that I had.
I’ve written before about how grateful I am for my feeding tube, it has given me back my life and I am also incredibly grateful for all those innovative thinkers and all those unfortunate patients that have gone before me. Thank you.
Sources and further reading:
- High Points in Feeding Tube History, Janice Fordyce
- Tubefeeding, a brief history
- The history of nonsurgical enteral tube feeding access, Gail Cresci and John Mellinger
- Brief History And Development Of Parenteral Nutrition Support, Ahmad Fuad Shamsuddin
- The History of Surgically Placed Feeding Tubes, Gayle Minard