Feeding tubes snake through medical history

Although the practice traces back to ancient Egypt, it didn't become widespread until a generation ago.

Published March 29, 2005

Thousands of years before Terri Schiavo started getting fed through a tube, people tried to find ways to nourish those unable to eat.

The ancient Egyptians used reeds and animal bladders to supply patients with a mix of wine, chicken broth and raw eggs.

In 1793, an early healer delivered jelly, eggs, milk, sugar and wine to a patient through a hollow whale bone covered with eel skin, which was pushed down the throat to the stomach.

"Most people assume that feeding tubes are a new item," said Charlene Compher, assistant professor of nutrition at the University of Pennsylvania Schools of Medicine and Nursing, who studies the history of such feeding. "But in all truth, there have been feeding tubes since ancient Egyptian times. ... People have perceived a need for a long, long time."

How successful such techniques were remains a question. Nor were they widespread until a generation ago, when techniques in providing liquid nutrition through stomach tubes and directly into blood vessels became more advanced.

Before then, a mix of factors made it unlikely that feeding techniques could have kept anyone in a condition similar to Schiavo's alive indefinitely, said Compher and Peggi Guenter, managing editor of special projects for the American Society for Parenteral and Enteral Nutrition.

First, before antibiotics became widely used in the 1940s, surgery to insert such tubes carried danger of infection. And in the 1960s and '70s, it was more likely that people would be resuscitated if their hearts stopped, as Schiavo's did in 1990, leaving her brain-damaged and unable to swallow food.

Even in 1972, when Compher began working in nutrition, feeding tubes were rare. Nutrition came in the form of powders that had to be mixed with water before being used in tubes.

"The cultural attitudes were just different then," Compher said. "People understood there's birth, there's death, and I think we're in a different environment now.

"In my professional lifetime," she said, "I have seen the use of the technology, and the use of (stomach tube) feedings just mushroom."

About 344,000 U.S. residents now use feeding tubes in their homes, according to ASPEN. About 120,000 patients in long-term care were using them in a 1995 study.

When the tubes should be used is becoming more controversial. A 2003 study found that more than one-third of nursing home patients with dementia were using feeding tubes. Such tubes can have complications, such as diarrhea and infection, and patients with dementia may have to be restrained and sedated to keep them from removing the tube.

"They clearly extend life, but is the risk-benefit ratio worth it?" Guenter asked. "What kind of quality do you have? People are really wrestling with it."

Over the centuries, attempts to feed people have included trying to give nutrition rectally, as the Egyptians and doctors for President James Garfield did. After Garfield was shot in 1881, he stayed alive for 79 days on a mix of beef broth and whiskey.

Some tubes for nasal and mouth feeding were made from silver, others from leather.

In 1969, University of Pennsylvania doctors made a huge leap forward by keeping a baby girl alive for nearly two years with intravenous nutrition. At that point, a team led by a prominent surgeon, Jonathan Rhoads, was still experimenting on animals. But the baby had lost most of her intestinal tract.

"They had this baby and they had no other choice," Guenter said. "She was going to die."

Among those who studied under Rhoads: C. Everett Koop, who later became the surgeon general.

Intravenous nutrition still carries risks, including bloodstream infection, and is a last-resort choice. But Compher knows of a woman who has no small intestine left who has survived on IV nutrition, known as total parenteral nutrition, for 30 years.

"People can live for a very long time when the need is there," she said.

Over the last 30 years, the kinds of patients using artificial nutrition have changed. In the beginning, there were more children with birth defects receiving such nutrition. Now, some of those children can be helped with surgery.

Nor were there as many elderly patients.

"Back then, they wouldn't even do surgery on someone 70 years old," Guenter said.

There are few studies of who uses such tubes. But one study showed about half the patients surveyed had neurological problems, such as brain injuries and dementia, while most of the others had some type of cancer.

--Information from "Clinical Nutrition: Enteral and Tube Feeding," by Drs. John L. Rombeau and Rolando H. Rolandelli, was used in this report.