Difficulty (dysphagia) or pain (odynophagia) in swallowing is a symptom of many diseases of the mouth, throat, and gullet. These conditions necessarily place limits upon the form and character of food that can be eaten. Dysphagia or odynophagia or both may be due to inflammations of the mouth, tongue, pharynx, larynx, or esophagus, to tuberculosis, syphilitic, or cancerous ulcer or stricture of these structures, or operations upon, or wounds or injuries to them, to retropharyngeal abscess, to esophageal abscess, and to spasm or paralysis of the muscles of deglutition.

So great may be the difficulty of swallowing that food must be given in as concentrated a form as possible and infrequently.

When dysphagia is of short duration, lasting only two or three days, it is not necessary to give much food. In proportion as the symptom is more persistent food must be given regularly and in concentrated form. As a rule, liquids are swallowed more easily than solids. A raw egg or oyster can sometimes be bolted, and thus a considerable amount of nourishment be taken with a single effort. The best articles of food are milk, gruels, custards, purees, with or without soma-tose or peptonoids, to make them more nutritious. These substances may be added to wine jellies, which are easily swallowed, to make them more nutritious. When dysphagia is not too great, soft food, such as milk toast and cereal foods, may also be taken.

Some patients take hot foods more easily; others, cold ones. A little ice held in the mouth will sometimes benumb the sensibility of an inflamed throat and make swallowing easier. The simplest ice-cream, such as vanilla, can often be eaten when other things cannot. This is partly due to its benumbing effect on the throat, and partly to the fact that, as it melts slowly in the mouth, it can be swallowed in very small amounts at a time. I recall one case of paralysis in which life was maintained for several months by ice-cream. This could readily be taken by the patient, who found it difficult to swallow liquids and impossible to swallow solids. When the pharynx is inflamed, it may be sprayed with cocain and food can be eaten while anesthesia lasts. Orthoform in powder, lozenges, or emulsion, applied about fifteen minutes before feeding, will often relieve pain sufficiently to permit of a fair meal being taken.

When the mouth or throat is too sore to make swallowing possible, a patient may be fed with an esophageal tube, or with a smaller one inserted through one nostril. The greatest distress in swallowing is often experienced because of movements of the soft palate and fauces when they are inflamed. If a tube is introduced through one nostril, movement of these and the consequent pain can be avoided. In other cases rectal feeding is resorted to and relied upon entirely or in part for the maintenance of life. Permanent intubation of the esophagus has been practised with success in some cases of stenosis, both of traumatic and of cancerous origin, and has enabled food to be swallowed for prolonged periods. When the esophagus or throat is impermeable, gastrostomy must be performed to make it possible to introduce food into the stomach through the wall of the abdomen. Food thus to be administered must be finely divided or in a liquid or semiliquid state.