Overfeeding in Early Infancy

Abstract

OESOPHAGEAL SPEECH MEDIBCLTJSHRNAL activity of the oesophageal smooth muscle. We believe that the whole knack lies in the control of the cricopharyngeal sphincter, and that the oesophagus behaves as a passive tube.It is surprising to find that a patient with no glottis can raise his intrathoracic pressure in the way shown. Such patients can, however, achieve positive pressures of 30 to 50 mm. Hg during sustained expiratory strain and considerably more during coughing. It appears that the effective resistance of the bronchioles to a suddenly applied expiratory pressure can be very high, so that in a sense air is trapped in the alveoli. Anyone who has witnessed a bronchoscopy will recall that the veins of the head and neck congest during coughing and straining even with the bronchoscope in place.In acquiring a voice after laryngectomy the patient has to gain control of the cricopharyngeal sphincter so that he can first relax the sphincter and allow air to enter the oesophagus during inspiration, and, secondly, control the degree of contraction during speech so that there is maximum economy in the use of the air in the oesophagus and the loss of air from the lungs. To acquire a good oesophageal voice therefore comprises two stages: (1) finding the voice, and (2) learning to use the new technique economically so that many syllables can be uttered without taking a fresh breath. Finding the voice usually takes a month or two, and the skill in the use of this voice increases over several years. SummryMeasurements of oesophageal pressure and chest movements during oesophageal speech have been made, and the oesophageal movements observed by fluoroscopy.The mechanism is discussed. Air enters the oesophagus down to the diaphragm. It is expelled by expiratory effort, the airway resistance allowing the intrathoracic pressure to rise above the atmospheric pressure despite the presence of a tracheostomy.We are grateful to Drs.

A Clinical Study of the Draught Reflex in Human Lactation

“…This may be the reason that the syndrome is now more often attributed to underfeeding (Wickes, 1952). It is also tempting to correlate the 'three months colic' with the period of establishment of lactation and the irregularity of the draught.…”