These diseases require no special care in the acute stage beyond giving food in such fluid form as can be most easily swallowed. The pain caused by this act is often so extreme that it is advisable to concentrate all food, to lessen the number of necessary acts of deglutition. Meat juice, peptonoids, beaten eggs, and brandy may be added to good milk. Plain vanilla ice cream may be given. Its coldness is sometimes soothing to the pharynx.

Holding cracked ice in the mouth before swallowing will sometimes annul the pain momentarily, or in extreme cases the pharynx and tonsils may be sprayed with cocaine, and the period of temporary anaesthesia may be utilised for swallowing considerable nourishment. This is rarely necessary, for unless the patient is emaciated by previous serious illness, he is not apt to be in need of much food for a day or two. In bad cases of suppurative tonsilitis the strength suffers more, and stimulants may be given by the rectum if deglutition is impossible.

After all forms of tonsilitis there is apt to be considerable anaemia, and the patient for a week or two should eat abundantly of animal food. Eggnog and milk punches are often needed for the first few days of convalescence.

Dysphagia

When the normal mechanism of swallowing the food is disturbed the condition is called dysphagia. It is commonly due to one of the following causes: Spasm of the muscles of mastication (trismus); inflammations of the mouth, tongue, pharynx, or tonsils; diphtheria; tubercular, cancerous, or syphilitic pharyngeal disease; retropharyngeal abscess; stricture or carcinoma of the oesophagus; paralyses (sometimes of central origin); operations upon or near the pharynx; or the wearing of an O'Dwyer tube in the larynx.

The devices employed to enable the patient to overcome pain or difficulty in swallowing his food should include reduction of the efforts at swallowing to a minimum. A raw egg or oyster may sometimes be gulped down by a single act when the dread of pain from more repeated effort deters the patient from taking other food. Whatever is given should therefore consist of concentrated nutriment in a smooth, semisolid or gelatinous form. Wine jelly may be re-enforced with beef peptonoids or egg albumin, and custards may be thickened with farinaceous material to a consistence which will enable them to be quickly swallowed.

When patients are unable to swallow, an oesophageal tube is inserted for feeding, which, however, should be a catheter of small calibre (English 8 to 18), and which need not be passed very far down into the oesophagus. If necessary, a 2- or 4-per-cent solution of cocaine may be first applied to the pharynx to relieve pam and irritation. The fluid food - eggnog, broths, thick gruels, milk, etc. - is poured into the tube through a funnel.

When the tube feeding cannot be practised, it becomes necessaay to resort to rectal enemata, or both methods may be employed in order to reduce the number of feedings through the painful throat.

Delavan calls attention to the important fact that the point of greatest irritation is often the palatine arches, and by passing the tube through the nose into the pharynx behind them this difficulty is neatly avoided.

In hopeless cases of cancer or of tubercular ulceration of the epiglottis, tonsils, etc., which are so intensely painful, it may be justifiable to perform gastrotomy in order to place food directly in the stomach. This is certainly preferable to letting the patient starve to death because he finds the agony of swallowing is even worse than the pangs of hunger.