Swallowing

“ Deglutition.—Deglutition, or swallowing, is the process by which food is transferred from the mouth to the stomach. Though this is not, strictly speaking, a digestive process, it is, nevertheless, necessary for the further digestion of the food. Mastication and insalivation, which are largely mechanical, prepare the food for certain chemical processes by which it is dissolved. The first of these occurs in the stomach and to this organ the food is transferred from the mouth. The chief organs concerned in deglutition are the tongue, the pharynx, and the esophagus. ”

“ It is not always open, however, but is opened during the act of swallowing, by a little muscle which is attached to it just as it reaches the throat. Most persons can distinctly feel that this is the case, by gently closing the nose and swallowing; when a distinct sensation is felt in the ears. ”

“ The throat may be tickled with the finger or a feather, to excite vomiting, and a teaspoonful of warm water administered. If the power of swallowing exists, a table-spoonful of warm wine or brandy and water may be given. ”

“ Especially serious is the mistake often made by persons in delicate health of swallowing—no other word can be used, for the digestive organs altogether refuse to respond to the action of the mouth—large quantities of some concentrated form of food, such as even the strongest stomach could not deal with in that form. ”

“ Swallowing is a series of reflexes in a row, so that food in the back part of the mouth sets a reflex going that carries it beyond the epiglottis; another reflex carries it to the esophagus and then one reflex after the other transports the food the rest of the way. ”

“ If one watches a horse or cow in the act of swallowing, the rather deliberate progress of this wave down the neck can be followed. What happens as we eat a meal is that every mouthful, as it is swallowed, is passed through the sphincter into the stomach and room is made for it by a gradual relaxation of the stomach wall, so that, as we saw in Chapter VII, the pressure of the stomach against its contents stays fairly steady, in spite of the fact that more and more material is being taken into the stomach from the esophagus. ”

“ Moreover the pharyngeal muscles are unable to seize the food and start the process of swallowing on account of the paralysis of the soft palate; liquids are apt to regurgitate through the nostrils, the patient must therefore be nourished with soft semi-solid food. As the disease proceeds, the difficulty of speech and swallowing is increased by the affection of the laryngeal muscles ”

“ The influences unfavorable to digestion, however, are stronger than those which promote it. And evidently, if the digestive process, because of emotional disturbance, is for some time inhibited, the swallowing of food which must lie stagnant in the stomach is a most irrational procedure. ”

“ The mechanical work is done with the jaws and tongue, and the chemical work is performed by the saliva. When the mechanical work is done thoroughly the chemical work is also thorough, and the test for thoroughness is loss of taste. Masticate the food until all taste has disappeared, and then it will be found that the swallowing reflex unconsciously absorbs the food, conscious swallowing, or at least, an effort to swallow, not being called for. ”

“ Some old people suffer from a difficulty in swallowing, which seems to be the result of a partial paralysis of the throat; the pharynx does not respond to the stimulus of food as it passes over it. Solids pass more easily than liquids. Deglutition is more difficult in an upright than in a horizontal position. Fisher speaks of the case of a man sixty years of age who swallowed soft and mucilaginous preparations with great difficulty, but warm food, salty or irritating substances gave little trouble. ”

“ When a difficulty of swallowing is not attended with an acute pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey ”

“ Hygiene of the Mouth.—Food should simply be chewed and relished, with no thought of swallowing. There should be no more effort to prevent than to force swallowing. It will be found that if you attend only to the agreeable task of extracting the flavors of your food, Nature will take care of the swallowing, and this will become, like breathing, involuntary. The instinct by which most people eat is perverted through the "hurry habit" and the use of abnormal foods. ”

“ Mastication facilitates swallowing.—Many foods cannot be swallowed without first going through some preparation in the mouth. Soft, moist, pultaceous foods, such as milk pudding and porridge, can be and often, indeed, are swallowed with little or no preliminary chewing. On the other hand, it is a mechanical impossibility to swallow large lumps of tough food, or very dry food, even though, like flour, it be in a finely divided state. ”

“ I wish only to observe further on this subject, that as the act of bodily swallowing requires a distinct exertion on the part of man, since the bodily food will not descend, of itself, into the stomach, in like manner, and for the same reason, a distinct exertion is requisite in regard to the swallowing, or interior reception, of spiritual food, and that probably this exertion is excited in every state of mental trial and trouble. ”

“ Common Form.—At the moment of swallowing, a disagreeable taste and smell are generally experienced, and there may be immediate and intense pain in the throat, gullet, and stomach, and almost immediate retching and vomiting. The throat and tongue also may become swollen and painful; but in a considerable number of cases the symptoms are not at once apparent, but are delayed from one to six hours—rarely longer. The person’s breath may be phosphorescent before he feels in any way affected, and he may go about his business and perform a number of acts requiring both time and mental integrity. ”

“ If it is in the esophagus, Aëtius suggests that the patient should be made to swallow a sponge dipped in grease, or a piece of fat meat, to either of which a string has been attached, in order that the foreign body may be caught and drawn out. If it seems preferable to carry the body on into the stomach, the swallowing of large mouthfuls of fresh bread or other such material is recommended. ”

“ The spasms rapidly spread to all the muscles of deglutition and respiration, so that the patient not only has the greatest difficulty in swallowing, but has a constant sense of impending suffocation. To add to his distress, a copious secretion of viscid saliva fills his mouth. Any voluntary effort, as well as all forms of external stimuli, only serve to aggravate the spasms which are always induced by the attempt to swallow fluid, or even by the sound of running water. ”

“ SWALLOWING, or Deglutition, is the act of taking any food, whether solid or liquid, down the throat. It succeeds Mastication, and is performed primarily by the tongue, which propels the aliment into the gullet ”

“ It is usually accompanied with catarrh.
Symptoms.—Difficulty of swallowing, so that solid food is partially chewed and then dropped from the mouth; fluids are gulped down, or partly return through the nostrils; or all food may be refused in consequence of the severe pain attending swallowing; the cud is not chewed; the throat and glands of the neck are swelled, hot and painful; the cough is frequent, hoarse, and indicates 147pain; the breathing becomes very difficult and labored, and the pulse full and quick. ”

“ The tongue, like the bill, however, is only an accessory to the digestive apparatus; for while the beak serves the purpose of prehension and trituration, the tongue assists in deglutition or swallowing. ”

“ Restoration of the tone of the stomach may be promoted by the taste, sight, or smell, of pleasant food, and expectoration is stimulated by the swallowing of remedies that can not be expected to reach the mucous membrane of the respiratory passages, simply by the operation of the principle under consideration. ”

“ For lungs and heart can tolerate neither so foul an odour nor the ulcers themselves nor the ichor (puriform, septic matter) coming from them, but cough and difficulty of breathing supervene. Origin of this affection of the throat is the swallowing of cold, pungent, hot, sour, or strongly astringent, substances. ”

“ We may briefly remind the reader that our own throats contain two passages, one to the lungs, the other to the stomach; and in order that the air passage may be safely guarded from the entrance of any foreign particles, there are various parts, valves, and muscles which come into play with the action of swallowing, each and all having technical names, larynx, pharynx, glottis, epiglottis, etc., which need not be here described. ”

“ By a series of rhythmic contractions, especially of the circular fibers, the food is pushed along, though sometimes with liquid food there is no peristaltic action of the esophagus, the pharyngeal muscles alone sending it to the stomach. At the lower end of the esophagus an especially strong band of circular muscle fibers form a sort of sphincter, which prevents the regurgitation of food. The whole act of swallowing is a reflex, not a voluntary act and is due to irritation set up by the stimulus of the foreign body, the food. ”

“ But there being no traction, the whole length remains equal in such cases. And for this reason it is easier to swallow than to vomit, for deglutition results the coats of the stomach being brought into action, the inner one exerting a pull and the outer one helping by peristalsis and propulsion, whereas emesis occurs from the outer coat alone functioning, without there being any kind of pull towards the mouth. For, although the swallowing of food is ordinarily preceded by a feeling of desire on the part from the mouth-parts for the experience ”

“ Not infrequently these idiosyncrasies for food are found to follow ideas with regard to their digestibility. If the patient is hurrying for any reason and suddenly becomes conscious that he is not masticating sufficiently, swallowing at once becomes much more difficult. ”

“ Disturbances of the power of swallowing and of nutrition are often grave and sudden, and in curious contradiction to her abnormally acute and shifting longing for and revulsion from certain specific kinds of food. ”

“ One must have lived on such diet to discover what ghastly trouble the necessity of swallowing one’s food may become. ”

“ The first symptoms are pain in the stomach, vomiting, purging, and dryness of the mouth and nose. The eyes, eyelids, and pupils then become fixed and motionless; the voice is rendered hoarse, or is lost altogether; the power of swallowing is much impaired; the pulse 493gradually fails, frequent swoonings ensue, and the skin becomes cold and insensible. The secretions and excretions, with the exception of the urine, are then commonly suspended; but sometimes profuse diarrhœa continues throughout. ”

“ In all of these operations, except in breathing, the various parts of the mouth are engaged. In eating we use the lips, the tongue, and the teeth. The teeth serve the purpose of grinding the food, the tongue turns it during the process of grinding, and delivers it up to the throat for the purposes of the stomach, when sufficiently masticated. The lips serve to confine the food in the mouth, and assist in swallowing it, and there are glands underneath the tongue, and in the sides of the mouth, which pour in a fluid to moisten the food. ”

“ Prickling at the tip of the tongue. Sour eructations, desire for cold water, ice. Loathing of food, acidity after every mouthful of food. 35. Pressive constriction in the throat. Burning from the larynx to the tongue as from peppermint, with desire for fresh air. The food descends in the œsophagus as if turned round like a screw. At other times the soup falls heavily and precipitately, as if through a metallic tube into the stomach, which trembles violently. Watery, yellowish diarrhœa, which is mixed with slime, attended with rumbling in the bowels. 40. Urine almost red. Urine profuse. ”

“ If the throat be slightly tickled with a feather, a nausea is produced, that is, an inverted action of the mouths of the lymphatics of the fauces, and by direct sympathy an inverted action of the stomach ensues. As these parts have frequently been stimulated at the same time into pleasurable action by the deglutition of our daily aliment, their actions become strongly associated. And as all the food, we swallow, is either moist originally, or mixed with our moist saliva in the mouth ”

“ How Food is Swallowed.—After food has been chewed and mixed with saliva, it is rolled into little balls and pushed by the tongue into such position that the muscles of the throat cavity may seize it and force it downward. Food, in order to reach the gullet from the mouth cavity, must pass over the opening into the windpipe. When food is in the course of being swallowed, the upper part of this tube forms a trapdoor over the opening. When this trapdoor is not closed, and food "goes down the wrong way," we choke, and the food is expelled by coughing. ”

“ That the act of nausea and vomiting is a decreased exertion of the fibres of the stomach may be thus deduced; when an emetic medicine is administered, it produces the pain of sickness, as a disagreeable taste in the mouth produces the pain of nausea; these pains, like that of hunger, or of cold, or like those, which are usually termed nervous, as the head-ach or hemicrania, do not excite the organ into greater action; but in this case I imagine the pains of sickness or of nausea counteract or destroy the pleasurable sensation, which seems necessary to digestion, as shewn in Sect. ”