The operation of tracheotomy is performed for obstructions of various kinds, such as accumulation of diphtheritic membrane in the larynx, oedema of the glottis, laryngeal new growths, etc. The conditions which require this procedure are usually among those which interfere to a greater or less extent with swallowing, although the presence of the tracheotomy tube in the trachea is well borne and does not necessarily conflict with deglutition in any manner. No special precautions in feeding are necessitated by the presence of the tube, as in the case of intubation.

Post-Diphtheritic Paralysis

In post-diphtheritic paralysis the soft palate is oftenest affected, but the muscles of the tongue and pharynx, or even the oesophagus, may also be involved, in which case deglutition is hindered and the patient must be fed through a catheter or stomach tube (see Gavage) or by enemata. (See Food Enemata.) Meltzer has shown that in man and the horse the mylo-hyoid muscles contract upon fluids so as to squirt them down into the oesophagus at a rate exceeding that of ordinary peristaltic motion, or several feet a second; hence, in paralysis affecting these muscles fluids can scarcely be swallowed. W. B. Cannon and A. Moser, by means of the X ray, studied the swallowing of capsules of bismuth, and found that "solids and semisolids are slowly carried through the entire oesophagus by peristalsis alone".

The phenomenal success of antitoxin inoculations in reducing the mortality of diphtheria to less than one third of its former degree have made sequelae of this nature very infrequent.