The A.B.-Z. of our own nutrition

by Horace Fletcher

The X-ray method lends itself less successfully to the study of deglutition in man than in the other animals we have studied. The thickness of the thorax, the distance of the œsophagus from the surface, and the relation to dense tissues render the observation of a swallowed mass difficult, especially when the mass is in rather rapid motion. The few observations which we have to report were made on a seven-year-old girl, placed in the sitting posture. Gelatine capsules containing bismuth were used for solids, and were traced to a point below the heart. The motion was very regular, and apparently due to peristalsis, for the bolus descended without a hitch or irregularity of any kind. Sometimes the capsule became fixed in the upper œsophagus, at about the level of the second rib. Repeated swallows of water would fail to dislodge it. An interesting point was noted here. With each attempt at swallowing, the capsule would rise slightly, as if the œsophagus was pulled up with the rise of the larynx; then the capsule would descend to its former position.

Semi-solids—a mush of bread and milk—could be seen about as far as solids; that is, to just below the heart. The motion of the mushy bolus was the same as with solids, except that the rapidity was perhaps slightly greater.

It should be noted here that with the human subject, as well as with the horse, our results for semi-solids differ from those derived by Meltzer’s method; for according to his statements semi-solids, like liquids, are squirted down the œsophagus, and are not propelled by peristalsis, as has been the case in our observations.

Liquids—bismuth and water—were seen only in the neck and upper thorax. Here there was a decided squirt. With the rise of the larynx the liquid was seen to pass rapidly through the pharynx and well down into the thoracic œsophagus before it was lost to observation. The rate, however, by estimation was less than that of liquids in the horse.

There remains to be considered Meltzer’s latest investigation, in which he endeavoured to ascertain whether liquids remain above the cardia till the arrival of the peristalsis, or ooze down before. An experimental answer was secured by Meltzer by the following method. The abdominal and gastric walls of an anæsthetised dog were incised, and a tube (vaginal speculum) introduced. Through this the entrance of food into the stomach could be observed directly. In repeated experiments no liquid was seen to pass through the cardia before the arrival of the peristaltic wave. An incision through the diaphragm near its anterior origin showed that the swallowed liquid was not squirted as far as a point an inch above the diaphragm. To observe the œsophagus nearer its beginning, the upper three ribs were resected on the left side. Thus the swallowed liquid was seen to shoot along the œsophagus before any peristalsis reached this point. The resection of the fifth rib exposed the œsophagus half-way between the bifurcation of the trachea and the diaphragm. Here a bulging was sometimes observed immediately after the beginning of the act, and the swallowed mass remained there until a peristaltic wave carried it down. If the mass swallowed was small, or was projected with moderate force, it might not even reach as far as the bifurcation. From these experiments Meltzer concluded that in animals, as in man, liquid food is not carried down the œsophagus by peristalsis, but is thrown rapidly into a deep part of the canal. The depth reached depends on the quantity swallowed, the force used, and the tonicity of the lower part of the œsophagus.

The difference between these methods of Meltzer and those employed in our experiments has already been mentioned; and merely his results, which were obtained with liquids alone, need be considered here. According to our observations on the dog, there was no distinct pause at any part of the canal. The movement simply became slower, and continued at this rate until the stomach was reached. Neither was the rate through the diaphragmatic part of the œsophagus slower than through the thoracic. The quick propulsive movement noticed in the dog was observed with solids and semi-solids as well as with liquids, but the liquids descended further down the canal before the movement changed to the slower peristalsis. While this difference was evident to the eye, the total time consumed by liquids in passing from pharynx to stomach was not enough shorter than the time for solids and semi-solids to be determined by our measurements.

Summary.

The phenomena of œsophageal deglutition as determined by our experiments may then be described as follows:—

There is a difference in swallowing according to the animal and the food which is used.

In fowls the rate is slow and the movement always peristaltic, without regard to consistency. A squirt-movement with liquids is manifestly impossible, as the parts forming the mouth are too hard and rigid. With this diminution of propulsive power in the mouth there is observed a greater reliance on the force of gravity. The head is raised each time after the mouth is filled, and the fluid by its own weight trickles into the œsophagus, through which it is carried by peristalsis.