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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..a86e6b8 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #67326 (https://www.gutenberg.org/ebooks/67326) diff --git a/old/67326-0.txt b/old/67326-0.txt deleted file mode 100644 index f6f1c69..0000000 --- a/old/67326-0.txt +++ /dev/null @@ -1,12147 +0,0 @@ -The Project Gutenberg eBook of The A.B.-Z. of our own nutrition, by -Horace Fletcher - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: The A.B.-Z. of our own nutrition - -Author: Horace Fletcher - -Release Date: February 5, 2022 [eBook #67326] - -Language: English - -Produced by: Mark C. Orton, Les Glloway and the Online Distributed - Proofreading Team at https://www.pgdp.net (This file was - produced from images generously made available by The - Internet Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK THE A.B.-Z. OF OUR OWN -NUTRITION *** - - - Transcriber’s Notes - -Obvious typographical errors have been silently corrected. Variations -in hyphenation and accents have been standardised but all other -spelling and punctuation remains unchanged. - -Italics are represented thus _italic_ and bold thus =bold=. - - - - - THE A. B.-Z. - - OF - - OUR OWN NUTRITION - - - - - HORACE FLETCHER’S WORKS - - - THE A. B.-Z. OF OUR OWN NUTRITION. 462 pp. Just issued. - - THE NEW MENTICULTURE; OR, THE A-B-C OF TRUE LIVING. Fortieth thousand. - 310 pp. - - THE NEW GLUTTON OR EPICURE; OR, ECONOMIC NUTRITION. 324 pp. Just - issued. - - HAPPINESS AS FOUND IN FORETHOUGHT MINUS FEARTHOUGHT. Tenth thousand. - 251 pp. - - THAT LAST WAIF; OR, SOCIAL QUARANTINE. 270 pp. - - - - - _The_ A. B.-Z. - _of_ OUR OWN - NUTRITION - - - _By_ HORACE FLETCHER - _Author of “Menticulture,” “Happiness,” “That - Last Waif,” “Glutton or Epicure,” Etc., Etc._ - - EXPERIMENTALLY ASSISTED BY - DR. ERNEST VAN SOMEREN, - M. R. C. S., L. R. C. P., _of Venice, Italy_ - & DR. HUBERT HIGGINS, M.A., - M. R. C. S., L. R. C. P., _of Cambridge, England_ - - - _NEW YORK_ ‧ FREDERICK A. - STOKES COMPANY ‧ _PUBLISHERS_ - - - COPYRIGHT, 1903 - BY HORACE FLETCHER - - - Published November, 1903 - Reprinted February, 1904, August, 1904 - February, 1905, August, 1905 - - - THE UNIVERSITY PRESS - CAMBRIDGE U. S. A. - - - - - CONTENTS - - - Page - INTRODUCTION ix - - POSTINTRODUCTORY xxvii - - THE A.B.-Z. PRIMER - - Explanation 3 - - Some Pertinent Questions 4 - - A.—The Psychology of Nutrition 6 - - B.—The Mechanical and Chemical Physiology of - Nutrition 8 - - Method 9 - - Z.— The True Chemical End-Point of Digestion 10 - - A.B.-Z. Figure 12 - - Preface to 1906 Edition 13 - - - HISTORY OF DEVELOPMENT AND SUPPORTING - EVIDENCE - - Summary of the Foregoing Pages by an Experimenter - of One Month’s Experience 19 - - First Scientific Recognition of the Principles of - Economic Nutrition Outlined in “Glutton or Epicure.” H.F. 26 - - Was Luigi Cornaro Right? by Ernest Van Someren 27 - - The Cambridge Tests.H.F. 47 - - Experiments upon Human Nutrition, by Sir Michael - Foster, K.C.B., M.P., F.R.S. 48 - - Report of a Plan for the Institution of an International - Inquiry into the Subject of Human - Nutrition.H.F. 53 - - Proposal to Found an International Laboratory of - Research for the Study of Nutrition in all Its - Aspects. Recommended by the following 55 - Professors of Physiology, etc.: - - Sir Michael Foster, Cambridge, England. - Angelo Mosso, Turin, Italy. - Hugo Kronecker, Bern, Switzerland. - N. Zuntz, Berlin, Germany. - Paul Heger, Brussels, Belgium. - A. Dastre, Paris, France. - Henry P. Bowditch, Harvard Medical School. - Russell H. Chittenden, Yale University. - William H. Welch, Johns Hopkins University. - J.P. Pawlow, Saint Petersburg, Russia. - - Nationality and Scientific Titles of the above Board - of Scientific Assessors 68 - - Persistent Scientific Doubts.H.F. 69 - - Physiological Economy in Nutrition, by Professor - Russell H. Chittenden 72 - - Introduction to Dr. Harry Campbell’s Contribution - on the Importance of Mastication.H.F. 92 - - Observations on Mastication, by Harry Campbell, - M.D., F.R.C.P. 96 - - Introduction to Professor Pawlow’s Demonstrations - of Psychic Influence in Digestion.H.F. 180 - - Selected Lectures by Professor J.P. Pawlow (Dr. - W.H. Thompson’s translation) 182 - - Lecture IV.: General Scheme of an Innervation - Mechanism--The Work of the Nervous Apparatus - of the Salivary Glands--Appetite, the First - and Most Potent Exciter of the Gastric Secretion 182 - - Lecture V.: Period of Occurrence and Importance - of the Psychic or Appetite Juice in the Secretory - Work of the Stomach--The Inefficiency of - Mechanical Stimulation of the Nervous Apparatus - of the Gastric Glands 212 - - Lecture VIII.: Physiological Action and the Teaching - of Instinct: Experiences of the Physician 247 - - Introduction to Dr. Cannon’s Papers on Movements - in the Alimentary Canal studied by Means - of the Röntgen Rays.H.F. 284 - - Swallowing and Movements of the Stomach and - Intestines, by W.B. Cannon, M.D. 285 - - The Movements of the Food in the Œsophagus, - by W.B. Cannon and A. Moser 285 - - The Movements of the Stomach, by W.B. Cannon 301 - - The Movements of the Intestines, by W.B. Cannon 342 - - The Battle Creek Laboratories.H.F. 389 - - Experimental Investigation of the Influence of - Mastication and Cooking of Food, etc., in the - Laboratories of the Battle Creek, Michigan, Sanitarium, - under the direction of Dr.J.H. Kellogg 391 - - Dr. Edward Hooker Dewey and the “No Breakfast - Plan.” H.F. 396 - - Professor Jaffa and the Fruitarians.H.F. 397 - - Dr.H.P. Armsby.H.F. 397 - - Explanation of the A.B.C. Series.H.F. 399 - - INDEX 409 - - - - -INTRODUCTION - - - _DO WE EAT TOO MUCH?_ - CAN WE LEARN TO EAT RIGHT? - WITHOUT LOSS OF ENJOYMENT? - WITHOUT CARE BEING A NUISANCE? - WITHOUT SOCIAL INTERFERENCE? - WITH ASSURANCE OF HEALTH? - WITH INCREASE OF ENERGY? - WITH INCREASE OF ENDURANCE? - - * * * * * - - TO ALL THESE VITAL QUESTIONS, - THIS BOOK ANSWERS ONLY “YES.” - - * * * * * - - VERIFY THIS BY PERSONAL EXPERIMENT. - IRRESISTIBLE DESIRE FOR PHYSICAL EXERCISE - WILL FOLLOW, AS A MATTER OF COURSE, - PROBABLY FRUITING IN USEFUL ACCOMPLISHMENT - BY THE SAME INVITATION OF HEALTHY IMPULSE - WHICH CAUSES CHILDREN TO PLAY TIRELESSLY. - DO RIGHT YOUR FEEDING OF THE BODY. - NATURE WILL DO ALL THE REST FOR YOU ARIGHT. - - - - - Introduction - - DO WE EAT TOO MUCH? - -(_A propos of the Scientific-Military Experiments at Yale University_) - - -Do we eat too much? - -Nine out of every ten physicians tell us “Yes,” and tell us true! - -How much too much? - - * * * * * - -Luigi Cornaro suggested that all persons in his time ate more than was -necessary; most persons ate twice as much as was good for them; and -some, who were extravagantly gluttonous, ate ten times as much as was -their most economic need; and Cornaro, who was a dissipated wreck at -forty, reformed his manner of eating and lived to be a hundred to prove -his declaration. - -Experiments carried on in this country and in Europe during the -past five years confirm this estimate of habitual excess; but -fortunately they have also revealed a natural protection, heretofore -unappreciated, available to all, which can regulate the appetite to -suit the real needs of nutrition and thus avoid the dangerous excess -which predisposes to discomfort and disease. - - * * * * * - -Luigi Cornaro lived more than three hundred years ago. His charmingly -frank and interesting autobiography has been published in English -upwards of forty times in different new editions, and no one has -disproved the possibility or probability of his claim. We all know that -Cornaro was right. We know, in a general way, that the great Italian -dietitian and philosopher was wise and uttered wisdom, and we are told -that most, if not all, of the diseases which pain, worry, and afflict -us are caused by indigestion or mal-assimilation of food, the result -of some indiscretions of eating. The questions then are “What are our -indiscretions?” “How can we avoid them?” and “What is the new discovery -that will protect us and, at the same time, add to the pleasures of the -palate and of living?” - -The answers to all these queries will be found herein, as will also -an explanation of the very active interest which is being taken just -now in the problem of human nutrition by scientific and military -authorities, as evidenced by the Yale investigation. - -The author has, in collaboration with several others, found a way how -_not to eat too much_ while eating _all that the appetite desires_, and -in a way that leads to a _maximum of good taste_ and at a _minimum of -cost and waste_, but it is necessary to test many persons of different -physiques and varying temperaments, and also to test other methods of -attainment of economy, to learn what is best for general application, -and that is what is being done at Yale. - - * * * * * - -The cost to the pocket that is saved by economic nutrition is of little -matter as compared with the saving of the waste of energy and the -menace of disease. - - * * * * * - -Nature certainly never intended that we should weaken, depress, and -distress ourselves in the way that is common to present-day living, as -is made evident by the prevalence of discomfort and disease relative -to our daily food. Nature’s plan of evolution does not work that way -in general, does not retrograde in the progress of the improvement -of plants and dumb animals, and certainly does not intend that Man, -the First Assistant of Nature in the cultivation of things and in the -domestication of the powerful natural forces, should suffer and become -degenerate contrary to her general law. - -If we are agreed upon the foregoing, let us ask ourselves a few -questions. - -Without any undue egotism, may it not be possible for a generation of -human beings, who have progressed so far in intelligence as to be able -to move things by steam, to communicate across the ocean even without -wires to guide our messages, and to see clearly through objects that -are as dark as night to the unassisted human eye with the aid of an -artificial light, to learn the secret of right self-nutrition and -practise it in a manner that will not deprive us of the maximum of -pleasure which Nature invariably gives as a reward for conformity with -her beneficent requirements? May we not assume that beings who have -learned to breed and train horses to race with human intelligence, and -to run, trot, or pace a mile in less than two minutes, may also train -themselves to have the proportional relative speed, endurance, and -longevity that has been attained by race horses through man’s care, -and to enjoy the pleasure of living that is evident in these favoured -animals, mere servitors of man though they be? - -If this disparity of man is due to ignorance arising in self-neglect, -which is the usual accompaniment of genius, may we not now, at the -beginning of the pregnant twentieth century, rest for a moment from -discovering, developing, and improving the world outside our personal -selves and concentrate our attention for a while on learning to know -and care for ourselves? May we not, at least, give “horse sense” -attention to such a vital interest? - - * * * * * - -In the midst of the present confusion which exists among opinions as to -the right conduct of life and activity, and the best manner and system -of diet to be used to secure health and efficiency, it seems almost a -vain appeal to call for concert of action in a matter of common and -persistent neglect. Each person, as his own keeper, is careless, and -in matters of bodily management no one feels called upon to be his -brother’s keeper; but this is merely the lethargy of oversight and -consequent ignorance, and this book is published to call attention to -the oversight and to attempt to dispel the ignorance. - - * * * * * - -At the present moment of writing (October, 1903) there are quartered -at New Haven, Connecticut, twenty privates of the Hospital Corps of -the United States Army and three non-commissioned officers, under the -command of Assistant Surgeon, Lieutenant Wallace DeWitt. These men -and officers, while they are under regular army discipline and are -performing duty in conformity with their oath of enlistment, are yet -volunteers. They are from the same corps, if they are not the same -men, which furnished volunteers to investigate the causes of yellow -fever in Cuba, whose heroism resulted in stamping the fever out of the -islands and in that more effectually protecting our coast states from -its yearly incursions. These are the same men who generously refused to -accept the offered bounty. This latter expression of exalted manhood is -evidence of what humanity is whenever there is real need for heroes to -serve the general good. They refused to _sell_ themselves as risks for -money, but they freely _offered_ themselves as subjects of scientific -investigation for the benefit of their fellows and of mankind at large. - - * * * * * - -The duty that the soldiers are engaged in at Yale has no element of -risk, and need not have any feature of monotony or tediousness in -it, much less has it the romance of sacrifice, for it deals with an -attempt to restore normality and does not consort with disease. But the -service being rendered by these guardians of our health, these soldiers -of hygiene, is even more important than was the service rendered in -stamping out yellow fever, for it deals with an enemy much more -subtle, treacherous, common, and deadly than Yellow Jack. Yellow fever -calls for a halt and an immediate attempt at cure, and further, for -stringent defence to extermination; but indigestion and the American -plague, _dyspepsia_, work their evils slowly but surely to cut off our -best men and loveliest women in their prime and to rob us of their -richest product and of their maturest wisdom. - - * * * * * - -The investigation at Yale is a link in a chain of effort that has -developed in logical sequence and has been planned to effect a cure of -the common ignorance and practice relative to right human nutrition in -its relation to profitable thinking and doing; and to discourage the -personal neglect which has been responsible for the existing ignorance, -this book is issued to show what may easily be done and what has been -done, so far, in this direction. It is a compilation of important -knowledge which has been born of recent scientific research but which -is hidden away from common comprehension in scientific publications; -and it relates the story of the development of which this book is an -exponent. Herein are given the reasons why the government and the -most eminent scientists in the line of researches in nutrition are -coöperating so earnestly and so unusually in a commonweal inquiry. - - * * * * * - -About ten years ago, at the critical age of forty-four, the author was -fast becoming a physical wreck in the midst of a business, club, and -social tempest. Although he was trained as an athlete in his youth -and had lived an active and most agreeable life, he had contracted a -degree of physical disorder that made him ineligible as an insurance -risk. This unexpected disability, with such unmistakable warning, was -so much a shock to his hopes of a long life that it led to his making -a strong personal effort to save himself. The study was taken up in -systematic manner, account of which is too long to relate here; but the -eager auto-reformer soon learned that his troubles came from _too much_ -of many things, among them too much food and too much needless worry; -and realising the danger ahead, he sought a way to cure himself of -his disabilities by the help of an economic food supply, as did Luigi -Cornaro; but what is even more important, he found a way to enjoy the -smaller quantity of food much more than any plethoric luxury can give, -and arrived at the method by a route that showed a means of conserving -a healthy economy and an increased pleasure of eating, at the same -time, in quite a simple and scientific manner, that any one may learn -and practise without any ascetic deprivation whatever. Cornaro buried -the real clew to his economic and pleasurable success with his body, -owing to his vague generality of description of his method. The author -is determined not to make the same mistake, and thereby bury _his_ key -to a happy and easy life. - - * * * * * - -The secret of the method is all told in this book and is confirmed -herein by both theoretically scientific and scientifically practical -authority; but the experiments which are being conducted at Yale by -Professor Chittenden, in coöperation with Surgeon-General O’Reilly of -the army, of which the _Daily Press_ has given notice, together with -experiments which are in progress in many university laboratories in -this country and in Europe, are for the purpose of explaining the -“reasons for things” by complete scientific reasoning, so that none may -doubt the disadvantage and sin of dietic ignorance and carelessness. - -The acceptance of the theory and method of the author at the great -Battle Creek Sanitarium, after more than a year’s trial, and elsewhere -among curative agencies, and their adoption and use as the first -requisite of treatment, of which the public have not so generally -heard, are indorsements coming from practical, intelligent, and expert -sources of experience and judgment, and hence they are of the utmost -value and significance. - - * * * * * - -This introductory chapter is being written after the “clippings” of -newspaper comment relative to the presence of the soldiers at Yale have -begun to come in. The majority of comments are generous in spirit, but -indicate a lack of complete understanding which this “Introduction” is -intended to correct. - - * * * * * - -Some of the comments are couched in ridicule, and express pity for the -poor soldiers who are being “misused” as subjects of starvation in an -investigation which promises to make starvation a rule in the army. To -the writers of such trifling and unfair paragraphs let me, one of the -fraternity in an amateurish way, beg consideration of the following. - -The campaign that has been started is against a common enemy of -mankind, and of the American and English nations in particular. In our -successes in agriculture, manufacture, and commerce we have cultivated -insidious, luxurious temptations which bring all of us some ill and -many of us, or our loved ones, fatal disease and premature death. The -advance agent of these enemies of ours is Eating-and-drinking-too-much. - - * * * * * - -The officers and men of the army and the eminent scientists of our -country and those of all nationalities who have entered into the -campaign with us, and the great power of the sanitaria joining as -practical nurses, demonstrators, and exponents of the reform, are all -working for you and for everybody. It is voluntary service and has -already cost some of the volunteers much time and patience and also a -considerable sum in money. - - * * * * * - -You, gentlemen of the Press, wielders of the helpful or careless pen, -have a conspicuous pulpit and a far-reaching influence. No one can -escape you. In the search for the news of the day you are encountered -at every turn in your editorials or your paragraphs. In this campaign -we need your assistance to make the coöperation between the army and -science easy and effective. They are too busy working for you and your -best interest to stop to argue to correct your misunderstanding, but -the cause will feel the benefit of your assistance. - -Encouragement has powerful influence in stimulating effort and also in -creating and conserving conditions in which men may “do their best.” -What we are trying to learn is, what man _may_ do, under favourable -conditions of knowledge and confidence, to relieve his body of the -_strain of energy-taxing labour_ in disposing of the waste _which any -excess of food imposes_. It is a constructive experiment and not a mere -statistical measurement. Appreciation and applause assist; doubt and -ridicule obstruct. - -The soldiers and physiologists are too busy studying indigestion and -possible proteid poisoning and what-not-other causes of intemperance, -disease, and suffering to ask you to assist in spreading only serious -report and right suggestion relative to the importance and purport of -the investigation, but it is my privilege to ask it for the general -good. - - * * * * * - -Just another word of introduction and then will follow some -_postintroductory_ coincidences relative to the work in hand, and then -an attempt to lay out a ten-page chart of the personal responsibility -in the care of the body and the nourishment of the mind by aid of an -economic and most satisfactory nutrition, so as to make conservation -of energy as easy as possible and life well worth the living. The -scientific support from the pens of professional observers is, however, -the real meat of the book, for which compiler and reader alike are and -should be grateful. - - * * * * * - -In serving in the humanitarian ranks in a commonweal campaign one -should not need to use the concealment of modesty, nor should he fail -to speak with all frankness. What are the motives behind all this -energy to reform the eating habits of the people? The question has been -so often asked that it is better thus publicly answered. - -No one concerned in the campaign has any personal monetary interest -in any kind of food, prepared or otherwise. The movement began in a -suggestion carried by an accidental word given to the author by a -friend, an old-time friend in Japan, and a friendship never to be -forgotten, as related in the author’s book “Menticulture.” Pursuit of -menticulture led further to the discovery that the best mental results -could not be accomplished in a body weakened by any indigestion, any -mal-assimilation of nutriment, any excess of the waste of indigestion. -Then came the quest for the causes of mal-nutrition, which were soon -found, by study of the natural sequences and by going behind the -hypotheses of text-book authority, to arise in the careless ingestion -of food, its neglect in the mouth, and the consequent glut of -unassimilable excess within the body, necessitating enormous expense -of brain and body energy to get rid of the excess. - -When the secret of the potency for good of a rationally economic -alimentation was revealed to the author, was confirmed by several -colleagues of different ages and both sexes, and was tested by work -and endurance measurement, and also by the test time, it became -necessary to have given to it the indorsement of highest authority -in order to have the information credited. The new rediscovery was -a simple matter, something everybody thought they knew all about -because it had been under their nose all their life and was one of the -commonplaces of every-day living, but for that very reason it failed -to receive credence, and the backbone of the doubt was habit--lifelong -habit--and this was hard to break even in those who accepted the theory -of economic nutrition as a logical conviction. It was also necessary -to prove that it was not personal idiosyncrasy that favoured us, its -advocates. - -It is in pursuit of the latter desideratum that the officers of the -army, the scientists, and the great humanitarian health-restoring -institutions have entered upon conclusive investigations, each in -their own way, to chart out a law of economy that will be generally -applicable and which, it is hoped, can be understood by kindergartners -and mothers for the benefit of the present and of coming generations. - - * * * * * - -It was just stated that no one concerned in the inquiry was interested -in any food product or in any personally profitable business concern, -and mention of the Battle Creek Sanitarium, so widely known as the -pioneer in fostering the pure food and prepared-cereal manufacture, -may cast a doubt upon the matter in the minds of those who do not -know that the Sanitarium organisation, in its every department, is a -philanthropic, humanitarian institution. It is the parent and feeder of -the American Medical Missionary Cause, which already has established -branches in something over sixty localities situated in or near large -cities in different parts of the world, chiefly America. By perpetual -charter all the profits revert to the spread of the work and the -employees serve for a mere pittance, deriving their major compensation -from enjoyment of the altruistic work. - - * * * * * - -The old prejudice against the human race which declared that “everybody -had an axe to grind,” that there was “a nigger in every woodpile,” and -such like slanders, must be modified in the light of recent altruistic -development. Altruism has always been existent and had a great new -birth with the beginning of our era, but it was never before so frankly -put upon a business basis as it is now, and this is fast being applied -to every department of business activity. It is now done, not in the -name of any particular creed or cult, or for future reward, but because -_it pays_--first, last, and all the time. - - * * * * * - -In the study and pursuit of menticulture the author has found that -working for the common good is as necessary to happiness as working for -self, and that the retroactivity and reciprocity of the idea multiplies -the profits indefinitely. - -The sequence of profitable, altruistic interrelation is stated in the -“Explanation” of the chain of the A. B. C. Life Series, of which this -book is one of the links. - - * * * * * - -Aside from those actively engaged in the several investigations to whom -reference is often made, the author wishes to express special gratitude -to Sir Michael Foster and to Professor Henry Pickering Bowditch of -the Board of Scientific Assessors. Unselfish and unremitting in their -assistance and encouragement, the author’s work has been made easy -since their interest was enlisted. - -Sir Michael, as Member of Parliament in England, and as a physiological -savant, knows that economic nutrition is the key to England’s welfare, -as well as the basic necessity of temperance, morality, health, and -efficiency, as is expressed in the two documents from him reproduced -in the “Report of a Plan for an International Investigation into -the Subject of Human Nutrition” and in his “Note” on the Cambridge -examination of the author and Dr. Van Someren at Cambridge University -laboratories, given herein. - -Professor Bowditch, as a distinguished physiologist, publicist, and -especially as the President of the Children’s Aid Society, of Boston, -Massachusetts, often mentioned as the model institution of its kind -in the world, realises that the effort of the author to secure basic -knowledge relative to right nutrition, adaptable to kindergarten -teaching and home training during the impressionable period of youth, -is of the greatest importance in social reform. - -A trial suggestion relative to ways and means of _beginning right_ with -_all the children_ and thus insuring a regeneration of the classes most -in need of reform, in not longer than two decades, is outlined in the -author’s appeal for the waifs of society, entitled “That Last Waif; or -Social Quarantine.” - -Whenever there is any disposition to slack up in patience or enthusiasm -to accomplish the ultimate end aimed at, the picture of the waif -in that story is flashed back by memory, and there can be neither -forgetfulness, indifference, nor repose until “that last waif” has been -given _at least a chance of choosing_ between the right and the wrong, -the good and the bad. - - - - - POSTINTRODUCTORY - - -[Just before “going to press” the author has received a letter from -his esteemed colleague, Dr. Hubert Higgins, giving the gist of -interviews with an eminent European physiologist and with a famous -American chemist and dietitian, which so well describes the attitude -of the scientific mind towards the problem of human nutrition that the -scientific mentor of the writer advises its addition to the book. - -By the same post there arrived a letter from Dr. J. H. Kellogg, the -life and director of the Battle Creek Sanitarium, expressing practical -appreciation, the result of demonstration, of what is being done to -solve the problem. - -Eliminating the personal element and keeping the ultimate object in -view, these communications are coincidentally _a propos_ and intimate -to our “Introduction”; hence their reproduction here. - -Numerous other letters and extracts from communications received by the -writer, bearing upon this subject, from the above and other sympathetic -friends are reproduced in “The New Glutton or Epicure,” a free and -easy companion of this book, intended to appeal to a variety of readers. - -When it is known that the proceeds of all the publications of the -author are dedicated to the promotion of the objects they advocate, -reference to them or advertisement of them cannot be considered -inappropriate.—HORACE FLETCHER.] - - - EXTRACTS FROM DR. HIGGINS' LETTER - - PALAZZINA TASSO, - CAMPO S. POLO, - VENEZIA. - - October 3, 1903. - -DEAR MR. FLETCHER,--A. appears to me to have an exceedingly broad and -philosophic grasp of the problem of nutrition. - -He recognises that all present data are subject to criticism, and that -there are no scientifically accurate data available because - - (_a_) Observations are taken over too short a period. - - (_b_) They have mainly dealt with one side of the problem,--the output - of muscular work. - - (_c_) The observations are not sufficiently complete. - -He acknowledges that cleavage products from food broken down in the -intestines by bacteria are the cause of - - (_a_) Inefficiency - (_b_) Diseases - (_c_) Mental derangements. - (See Mott’s work.) - -He recognises that the majority of people eat far too much. He puts -this in the following way. If a “mediæval devil” had wished to discover -the most subtle and most effective way to destroy mankind mentally, -morally, and physically, he would have arranged for them to be supplied -with tasty, well-cooked foods, wines, etc.; in short, he would have -used every means to tempt, confuse, and pervert their appetite. He -would also have arranged every possible means to prevent their being in -the fresh air and taking exercise. He thinks one has here the picture -of modern civilisation. - -He talked in a very interesting and instructive manner about the -necessity and value of exercise and a muscular body for the maintenance -of good health. He has evidently worked at and thought a good deal -about this side of the subject. - -He regrets that there are not more people who realise the huge -importance of understanding the nutrition problem for the sake of -the progress of humanity. He would like to join all those who are -interested in forming an international society, as far as I understood -him. - -He is most keen on getting subjects, such as myself, for study over -a very long period of time,--two to three years,--as he very justly -observed “Muscular output is a very small part of the measure of a -man’s efficiency. Mental efficiency, manual dexterity, and other -psychological tests are necessary.” He seemed very much interested in -my idea of making a large number of curves of daily observations. He -said that it appeared to him to offer the best means of ultimately -measuring the degree of deviation from the subject’s optimum state of -health. - -He argues the necessity of getting some scientific definition of health. - - * * * * * - -The phrase that reduces all these people to contemplative silence is -this. - -“You acknowledge that the state of knowledge is insufficient to -prescribe a diet for any individual that he should take daily; or -in other words, that there is very little accurate knowledge of the -nutrition problem.” - -Reply. “Yes. I do not feel I could prescribe a diet for any one with -any degree of confidence.” - -“Very well, then. Why should not the body have or acquire the quality -that all animals have, in a free, natural state, of knowing what their -body wants by appetite and taste?” - -This is more or less how you put it to me when I first met you at -Cambridge. Its full significance did not dawn on me till much later; -till, in short, I commenced the study of my desires at Cambridge. - -Now this point of view is the rock on which we stand, and is the cause -of H.'s and A.'s interest, and as H. said, is the “most fascinating -idea” he ever heard. - -It had very much the same effect on A. He was reduced to silence. The -more you think of it the more you see there is no answer that could -contradict it. - -_He then admits that_ - - (_a_) The food should be finely divided. - - (_b_) That it should be thoroughly insalivated. - - (_c_) That in all probability most diseases are caused by dietetic - error. - - (_d_) That we have still to find the optimum health and the optimum - diet. - -He only kicks at the low proteid. Now I don’t care a “kuss” for the low -proteid, as such, or high proteid. Proteid like everything else will -be demanded by the appetite when it is wanted. - -Our great danger, to my mind, is the tendency so strongly exemplified -by some of prescribing diets and quantities and the length of time food -should be chewed.[1] Now the very errors we are fighting against are -the prescription of methods on insufficient information or knowledge. -_You have gone straight back to Nature._ _There is your strength_ in -convincing the scientific world, and we must study the problem from -that point of view if we are to get any great degree of success. - -A. had nothing to say when I told him that I did not hold by either -high or low proteid but only by my appetite and taste, developed by -ample mouth opportunity to discriminate, which I hoped, in time, to -understand more thoroughly than I do now. He told me that he feared -that there would be great physical deterioration after a long period -of low proteid. I said that I did not believe it would be the case by -your method. For instance, right in the midst of a long period of most -satisfactory low-proteid supply, I once ate nearly a whole chicken -with some ham at Penegal. I could not get saliva for anything else.[2] -In short, then, I insisted only on thorough mastication to protect -taste and appetite, and had no other theories. I was only concerned -in observing the factors determining my taste and appetite. I would -be more than contented to leave the question of minimum and maximum -quantity of proteid to be settled in the future after normality had -been established by practical demonstration. - - Yours faithfully, - HUBERT HIGGINS. - - - EXTRACTS FROM DR. KELLOGG’S LETTER - - BATTLE CREEK, MICH. - October 7, 1903. - MR. HORACE FLETCHER. - -DEAR FRIEND,--Yours of September 30th just reached my hands and I -hasten to reply. - -I saw a newspaper note in reference to the soldiers which the -government has selected for the dietetic experiments, and also read -an interesting article in the _Popular Science Monthly_. You have -accomplished a great good thing in enlisting these scientific and -military men and interesting them in the investigation of this -wonderful reform. The marvellous thing about it is that these busy men -of science should have so readily undertaken an investigation which -involves so much surrender and self-denial, at least, at the start. I -know you are absolutely right. My personal experiences and observations -confirm me. In the experiments you mention, which I made in reference -to the daily ration for ordinary persons, I simply sought to ascertain, -as have others, how much and what kinds of food people are in the habit -of using, taking no account of the possible excess or the careless -manner in which they eat. The figures I got were sixteen ounces of -starch; 1.2 ounces fat, and three ounces proteids,--approximately 2,500 -calories. In observation of patients I have seldom found one able to -eat this amount. Personally, I habitually eat scarcely half as much. My -breakfast to-day was the yolks of two eggs, two or three tablespoonfuls -of corn flakes, a moderate-sized potato, and a couple of peaches. At -dinner I shall take a little more. - -I have been so busy with my patients and the new building, getting -things organised, that I have not done as much as I ought to in the -way of promoting your splendid reform; but I am going at it now in -good earnest. I feel it is one of the greatest things in sight, and it -fits right in to all the other things I am trying to do. I feel that -I owe you continually a great debt for the efforts you have made and -the splendid work you are doing, which will accomplish more for the -uplifting of humanity than all that Carnegie and Rockefeller are doing -with their millions. What they are doing is mainly to perpetuate old -errors, while you are bringing out new truth of basic importance, and a -kind Providence has certainly inspired you to do this grand work. - -I thank you for all your good thoughts towards us, and assure you -the loving encouragement your letters always contain is very much -appreciated, and sometimes it gives us a mental uplift just when we -need it. The road we are travelling over is not altogether free from -thorns. All your suggestions are gratefully received. I remain, - - Faithfully yours, - - J. H. KELLOGG. - - - - - A. B.-Z. PRIMER - - - - - EXPLANATION - - -This is a condensed presentment of a subject of basic importance to -everyone, supported by numerous appendices of great scientific weight. - -The special object of such brevity and elementary treatment of the -subject is: - -=1.= To accentuate the facts showing how little we really have to know -and do in connection with our sustenance in order to have the NATURAL -AUTOMATIC PROCESSES done rightly and healthfully. - -=2.= To permit busy persons who will take our dictum as gospel and our -advice as sound to learn their necessary share in their own nutrition -in the least possible time, leaving the less credulous and more curious -to study the appendices at leisure and at will. - -=3.= For some ten years it has been the ambition and the aim of the -older and non-professional author to embody the fundamental essentials -of human responsibility in self-understanding and self-management in -not more than ten pages of coarse print that a child could understand -and that mothers and teachers might commit to memory and never forget. - -This is only a first trial-attempt to fulfil the ambition and the aim; -but the appendices show the assembling and concentration of scientific -and militant forces which will not allow this subject of primal -human interest to remain longer the most neglected of educational -departments. - - - - - SOME PERTINENT QUESTIONS - - -Will the reader not ask himself the following questions? - -=1.= How much do I know about my own nutrition? - -=2.= Do I know the particular need and purpose of my last meal and what -it is likely to accomplish? - -=3.= Considering my body as an engine, would I accept myself as a -competent engineer on my own examination and confession? - -=4.= Were I an iron and steel automobile, instead of a flesh and blood -automobile, which I really am, could I get a license for myself, as a -_chauffeur_, to run myself with safety, based upon my knowledge of my -own mechanism and the theory and development of my power? - -=5.= Were I an owner of valuable live-stock, would I employ a farm-hand -or a stable man, even at so low a wage as fifteen dollars a month, who -knew as little about the proper feeding of my animals as I know about -the proper feeding of myself and my children? - -=6.= Should I employ such an ignorant attendant for my live-stock, and -catch him worrying them during their feeding, and hurrying them away -from their fodder to hitch them up for work, would I not have the man -arrested for cruelty to animals? And yet this is what is habitually -done to children! - -=7.= Do I appreciate how important it is to learn sufficient of the -requirements of economic and healthy nutrition to enable me to escape -the depressing and debilitating effects of a faulty nutrition. - -=8.= How can I religiously “ask a blessing” upon food and then -immediately sin by treating it in a manner abhorrent to the natural -requirements? - -=9.= If “cleanliness is next to godliness” is it respectable for me to -slight my proper feeding in a manner that I know may induce putridity -of excreta through indigestion and that _may_ produce fatal disease? - -=10.= With All Eternity ahead of me, cannot I afford at least 1∕48[3] -of my time for careful feeding of my body in a manner known to favour -physical health; mental keenness; firmness of character; enjoyable -temperance; sexual vigour without morbidity. In fact, general -respectability and efficiency? - -Having duly reasoned out logical answers to the questions, may they not -seem sufficiently important to be remembered and respected as a DIETARY -TEN COMMANDMENTS? - - - - - A - - The Psychology of Nutrition - - APPETITE ATTENTION APPRECIATION - - -APPETITE is the most important factor in digestion (vide Pawlow). - -NORMAL APPETITE is indicated by a desire for _some particular_ simple -food accompanied by a “watering of the mouth.” - -FALSE APPETITE is a general discontent of the body, indefinite of -description. It is often expressed by “all gone-ness,” or stomach -craving, and calls for _something_, ANYTHING! to smother the discomfort -of present or recent indigestion. It is like the thirst which follows a -debauch. - -IGNORE FALSE APPETITE, and WAIT for a RETURN of NORMAL APPETITE. -It will come as soon as body repairs have been effected by natural -agencies and more material is required. No one was ever injured by -intelligently and calmly waiting for an appetite. No one ever starved -to death for lack of appetite. Most human ills come from forcing -appetite, anticipating appetite, abuse of appetite in some form. - -APPETITE is the most important factor in nutrition. This estimation is -based upon evidence given more fully in the various appendices, but the -measure of its importance may be briefly stated, as follows:— - - -_First_ - -In its normal state, Appetite is a perfect indicator of the bodily need -of nutriment and moisture, both as to quantity and as to the chemical -elements required at the moment. - - -_Second_ - -APPETITE is a creature of the mind and does not attach to a tissue. -It can be as easily changed, from abnormal to normal, by suggestion, -as can the mind itself, and is not like a solid, the form or habit -of which has been set in a mould. Whoever has once experienced a bad -oyster and has abhorred oysters ever after will substantiate this claim -regarding the caprices of appetite. - - -_Third_ - -APPETITE can be easily comprehended and read and the degrees of its -satisfaction understood by simple attention and study for a brief -period (vide Van Someren). - - -_Fourth_ - -ATTENTION is necessary to create APPRECIATION, and appreciation is -absolutely necessary to stimulate the secretion and flow of gastric and -other digestive juices (vide Pawlow). - - -_Fifth_ - -ANGER, or shock of any kind, and WORRY, or any of the pessimistic -depressants, stop digestive activity and cause indigestion (vide -Cannon). - - -_Sixth_ - -MENTICULTURE should begin with its application to selection (through -a normalised appetite) of nutriment for the body, and continue to aid -digestion by right thinking. - -It is very easy to cultivate calm and fortify against surprise, shock, -and anger if the nutrition of the body is carefully attended to. The -physical and the mental equipments are beautifully reciprocal and -necessary to each other in promoting MENTICULTURE. - - - - - B - - The Mechanical and Chemical Physiology of Nutrition - - BUCCAL DIGESTION - - THROUGH - - MOUTH THOROUGHNESS - - -Mouth treatment of food, which permits, aids, and includes insalivation -(mixing with saliva), and which is both actively digestive in its -functions and preparatory to final digestion, is the only _actual -mechanical responsibility_ we have in our nutrition; and, in connection -with favourable A conditions, insures perfect digestion. It has been -so fully and clearly explained in some recent articles, “Observations -on Mastication,” by Dr. Harry Campbell, F.R.C.P., physician to the -Northwest London Hospital, printed in the “Lancet” of July 11th, 18th, -25th, and August 8th, 1903, that reference to the articles, reprinted -herewith, is all that is necessary here. - -In giving attention to careful mouth-treatment of soft or liquid foods -until they are absorbed by the Swallowing Impulse the best health and -economic results are obtained. It should, at least, be tried. - -This will not be found to be a tedious operation after a little -practice, when the habit of attention and care has been formed. On the -contrary, a new appreciation and enjoyment of taste will be acquired, -the delight of which has to be experienced to be understood. - -Some hints on learning how to _read_ the appetite, _command_ the -attention, and _masticate_ and _swallow_ food material _properly_ -follow. - - - - - METHOD - - - _First; Last; and All the Time_ - -Be sure that you are really hungry and are not pampering False -Appetite. If true appetite that will relish plain bread alone is -not present, wait for it. Especially beware of the early-morning -habit-craving. Wait for an _earned_ appetite, if you have to wait till -noon. Then: “Chew,” “Masticate,” “Munch,” “Bite,” “Taste” everything -you take in your mouth (except water, _which has no taste_), until -it is not only thoroughly liquefied and made neutral or alkaline -by saliva, but until the reduced substance all settles back in the -(glosso-epiglottidean) folds at the back of the mouth and excites -the Swallowing Impulse into a strong inclination to swallow. Then -swallow what has collected and has excited the impulse, and continue -to chew _at_ the remainder, liquid though it be, until the last morsel -disappears in response to the Swallowing Impulse. Never forcibly -swallow anything that the instincts connected with the mouth show any -disposition to reject. It is safer to get rid of it beforehand than to -risk putting it into the stomach. - -Sip and taste milk and all liquids that have taste as the wine-tasters -do. They never drink wine and yet they get all the enjoyment there is -in it and waste none. In a very short time sipping and tasting liquids -and masticating and tasting solid food for “all they are worth” will -become an agreeable and profitable fixed habit. - -WHETHER WE “EAT TO LIVE OR LIVE TO EAT,” WHY NOT DO AS ABOVE? - - - - - Z - - The True Chemical End-Point of Digestion - - THE DIGESTION-ASH WHAT IT SHOULD BE LIKE WHEN IT IS NORMAL - - -_First_ - -In adults; or, in children after the eruption of teeth and the -ingestion of solid food: The non-liquid and non-gaseous waste of the -human body, which, in its normal state, is not offensive, should be -very small, in quantity, should be pillular in form, either separate or -massed together; should have no odour when released, should take on no -odour on standing, should be entirely aseptic (non-poisonous); should -drop freely from the exit, leaving nothing behind to wash or wipe away. -It _may_ not be collected in the intestines of full-grown and elderly -persons, when normal, as above, in sufficient quantity to require or -necessitate emptying oftener than from twice a week to once in two -weeks; according to age, activity, etc.; and should neither invite nor -justify the description “it is not that which goeth into a man that -defileth him but that which cometh out.” - - -_Second_ - -Economic Digestion-Ash (solid _excreta_), as a daily average for an -adult of 140 lbs. (10 stone; 63.5 kilos), including moisture, when -released, should not weigh more than two ounces (56.70 grams). An -average of less than one half this amount of waste has been secured in -test experiments. - - -_Third_ - -The true test of healthy Z is absence of odour and completeness, ease -and cleanliness of delivery. Frequency or otherwise, does not so much -matter. Quantity too, is not so important; but with foul odour there is -disturbance, strain and danger. - -The normal man is a cleanly being with all excreta inoffensive; and by -these tokens he may be his own private judge. - -Why is it that barn-yards are tolerable to the human senses while open -_dépôts_ of human excreta are fever-breeding nuisances and intolerable -to beasts and humans alike? - -This curse of putrid excreta caused more deaths from enteric fever -during the Boer War in South Africa than all other causes. It is -equally a menace to health and even to life while being formed and -carried in the body. - - -_Fourth_ - -Offensive excreta are quite certain evidence of neglect of the -self-controllable parts of our own nutrition. They are the tell-tale -condemnation of ignorance or carelessness. Each person should learn to -read the true bulletins of his health conditions in his waste-products -of digestion. - - -Z - -is the form the body _must_ assume to render emptying of the -digestion-ash natural and easy. Man was built to squat on his heels in -defecating, and sitting erect on a modern seat is like trying to force -a semi-solid through a kinked hose. HEALTHY HUMAN EXCRETA ARE NO MORE -OFFENSIVE THAN MOIST CLAY AND HAVE NO MORE ODOUR THAN A HOT BISCUIT. - - - - - A. B.-Z. FIGURE - - TO ILLUSTRATE THE “DIVISION OF LABOUR” - - -_First._ A - - Psychic Environment } This - Mental State } involves: - - APPETITE (to select for) } - ATTENTION (to prepare for) } DIGESTION - APPRECIATION (to assist in) } - -(Absolutely necessary to secure secretion and flow of the digestive -juices: Vide Pawlow and Cannon.) - - -_Second._ B - - BUCCAL-DIGESTION } This - MOUTH-TREATMENT } involves: - - MECHANICAL (teeth) } THOROUGHNESS - CHEMICAL (salival) } - -(Absolutely necessary to secure complete digestion and avoid the -putridity incident to bacterial decomposition: Vide Campbell and Van -Someren.) - - -INTERMEDIATE - -The twenty-three letters between “=B=” and “=Z=” represent but an -inadequate proportion for the spelling of the enormous share Nature -assumes in our welfare, marvellously performing her forty-seven -forty-eighths share in the secret laboratory of the alimentary canal. - - -_Third._ Z - -The true chemical end-point of digestion, by which each self-respecter -may know how well he has respected his “A” and his “B,” and how -faithfully he has performed his one forty-eighth share in the promotion -of his own most fundamental interest. - - - - - PREFACE TO 1906 EDITIONS - - -Since the former introductions were written much success has been -attained in further advancing the reforms advocated in the _A. B. C. -Life Series_. Professor Chittenden has published his report on the -Yale experiments in book form in both America[4] and England,[5] and -his results have been accepted in scientific circles the world over as -authoritatively conclusive. - -At the present writing the most important Health Boards of Europe[6] -are planning to put the new standards of dietary economy into practical -use among public charges in a manner that can only result in benefit -to the wards of the nations as well as make an important saving to -the tax-payers. In the most important of these foreign public health -departments the Health Officer of the Board has himself practised the -newly established economy for two years, and his plans are formulated -on personal experience which fully confirms Professor Chittenden’s -report and that of the author as herein related. - -At a missionary agricultural college, situated near Nashville, Tenn., -where the students earn their tuition and their board while pursuing -their studies, a six months' test of what is termed “Fletcherism” -resulted in a saving of about one half of the drafts on the commissary, -immunity from illness, increased energy, strength and endurance, and -general adoption of the suggestions published in the several books of -the author included in the _A. B. C. Life Series_. - -In the various departments and branches of the Battle Creek Sanitarium -in America, and widely scattered over the world, some eight hundred -employees and thousands of patients have been accumulating evidence of -the efficacy of “Fletcherism” for more than three years, and scarce a -month passes without a letter from Dr. Kellogg to the author containing -new testimony confirming the _A. B. C._ selections and suggestions. - -The author has received within the past two years more than a thousand -letters bearing the approval of the writers with report of benefits -received which seem almost miraculous, and these include the leaders in -many branches of human occupation--physiologists, surgeons, medical -practitioners, artists, business men, literary workers, athletes, -working men and women, and almost every degree of mental and physical -activity. - -One of the medical advisers of King Edward, of whom the King once said: -“He is a splendid doctor but a poor courtier,” follows the suggestions -of these books in prescribing to his sumptuous clients. - - - - - HISTORY OF DEVELOPMENT - - AND - - SUPPORTING EVIDENCE - - - - - SUMMARY OF THE FOREGOING PAGES BY AN EXPERIMENTER OF ONE MONTH’S - EXPERIENCE - - (_Requested and given as a test of effectiveness_) - - -The entire principle of economic nutrition is simple and practical. It -does not prescribe that we shall follow any special diet nor do away -with any of our meals. It simply requires you to throw present habits -and conventions to the winds, and for a little time try the experiment -of giving the matter of your every-day living honest, intelligent -thought. - -Eat all you crave, but do not eat more than this simply because you -have been in the habit of doing so. See to it that each morsel put into -your mouth is thoroughly masticated and mixed with the saliva before -going down into the stomach, which is not equipped to perform the work -which the teeth and salivary glands were given you for. The stomach -will struggle bravely to overcome the abuse which you heap upon it, but -in spite of all it can do to manage hastily chewed food, undigested -portions remain which clog the intestines and interfere with the -healthy conditions which Nature intended. - -The appetite is given as an indicator of what the body requires. If -you crave potato, the system needs starch, which the saliva makes -digestible, but which the acids of the stomach cannot dissolve. Other -needs of the system are similarly indicated. Take the trouble of asking -your appetite the question, instead of accepting the conventional -number of courses simply because they are set before you. The appetite -will close the valve when you have eaten enough, if you will give it a -chance. - -Suppose your time for eating is limited; in twenty minutes you could -not eat slowly the luncheon which you usually select. Then eat that -much less. The amount of food which you can eat and thoroughly -masticate in twenty minutes will give you more nourishment and will -sustain you better than twice the amount thrown into the stomach in the -same manner in which a man usually packs a trunk. - -Why is it that so many men require a “bracer” at eleven o’clock? -Because they have loaded their stomachs with a heavy breakfast, and -instead of gaining nourishment from it, the smothered organ is doing -its best to tear the undigested morsels to pieces, that they may pass -into the intestines and prevent sickness, or even death. The time -finally arrives when it finds itself unable to do this, and then comes -acute indigestion, or something worse, and the system becomes run down, -ready to receive typhoid, or any other germs which happen to come along. - -Do you know why griddle-cakes hurt you? Because the syrup, which is -cane-sugar,--and as such is indigestible,--is allowed to pass through -the mouth and down into the stomach, without being properly mixed with -the saliva, which makes it digestible. As soon as it enters the stomach -it becomes acid and interferes with everything it meets. Had the cakes -been properly masticated and mixed with the saliva, the cane-sugar -would have become grape-sugar, and in this form it is easily digested. - -Why is it that stout people are advised to avoid starchy foods? -Economic nutrition does not advise this. Potatoes, eaten too -hastily, when not craved by the appetite, supply the system with a -superabundance of starch, and this is fat-inducing. Potatoes are -supposed to produce fat; but if your appetite craves potato, and you -properly masticate it, eating only as much of it as satisfies your -appetite, the system absorbs it all, leaving nothing to produce fat. -On this same principle economic nutrition assures that the same food, -taken in accordance with its requirements, will add to one man’s -weight and decrease another’s, simply because proper care of the -stomach supplies the vital organs with the necessary materials to form -each individual person after the model which Nature intended for him. -If Nature intended him to be slight, economic nutrition will not make -him heavy; if Nature intended him to be muscularly strong and heavy, -economic nutrition will not reduce his weight. In each case he will -enjoy that perfect condition which Nature intended him to possess -without fat encumbrance. - -Did you ever try to reason out why it is necessary for athletes to go -into training? Simply because, in order to get the best use of their -strength, they are obliged to spend some number of weeks or months in -overcoming false conditions which they have brought upon themselves. -Any person who lives in accordance with the simple requirements of -economic nutrition has nothing of this kind to overcome, but is in -perfect condition all the time. - -The requirements of economic nutrition are not hardships but pleasures. -Proper mastication and insalivation (mixing with saliva), give your -sense of taste far greater gastronomic enjoyment than you have ever -before had. If you are a wine drinker, try insalivating a little port -wine; but it must be good wine, for this is a severe test. A sip will -quench your immediate desire and give you more pleasure than a whole -glass gulped down. The professional tea-taster does this in tasting -tea; he never allows himself to drink any tea at all, for drinking -anything that has taste destroys the delicacy of the sense of taste. -But he will tell you that he gets more real enjoyment out of the little -he takes than he previously gained from drinking a larger amount. The -same thing applies to the professional wine-tasters; they never drink -any wine, and yet they enjoy the taste of wine as drinkers never can -do. These men adopt this method as a business; is their commercial -advantage of greater importance than your health and happiness, and -even life itself? - -Is it not ridiculous that the average man is so ignorant of the engine -which supplies him with all his activity and upon which depends every -action of his life? Could you tell, were you asked, the particular need -and purpose of your last meal and what it is likely to accomplish? -Consider your body as an engine: would you accept yourself as a -competent engineer on your own examination and confession? Would you -employ a chauffeur to run your automobile who knew as little about its -mechanism and requirements as you do about your own stomach? Yet which -is of greater importance? Were you the owner of valuable live-stock, -would you dare entrust their care to a farm-hand or stableman who knew -as little about their proper feeding as you know about your own proper -feeding or that of your children? - -Have you ever stopped to think why the excrements are foul and odorous? -Simply because undigested food, which should have been so masticated -as to give the body nourishment, is thrown off by the stomach into the -intestines, there to decay and produce this unclean condition. If the -dead carcass of a cow is lying in the road, it is removed before it has -an opportunity to decay and thus become filthy and dangerous. Yet how -much more safe it would be for the carcass to lie where it was than -for you to take portions of it into your intestines and allow it to -decay there instead of in the road? In other words, food is intended -to be eaten that nourishment may be gained from it, and when you only -gain a part of the nourishment, you prostitute your stomach and take -tremendous risks of germ diseases in your body. - -These facts are set forward thus simply in the hope that they may -impress the reader as they have impressed the writer. Economic -nutrition is not a joke, is not a fad; it is solely an appeal to -self-examination and self-instruction in the most vital question of -all the world, since upon perfect nutrition depends not only health, -but strength, mental acuteness, moral tendencies, attractability to -others, happiness, and, in fact, life itself. - - - - - FIRST SCIENTIFIC RECOGNITION OF THE PRINCIPLES OF ECONOMIC NUTRITION - OUTLINED IN “GLUTTON OR EPICURE” - - -[With the exception of a brief review of _Glutton or Epicure_, by Dr. -Joseph Blumfield, of London, published in _The Lancet_, no scientific -or professional recognition of the principles of an economic nutrition -attained by means of thorough buccal digestion was gained until issue -of the following paper by Dr. Ernest Van Someren, of Venice, Italy. - -The previous autumn and winter had been devoted to experiments by -Dr. Van Someren and the writer, in co-operation with Dr. Professor -Leonardi, for twelve years Professor of Chemistry in the University of -Pavia, Italy. In the spring and summer of 1901 the field of experiments -was changed to Mendel Pass, _bei_ Bozen, Süd Tirol, Austria, and -related to endurance work in climbing mountains and bicycle runs among -the Dolomites. - -Dr. Van Someren’s paper attracted the attention of Sir Michael Foster, -Professor of Physiology at the University of Cambridge, England, -and Permanent Honorary President of the International Congress of -Physiologists. - -Professor Foster entered into correspondence with Dr. Van Someren, and -this was followed by an invitation to Dr. Van Someren and the writer to -attend the Congress which was to convene in Turin, Italy, during the -month of September following. At the Congress Dr. Van Someren presented -a technical thesis on the probable causes of the economy attained, -and gave a demonstration of the movement of his Swallowing Reflex -in relation to food in the process of liquefaction and preliminary -digestion in the mouth. - -Following the Congress we received an invitation to visit Cambridge, -England, and submit to tests of nitrogenous measurements in the -Physiological Laboratory of the University, under the direction of Dr. -F. Gowland Hopkins; and also to an examination of the bacterial flora -incident to the nitrogenous estimations, under the direction of Dr. -George H. F. Nuttall. - -The report of the experiments in the Chemical-Physiological Department -is given in the “NOTE” of Sir Michael Foster, which follows Dr. -Van Someren’s paper, but the bacterial examination was not carried -far enough to warrant a scientific report, owing to difficulty of -obtaining, at the time, sufficient data.—HORACE FLETCHER.] - - - - - WAS LUIGI CORNARO RIGHT? - - A PAPER READ BEFORE THE PHYSIOLOGICAL SECTION OF THE BRITISH MEDICAL - ASSOCIATION, AUGUST, 1901, BY ERNEST VAN SOMEREN - - -_Mr. President and Gentlemen:_ - -Being a general practitioner, it is with some trepidation and an -apology that I present myself before this section. The reasons for my -doing so are: First, that I believe that a hitherto unsuspected reflex -in deglutition has come to light which has an important bearing on -health, the prevention of disease and on metabolism. Second, that any -theory whatever, based on a possible physiological function, claiming -to diminish, as this does, the amount of sickness and suffering now -existent, should have serious investigation. Third, that I desire to -enlist your skilled help in the consideration of the theories I have -doubtless crudely erected on my premise. - -According to the “Encyclopædia Britannica,” “Luigi Cornaro (1467-1566) -was a Venetian nobleman, famous for his treatises on a temperate life. -From some dishonesty on the part of his relatives, he was deprived -of his rank and induced to retire to Padua, where he acquired the -experience in regard to food and regimen which he has detailed in his -work. In his youth he lived freely, but after a severe illness at -the age of forty, he began under medical advice gradually to reduce -his diet. For some time he restricted himself to a daily allowance -of 12 ozs. of solid food and 14 ozs. of wine. Later in life he still -farther reduced his bill of fare, and he found that he could support -his life and strength with no more solid meat than an egg a day. So -much habituated did he become to this simple diet that when he was -about seventy years of age the addition, by way of experiment, of 2 -ozs. a day had nearly proved fatal. At the age of eighty-three he -wrote his treatise on the ‘Sure and Certain Method of Attaining a -Long and Healthful Life.’ And this work was followed by three others -on the same subject, composed at the ages of eighty-six, ninety-one, -and ninety-five, respectively. ‘They are written,’ says Addison -(‘Spectator,’ No. 195), ‘with such a spirit of cheerfulness, religion, -and good sense, as are the natural concomitants of temperance and -sobriety.’ He died at the age of ninety-eight. Some say of 103! - -Now, was Luigi Cornaro right? Did he make use of a physiological -process unknown to us of the value of which he was not cognisant? To -live to an advanced age, must we be as temperate as he, reducing the -quantity of our food to a minimum required by Nature? - -That we all eat more than we can assimilate is unquestionable. How can -we determine the right quantity? Instinct _should_ guide us, but an -abnormal appetite often leads us astray. Nature’s plans are perfect -if her laws are obeyed. Disease follows disobedience. Wherein do we -disobey? - -We live _not_ upon what we eat, but upon what we digest; then why -should undigested food, recognisable as such, be deemed a normal -constituent of our solid egesta? - -Something like the following must be a common experience to general -practitioners, especially to those practising on the Continent. The -patient comes to see us and volunteers the information that he or she -has the “gout,” “rheumatic gout,” or “dyspepsia.” Symptoms are asked -for. The case is gone into carefully for causation. An appropriate -diet and an appropriate bottle of medicine prescribed. As the patient -leaves the room, we may, or may not, call attention to the fact that -both teeth and saliva are meant to be used. The patient returns, -better, _in statu quo_, or worse. If better, he remains so while -under treatment, and relapses when he returns to ordinary habits. If -unaffected, or worse, we try again and again, until we despair, then -take or send him to a consultant. Temporary benefit, possibly owing to -renewed hope, results; but finally the unfortunate gets used to his -sufferings and, if he can afford it, is sent to join the innumerable -hosts that wander from one _Bad_ to another, all Europe over, trying, -praising, and damning each in turn. Their manner of living is, of -course, at fault. Nature never intended that man should be perpetually -on a special diet and hugging a bottle of medicine, nor did she ordain -that he should go wandering over the map of Europe drinking purgative -and other waters. - -Though early yet to speak with certain voice, it would seem that we -are provided with a Guard, reliance on which protects us from the -results of mal-nutrition. There seems to be placed in the fauces and -the back of the mouth a Monitor to warn us what we ought to swallow and -when we ought to swallow it. The good offices of this Monitor we have -suppressed by habits of too rapid eating, acquired in infancy or youth. - -Last November my attention was called by Mr. Horace Fletcher, an -American author living in Venice, to the discovery in himself of a -curious inability to swallow, and a closing of the throat against food, -unless it had been completely masticated. My informant stated that he -noticed this peculiarity after he had begun to excessively insalivate -his food, both liquid and solid, until all its original taste had been -removed from it. Any tasteless residue in the mouth, being refused by -the fauces, required a _forced_ muscular effort to swallow. He further -told me that since adopting this method of eating he had been cured of -two maladies, adjudged chronic, the suffering from which rendered him -ineligible for Life Insurance. His weight now became reduced from 205 -lbs. to 165 lbs. He had practised no abstemiousness, had indulged his -appetite, both as to selection and to quantity, without restraint, and -for the last three years had enjoyed perfect health. - -After his cure, he was accepted without difficulty for insurance, the -last examination finding him an unusually healthy subject for his age. -Having leisure, he had spent three years in investigating the cause of -his cure, had pursued experiments upon others, and had extended his -inquiries, both in America and Europe, until our meeting in Venice. -He had also published a statement and inquiry in book form, entitled -“Glutton or Epicure,” which had been reviewed by the “Lancet.” - -For nearly a year I also had been experimenting on myself and others -with various diets, and was ready to believe that in the _manner_ of -taking food and not altogether in its varying _matter_ lay perhaps its -protean effects on our system. I at once adopted the same method of -eating. At the end of six weeks, I noticed that not only did the fauces -refuse to allow of the passage of imperfectly prepared food, but that -such food was returned from the back to the front of the mouth by an -involuntary, though eventually controllable, muscular effort taking -place in the reverse direction to that occurring at the inception of -deglutition. - -What actually happens is this: Food, as it is masticated, slowly passes -to the back of the mouth, and collects in the glosso-epiglottidean -folds, where it remains in contact with the mucous membrane containing -the sensory end-organs of taste. If it be properly reduced by the -saliva it is allowed to pass the fauces,--a truly involuntary act of -deglutition occurring. Let the food, however, be too rapidly passed -back to these folds, _i.e._, before complete reduction takes place, -and the reflex muscular movement above referred to occurs. The process -of this reflex is as follows: The tip of the tongue is involuntarily -fixed at the backs and bases of the lower central incisor teeth by the -anterior fibres of the geniohyoglossi muscles. With this fixed point -as fulcrum, the lower and middle fibres of these muscles, aided by -those of the stylohyoid and styloglossi muscles raise the hyoid bone, -straighten out the glosso-epiglottidean folds, passing their contents -forward, by the fauces, the opening of which is closed by approximation -of its pillars and contraction of the superior constrictor. The -tongue, arched postero-anteriorly by the geniohyoglossi, palato, and -styloglossi muscles, laterally, by its own intrinsic muscles, is -approximated to the fauces, soft and hard palates in turn, and thus, -the late contents of the glosso-epiglottidean folds are returned to the -front of the mouth for further reduction by the saliva preparatory to -deglutition. - -The word reduction is used for the reason that all foods tested, -without exception, give an acid reaction to litmus, when served at -table. The reflex muscular movement occurs in the writer’s case from -five to ten times during the mastication of each mouthful of food, -according to its quantity and its degree of sapidity. As often as it -recurs, the returned food continues to give an acid reaction, while -food allowed to pass the fauces is alkaline. - -Saliva, flowing in response to the stimulation of taste, seems more -alkaline than that secreted in answer to mechanical tasteless -stimulation. It is found that the removal of original taste from any -given bolus of food coincides with cessation of salivary flow and -complete alkaline reduction. The fibre of meat, gristle, connective -tissue, the husk of coarse bread and cellulose of vegetables are -carefully separated by the tongue and buccal muscles and rejected by -the fauces. To swallow any of these necessitates a _forced_ muscular -effort, which is abnormal. - -Adult man was not originally intended to take his nourishment in a -liquid form, consequently all liquids having taste, such as soup, milk, -tea, coffee, cocoa, and the various forms of alcohol, must be treated -as sapid solids and insalivated by holding them in the mouth, moving -the tongue gently, with straight up and down masticatory movements, -until their taste be removed. Water, not having taste, needs no -insalivation and is readily accepted by the fauces. - -In explanation of the phenomenon described, the following theory is -advanced: The fauces, back of the tongue, epiglottis, in short, those -mucous surfaces in which are placed the sensory end-organs of taste -and “taste-buds” (the distribution of which, by the way, has yet to -be explained), that these surfaces, readily becoming accustomed to -an alkaline contact by excessive insalivation and consequent complete -alkaline reduction of the food, afterwards resent an acid contact and -express their resentment by throwing off the cause of offence by the -muscles underlying them. - -This phenomenon must not be confused with the cases of rumination and -regurgitation, which from time to time are recorded. The food in this -case is not swallowed, nor does it pass any point from which it can -be regurgitated. Eighty-one individuals of different nationalities -and from several classes of society whom we have studied are now in -conscious possession of their reflexes. These seem readily educated -back to normal functions by all who seriously and patiently adopt the -habit of what seems only at first to be excessive insalivation. - -The dictum “bite your food well” that we so often use, has no -meaning to those suffering from the results of mal-assimilation and -mal-nutrition, especially should they have few or no teeth of their -own. I make so bold as to state that dyspepsia _et morbi hujus generis -omnis_ will cease to exist if patients be persuaded to bite their -food until its original taste disappears, and it is carried away by -involuntary deglutition. - -The important point of the whole question seems to be this alkaline -reduction of acid food before it passes on to meet subsequent -digestive processes elsewhere, which then become alternately acid and -alkaline. - -In the first few months of infant life, when saliva is not secreted, -Nature ordains that mammary secretion be alkaline. With the eruption -of teeth come an abundant flow of saliva and a synchronous infantile -capacity for managing other foods. This flow of saliva depends on a -thorough demand and use to maintain its generous supply. It is just -at this time that children learn to bolt their food,--the demand -fails, with a consequent detriment to the salivary glands, digestive -processes, and the system generally. - -A, B, C, and D were placed on an absolute milk diet. A drank his milk -in the ordinary way, and at the end of three days begged to discontinue -the experiment owing to disgust at the monotony of the diet. B, C, and -D continued the experiment for seventeen days, insalivating the milk, -but to a varying extent, B the least and D the most. Though D took most -milk, he excreted least solid egesta, C excreting less than B. Can one -infer that increased insalivation of a non-starchy food insured its -better digestion and assimilation? Each subject took as much milk only -as his appetite demanded, D taking the most, which never exceeded two -litres daily. The weights of the subjects after the usual sudden drop -of the first three days remained remarkably even until the end of the -experiment. B, C, and D all relished the diet, and it satisfied the -requirements of their appetites, but they experienced an increasing -monotony. - -As long ago as the seventeenth century, before the transformation of -matter into energy by the animal organism, known as Metabolism, was -understood, the fact was recognised that by the lungs, kidneys, skin, -and intestines, substances no longer useful to the organism were -eliminated, the retention of which proved harmful. The nature of these -substances was unknown, but it was noted that however much the food was -increased the weight of the body remained the same. In other words, a -state of complete nutritive equilibrium was maintained. - -The following table contains the _résumé_ of two experiments in which a -state of complete nutritive equilibrium was maintained by individuals -of about the same weight, on widely different quantities of food -similar in quality. The subjects of the experiments were a laboratory -assistant of Dr. Snyder, of the U. S. Department of Agriculture, and -the writer. The experiment of the former was made primarily to show -the relative digestibility of the several articles of diet, potatoes, -eggs, milk, and cream: - - ═════════════════════════╤══════════════════════════╤═══════════════ - │ Dr. Snyder’s │ - │ Experiment. │ Writer’s - │ Published in │ Experiment. - │ Bulletin 43 │ - —————————————————————————┼————─—─—─—─—─—────—─—─—─—─┼─—─—─—───—─—─—─ - Age of subject │ 22 years │ 30 years - Duration of experiment │ 4⅓ days │ 5 days - Number of meals │ 13 │ 10 - Weight at beginning │ 62.5 kilos. │ 57.3 kilos. - Weight at end │ 62.6 kilos. │ 57.5 kilos. - Potatoes (daily average) │ 1587.6 grammes │ 159.4 grammes - Eggs (daily average) │ 411.08 grammes │ 124.7 grammes - Milk (daily average) │ 710 c.c. │ 710 c.c. - Cream (daily average) │ 237 c.c. │ 237 c.c. - Daily urine │ 1108 grammes │ 1098 grammes - Daily fæces │ 204 grammes │ 18.9 grammes - —————————————————————————┴————─—─—─—─—─—────—─—─—─—─┴─—─—─—───—─—─—─ - -The daily diet of Dr. Snyder’s subject consisted of three and one-half -pounds of potatoes, eight eggs, a pint and a half of milk, and half a -pint of cream. The writer’s diet of twelve ounces of solid food (like -Luigi Cornaro) consisted of three eggs, the remainder of the twelve -ounces in potatoes, and an equal quantity of similar liquid food to -that taken by Dr. Snyder’s subject. The exercise of the laboratory -assistant comprised his daily routine of laboratory work, while that of -the writer consisted of six sets of tennis, or an hour and a half on -horseback, with an hour to an hour and a half’s walk or climb daily, in -addition to much reading and writing. - -In each case complete nutritive equilibrium was maintained, although -the author subsisted on three-seventeenths of the solid food taken by -the other subject. - -Again, cannot one infer that better assimilation and less waste -resulted from the better preparation of the smaller quantity of food -by insalivation? Surely, too, there must be less daily strain on the -intestinal canal, and body generally, in getting rid of 18.9 grammes -of inoffensive dry waste, than in getting rid of 204 grammes of humid, -decomposing, and offensive matter. - -“Considerable importance has been attached to the normal action of the -bacteria in the intestines; and it has even been supposed that the -presence of bacteria is essential to life. Such a view has recently -been shown to be erroneous by an elaborate and painstaking research -carried out by Nuttall and Thierfelder, who obtained ripe foetal -guinea-pigs by means of Caesarean section carried out under strict -antiseptic precautions. They introduced the animals immediately into an -aseptic chamber through which a current of filtered air was aspirated, -and fed them hourly on sterilised milk day and night for over eight -days. - -“The animals lived, and throve, and increased as much in weight as -healthy normal animals subjected to a similar diet for the purpose of -controlling the results. Microscopic examination at the end of the -experiment showed that the alimentary canal contained no bacteria of -any kind, nor could cultures of any kind be obtained from it. - -“The same authors, in a subsequent paper, described the extension of -their research to vegetable food. This was also digested in the absence -of bacteria. Under such conditions cellulose was not attacked. Hence -they consider that the chief function of this material is to give bulk -and proper consistency to the food so as to suit the conditions of -herbivorous digestion.” (Schäfer’s “Text-Book of Physiology,” vol i. p. -465.) - -Now, inasmuch as bacterial digestion has no place in the animal -economy, surely it can only occur at the expense of the organism? - -Can micro-organic action take place in the intestines without the -production of toxins and the consequent absorption of these toxins into -the blood? - -We know that the metabolism of a cell is determined by the general -physical environment of the whole organism, by supplies of oxygen and -water, on nervous impulses, and, what chiefly concerns this argument, -on the nature and amount of the pabulum supplied to it. This pabulum is -derived from the alimentary canal. - -Are not even those of us who may be enjoying seemingly the best of -health supplying to our tissues pabulum containing mild toxins, thus -causing an increased katabolic action to occur in each individual cell -of our bodies? - -Are not the blood elements, floating in a plasma containing such -toxins, rendered resistant, weaker, less capable of fulfilling their -functions as carriers and combatants of disease? - -Are not their and our lives, in consequence, more painful and shorter -than they need be? - -Would not the elimination of these toxins render us less liable -to disease? And is not their presence an important element in -predisposition to disease? - -When this reflex is restored micro-organisms get no further than the -stomach. They are destroyed there by the acid gastric juices, then -only stimulated to their full and normal secretion by the presence -of a sufficiency of alkaline substance. Undigested matter having -been eliminated, micro-organisms, still existing in the intestines, -deprived of their means of subsistence, decrease, and, in time, may -cease to exist. The body no longer absorbs the toxins these produced. -To this fact may be ascribed the increase of mental energy, the -general physical betterment, the cessation of morbid cravings for -food and drink and of those of a sexual nature, which are noticed and -experienced. - -What has just been stated is based not entirely on experimental -evidence but somewhat upon inference. The inference seems justified -because the excreta, more especially of the intestines, but also of the -kidneys and skin, become almost odourless and entirely inoffensive. -The solid egesta are voided thickly covered with mucus, leaving the -end of the bowel dry and clean. The sense of cleanliness can only -then be appreciated to the full, for it is internal as well external. -_Flatus_ is no longer produced. The urine is inoffensive and seems to -be materially changed in quality, as shown by chemical analysis. Uric -acid, the chlorides, and, more markedly, aromatic sulphates are reduced -in quantity. - -Owing to deliberation in eating, necessitated by this new habit, -satiety occurs on the ingestion of considerably less food. By carefully -studying one’s self I believe it possible to cultivate an instinct -which will regulate not only the quantity but the quality of food that -the body may need, and that in the _normal health_ of a full-grown -body, no more food either in quantity or quality should be supplied -than suffices to supply diurnal waste. Any excess must result in -pathological processes. - -Although there results enhanced pleasure in the taking of all foods, -rich and simple, and especially in the appreciation of good wines, the -quantities of these foods and beverages that suffice to fully satisfy -the appetite are much smaller than before, while there is a marked -preference for the simpler kinds of food. The writer now can imagine no -more pleasurable meal than one consisting of good brown bread, eggs, -butter, cheese, and cream. These, with fresh vegetables and a very -little fruit, form his staple diet. This tendency and preference for -simple foods is the general experience among those who have recovered -their reflexes of deglutition. - -Following on the ingestion of a lessened quantity of food and on its -better assimilation, there is less waste, the egesta are voided less -frequently, sometimes only once in five to eight days. - -The lower bowel is not the reservoir it formerly was. So hæmorrhoids -cease from troubling and constipation cannot exist. For this same -reason the body, at the beginning of the practice, commences to -approximate to its normal weight, increasing or decreasing as the -individual’s environment demands. - -A few more words only need be said. It has been easy to state the -results of experiments and observations: but the acquiring of this -new reflex, while pursuing daily occupations, is not easy, and needs -more than a little patience and much serious thought. The habits of a -lifetime cannot be changed in a few days or weeks. The shortest time in -which the reflex has been re-established is four weeks, and this only -by avoiding conversation at meal-time and concentrating the attention -on keeping the food in the mouth until complete alkaline reduction has -taken place and sapidity has disappeared. - -In closing I wish to maintain as a fact, gentlemen, of the truth of -which you will only be convinced by actual experience, that by the -restoration of this reflex and in complete dependence on its use, -there lies true health, the establishment of a condition of stable -nutrition and the possible abrogation of two great predisposing factors -of disease, mal-assimilation and mal-nutrition. Unless there be among -you, as in the “Cities of the Plain,” a parlous minority who possess -this reflex and take your food as you ought, none of you are in the -enjoyment of such health as you might have. A like punishment will be -meted out to you as was visited on those cities, for you will all be -consumed long before your day by the unnecessary combustion in your -bodies caused by the circulation in them of toxins, the product of -undigested and decomposing food. - -The writer, bearing in mind the warning suggested by the Frenchman -whose donkey died as soon as he had reduced his food to a single wisp -of straw, finds that he is taking less and less food. While his mind is -open as to his arriving at the final diet of Luigi Cornaro, yet it is -easily conceivable that living a similar life of retirement in a placid -environment, it would be quite possible to do as he did. Hence the -title of this paper and the queries at the commencement. - -The objects in publishing and distributing this paper are twofold: to -make the subject as widely known as possible, and to solicit the aid of -colleagues in investigating it more fully. - -There is ready at the service of the general practitioner an important -and potential therapeutic agent in the saliva of his patients and in -the use _ad finem_ of their salivary digestions. - -By any chance should readers of this paper wish to ask any questions, -the writer will be happy to communicate with them. - - 183, CALLE DEL CAPELLO NERO, - Piazza San Marco, - Venice, Italy. - -_Editor’s notes._ (1) Confirmatory evidence of the correctness of -the deductions made in this paper has begun to come in from many -professional sources and notably from a famous child specialist who -avers that children would follow the natural requirements in eating -were it not for artificial food, bad example, and bad teaching. - -(2) In a report of a paper read before the _Société de Biologie_, -Paris, France, March 15th, 1902, by M. Max Marckwald, of Kreuznach, “ON -DIGESTION OF MILK IN THE STOMACH OF FULL-GROWN DOGS,” the following -appears: “Hence these experiments confirm those of Horace Fletcher -and Ernest H. Van Someren on the importance of prolonged mastication” -(_translation_). Referring, as the latter statement does, to -mastication (insalivation) of liquid, it gives an important suggestion -relative to some probable causes of uncertain or defective digestion in -human nutrition. - - - - - THE CAMBRIDGE TESTS - - - [In connection with a report of the Cambridge Examination the writer - wishes to acknowledge the interest and assistance of Dr. Francis - Gowland Hopkins, head of the Physiological-Chemical Department of - the Physiological Laboratory of the University; Dr. George H. F. - Nuttall, in charge of the Bacteriological Section of the Pathological - Laboratory; Mr. Sidney W. Cole, Mr. Robert Barrett, and Dr. Hubert - Higgins, both for practical work in the laboratory and in serving as - test-subjects. To Dr. Higgins so much is due that it is difficult to - measure. Since our first meeting in Cambridge, Dr. Higgins has been - unremitting in his study of the subject and in consideration of its - application to human betterment. Having the altruistic temperament - inborn and not yet smothered by disappointment, the good doctor - has consecrated himself to the service of poorer humanity, and his - inspiration in so good a cause is wonderful motive power behind the - native desire to do good. The statement of Dr. Higgins' experiences in - pursuit of an Economic Nutrition is given in his own manner in the new - edition of _Glutton or Epicure_, which is being published coincidently - with this volume in the A. B. C. Life Series. - - At the time we were in Cambridge, Dr. Hopkins and Mr. Cole had just - published their paper in the _Journal of Physiology_ (English), - describing their isolation of the tryptophane element of the proteid - molecule which had eluded chemists from the beginning. In tryptophane - they found embodied the odourous indol and skatol which appear so - offensively in the putrid decomposition of proteid. In the excreta of - the test-subjects in our Economic-Nutrition-Inquiry these malodorous - substances did not appear, and hence another question is opened up - to investigation relative to the putridity of human excrement under - ordinary conditions of carelessness, and the absence of putridity in - the case of nutrition accomplished by aid of thorough buccal treatment - of food preparatory to digestion. - - It is a matter of interest, relative to the patience required in - science, to state that Dr. Hopkins and Mr. Cole were fourteen months - searching for the fugitive tryptophane element after they received - their first clew to its whereabouts. When isolated, tryptophane masses - in a substance having the appearance of silver, but not the solidity - of that metal.—HORACE FLETCHER.] - - - - - EXPERIMENTS UPON HUMAN NUTRITION - - NOTE BY SIR MICHAEL FOSTER, K.C.B., M.P., F.R.S. - - -In 1901 Dr. Ernest Van Someren submitted to the British Medical -Association, and afterwards to the Congress of Physiologists at Turin, -an account of some experiments initiated by Mr. Horace Fletcher. -These experiments went to show that the processes of bodily nutrition -are very profoundly affected by the preliminary treatment of the -food-stuffs in the mouth, and indicated that great advantages follow -from the adoption of certain methods in eating. The essentials of these -special methods, stated briefly and without regard to certain important -theoretical considerations discussed by Dr. Van Someren, consist of a -specially prolonged mastication which is necessarily associated with -an insalivation of the food-stuffs much more thorough than is obtained -with ordinary habits. - -The results brought to light by the preliminary experimental trials -went to show that such treatment of the food has a most important -effect upon the economy of the body, involving, in the first place, a -very notable reduction in the amount of food--and especially of proteid -food--necessary to maintain complete efficiency. - -In the second place this treatment produced, in the experience of its -originators, an increase in the subjective and objective well-being -of those who practise it, and, as they believe, in their power of -resistance to the inroads of disease. These secondary effects may -indeed be almost assumed as a corollary of the first mentioned; -because there can be little doubt that the ingestion of food--and -perhaps especially of proteid food--in excess of what is, under the -best conditions, sufficient for maintenance and activity, can only be -deleterious to the organism, clogging it with waste products which may -at times be of a directly toxic nature. - -In the autumn of 1901 Mr. Fletcher and Dr. Van Someren came to -Cambridge with the intention of having the matter more closely inquired -into, with the assistance of physiological experts. The matter evoked -considerable interest in Cambridge, and observations were made not only -upon those more immediately interested, but upon other individuals, -some of whom were themselves medical men and trained observers. - -Certain facts were established by these observations, which, however, -are to be looked upon as still of a preliminary nature. The adoption of -the habit of thorough insalivation of the food was found in a consensus -of opinion to have an immediate and very striking effect upon appetite, -making this more discriminating, and leading to the choice of a simple -dietary, and in particular reducing the craving for flesh food. The -appetite, too, is beyond all question fully satisfied with a dietary -considerably less in amount than with ordinary habits is demanded. - -Numerical data were obtained in several cases, but it is not proposed -to deal with these in detail here, as they need the supplementary study -which will be shortly referred to. - -In two individuals who pushed the method to its limits it was found -that complete bodily efficiency was maintained for some weeks upon a -dietary which had a total energy value of less than one-half of that -usually taken, and comprised little more than one-third of the proteid -consumed by the average man. - -It may be doubted if continued efficiency could be maintained with such -low values as these, and very prolonged observations would be necessary -to establish the facts. But all subjects of the experiments who -applied the principles intelligently agreed in finding a very marked -reduction in their needs, and experienced an increase in their sense of -well-being and an increase in their working powers. - -One fact, fully confirmed by the Cambridge observations, consists in -the effect of the special habits described upon the waste products of -the bowel. These are greatly reduced in amount, as might be expected; -but they are also markedly changed in character, becoming odourless and -inoffensive, and assuming a condition which suggests that the intestine -is in a healthier and more aseptic condition than is the case under -ordinary circumstances. - -Although the experiments hitherto made are, as already stated, only -preliminary in nature and limited in scope, they establish beyond all -question that a full and careful study of the matter is urgently called -for. - -For this fuller study the Cambridge laboratories do not possess at -present either the necessary equipment or the funds to provide it. For -the detailed study of the physical efficiency of a man under varying -conditions, elaborate and expensive apparatus is required; and the -advantages claimed for the special treatment of the food just discussed -can only be fully tested by prolonged and laborious experiments calling -for a considerable staff of workers. - -It is of great importance that the mind of the lay public should -be disabused of the idea that medical science is possessed of final -information concerning questions of nutrition. This is very far indeed -from being the case. Human nutrition involves highly complex factors, -and the scientific basis for our knowledge of the subject is but small; -where questions of diet are concerned, medical teaching, no less than -popular practice, is to a great extent based upon empiricism. - -But the scientific and social importance of the question is clearly -immense, and it is greatly to be desired that its study should be -encouraged. - - M. FOSTER. - - April 26th, 1902. - - - - - REPORT OF A PLAN FOR THE INSTITUTION OF AN INTERNATIONAL INQUIRY INTO - THE SUBJECT OF HUMAN NUTRITION - - - [Sir Michael Foster’s “Note” (preceding) and Professor Chittenden’s - article in the _Popular Science Monthly_ (following), which form a - part of this book, show a common want of exact knowledge relative to - human nutrition not at all creditable to human intelligence at the - beginning of the twentieth century; but they both offer hope of relief - from this discreditable stigma in systematic study of the question. - For this purpose an international inquiry was proposed, a plan was - drawn up under advice of Sir Michael Foster, and the matter was given - to the writer to promote by the best means available. - - The Carnegie Institution seemed, at the time, the most likely - supporter of such a scheme; but owing to an embarrassment of - applications for support of American science needs, it was considered - best not to attempt any foreign or even international benefaction, for - the present at least, and hence other means of furthering the inquiry - were sought. - - The invitation of Professor Chittenden to repeat the demonstration - of food-economy made by the author and Dr. Van Someren at Cambridge, - England, of which Sir Michael Foster’s “Note” treats, at the - laboratories of the Sheffield Scientific School of Yale University, - led to the discovery that New Haven already possessed an equipment - suitable for the inquiry much more complete than the plan Professor - Foster had outlined as being desirable. - - At Yale were found not only a very well-adapted chemico-physiological - laboratory with some of the most active and scientifically respected - research talent of the world in charge, but the laboratory stood only - three minutes away from one of the best furnished gymnasiums in the - world, under a director who is an M. D. of twenty years' experience, - as well as a famous athlete and author of an athletic manual. It so - happened that this gymnasium was especially suited for assisting in - a research into the very causes of human efficiency, or lack of it, - which nutrition is supposed to affect. - - Only forty minutes from New Haven by rail,--a distance not greater, - as measured by time separation, than from one side of London to the - other,--at Middletown, Conn., stood also the recently completed - calorimeter of Professors Atwater and Benedict ready for making a - calorimetric trial-balance measurement of metabolism attained and - chemically estimated in the tests at New Haven. - - After the Yale demonstration, of which Professor Chittenden’s article, - previously mentioned, treats, the author responded to an invitation - from Professor Atwater and submitted himself to a 32-hour confinement - in the calorimeter for confirmation of the results obtained at New - Haven. - - This experience in the calorimeter at Middletown was very significant - and instructive. The author was the first test-subject used in the - newly completed calorimeter. The oxygen-measuring attachment of Dr. - Benedict that completed the apparatus and gave a complete trial - balance of the metabolism of the subject under examination was as - yet untried, but it proved its integrity within the fraction of one - per cent and registered as accurately as necessary for all practical - purposes. So much for the machine; but it measured a result which is - of the greatest importance to the human race. The author had just - demonstrated the possibility of running the human machine on half the - heat, on one-third of the fuel, and with only one-tenth of the waste, - as represented by the waste, or ashes of digestion. Not only was this - done while in pursuit of the ordinary activity of present-day life, - but under stress of 'Varsity-Crew exercise, as reported by Professor - Chittenden and Dr. Anderson. Had this demonstration been made relative - to steam engines or electrical motors, the information would have been - revolutionary in establishing new values for things industrial and - commercial. - - Its significance relative to human profitable possibilities is even - more important than if related to steam or electrical power. The - possibility of economy in the human machine gives also a hope of - immunity from the common diseases which now afflict mankind. - - The trial of the calorimeter as a measuring machine and the trial - balance of the economic metabolism which the author had attained - by five years of careful attention to the natural requirements of - nutrition were epoch-making events coincidently related, and for them - the author here makes this distinguished claim--not on account of any - accomplishment of himself, but as a promise of great possibilities for - human betterment. - - Here follows a reproduction of the plan just referred to, with - _fac-simile_ of the signatures of the distinguished physiologists - who approved the plan and consented to serve as “Assessors.” To this - list should have been added the name of Professor Ozawa, professor of - physiology at the University of Tokio, Japan; but time and distance - did not permit gaining the required understanding and assent. - Professor Ozawa’s connection with the inquiry would make it not only - international but interhemispherical and interracial as well, and this - possibility of scientific coördination and coöperation is typical of - the harmonising wave that is fast enveloping the earth for the benefit - of mankind. - - I give a copy of the document entire, with estimates of cost, - etc., just as it was originally drawn and intended only as a trial - suggestion, to be modified by circumstances.—HORACE FLETCHER.] - - - - - PROPOSAL TO FOUND AN INTERNATIONAL LABORATORY OF RESEARCH FOR THE - STUDY OF NUTRITION IN ALL ITS ASPECTS - - -Notwithstanding the enormous development which the study of -Experimental Physiology has undergone during the last half-century, and -the constant multiplication of physiological laboratories fitted in -a manner which enables them to be used as places of research as well -as of instruction in the methods of physiological inquiry, it has -appeared to many physiologists that a great need remains to be supplied -by the establishment of an International Laboratory of Research, -devoted primarily, if not exclusively, to the investigation of problems -connected with the Nutrition of the Animal, and particularly of Human -Organisms,--studies particularly, and in the first instance, from the -point of view of the relation of the food consumed by the animal body -to its output of energy, either in the form of heat or mechanical work. - -The reason for establishing such a laboratory, available for the use -of investigations of all nations, is to be found in the fact that the -researches which are now called for, in order to place upon a firm -foundation our knowledge of food and its relations to the activity of -the organism, necessitates an assemblage of apparatus and machinery -so specialised and so costly that they are not to be found collected -together even in the best equipped of the physiological laboratories -of Europe or America, which all subserve in the first instance the -purposes of systematic instruction. Undoubtedly, unquestionably, -certain of the great and costly appliances of research are to be found -in particular laboratories, as, for instance, in those of Berlin, -Munich, Paris, and Turin, but there certainly exists no laboratory -in which the investigator can find assembled under one roof all -the specially fitted chemical, physical, and even bacteriological -appliances which he may need to employ in the investigation of the -Phenomena of Nutrition. - -A more precise conception of the nature of the proposed laboratory -may be formed if reference is made to certain groups of appliances -which such a laboratory should possess and be able to place at the -disposal of the scientific men coming to it for facilities which may be -denied them at home. It should possess a complete set of respiration -chambers of various types, and especially should be provided with the -“Atwater Respiration Apparatus;” the most perfect appliances for the -analyses of gases should be available; it should be provided with the -most perfect calorimeters of various types, both for the investigation -of the calorimetric value of the foods experimented on, and for the -determination of the heat produced by man or by the lower animals,--the -subjects of observation. The laboratory should possess, besides, the -most perfect appliances for the measurement of work done by man and -by animals (“ergostat,” “ergograph”), and a set of balances of the -highest perfection capable of weighing with accuracy very heavy loads. -These characteristic appliances of a laboratory specially designed for -placing our knowledge of Animal Nutrition on a thoroughly sound basis -must be superadded to the ordinary means for pursuing with success -researches in Pure Organic, Physiological, and Physical Chemistry, as -well as in Bacteriology. - - - OUTLINE OF THE PROPOSED SUBJECTS OF RESEARCH TO BE UNDERTAKEN IN THE - PROPOSED INTERNATIONAL LABORATORY - -1. To determine with greater precision than has yet been possible the -efficiency of the animal organism considered as a machine in which -potential energy of the organic constituents of food is converted -into mechanical work. The knowledge that we already possess has shown -that in the animal we have an engine infinitely more efficient as a -utiliser of the potential energy supplied to it than any appliance yet -constructed, or which we can, in the present state of physical science, -construct. A still more precise study of the actual efficiency of the -animal as a whole, as well as of certain of the vital organs which are -mainly concerned in mechanical work, and a more thorough investigation -of the processes whereby--for instance, in the muscles--the potential -energy of stored-up chemical compounds is, as appears certain, directly -converted into mechanical work, is not only desirable in the interest -of the ultimate object of the work of the Laboratory, but possesses a -high degree of theoretical interest, even from the point of view of -Pure Physics. To sum up: One of the first objects of the investigations -to be carried out in the projected Laboratory should be “the more -precise determination of the minimum transformation of energy which -corresponds to mean and accurately determined conditions of the animal -body, and of that of man in particular.” - -2. We are acquainted with the fact that the potential energy which -is utilised by the animal is supplied to it with the least wear and -tear to, or strain upon, its mechanism by non-nitrogenous organic -constituents of food which must belong to the groups of starches and -sugars or fats, but that the continued existence of the organism -demands, as an essential condition, the introduction of a certain -proportion of albuminous matter. In spite of numerous very fine -investigations on this subject, the yet more precise determination -of the minimum quantity of the albuminous constituents which are -absolutely necessary or desirable, under the most varying conditions, -is eminently desirable, especially in the light of recently recorded -facts, amongst which are those to be referred to under 3 (following):— - -3. Certain very noteworthy observations made by Messrs. Horace Fletcher -and Ernest H. Van Someren have shown that an excessively prolonged -mastication and insalivation of food leads to remarkable results in -respect to the diminution of the total quantity of food necessary to -keep the body in a state of health, and to, as is alleged, a remarkable -improvement in the digestive functions as well as of the general -health of the individual. It appears highly important thoroughly to -investigate the remarkable phenomena discovered by Messrs. Fletcher and -Van Someren, and to determine how far they may lead to a modification -of or improvement in the dietary of healthy individuals and of persons -in a state of disease. - -4. Indeed, it may truly be said that the average diet of man, that is -to say, the absolute and relative amount of certain food-stuffs on -which an average man should live, is at present, to a large extent, -determined in an empirical manner. It is most necessary that this -should be determined in an exact manner, since it is at least possible -that a more complete knowledge may reveal that the good results -thus obtained empirically are only reached by means of an excess of -one element being counterbalanced by excess of another element, and -thus open up a way to considerable economy. The changes needed for -variations from the average, to meet certain conditions, are also at -present, to a very large extent, determined empirically, and these also -most certainly ought to be determined in an absolutely exact manner. - -5. The researches of Pawlow on the conditions which influence the -activity of the secreting glands of the organs of digestion, upon the -relation of their activity to the nature of the food ingested, upon -the influence exerted by the secretion of the glands situated in one -part of the alimentary canal, upon the activity of glands situated -lower down, indicate lines of research only recently opened out, but -the importance of which in reference to the problems of nutrition is -probably great. - -6. Similarly, the facts which have in recent times been ascertained -in reference to the remarkable influence exerted by the so-called -“internal secretion” of certain ductless glands on the general -metabolism, the part played by the pancreas in reference to the -transformations of sugar in the body indicate yet other lines of -research to be carried out in connection with the main inquiry. - -In conclusion: The final problem of the work of the proposed Laboratory -will be to ascertain the conditions which will “render it possible to -obtain from the human machine, under varying conditions, the highest -efficiency at the least cost.” - -The value of results which may be thus obtained, considered from the -point of view of social, political, and administrative economy, is -hardly to be exaggerated. - - - SUGGESTIONS AS TO STAFF AND PERSONNEL OF THE PROPOSED INTERNATIONAL - LABORATORY - -For the coördination and general direction of the several -investigations, the services of an eminent physiological chemist -(preferably one having the principal European languages at his command) -is essential. - -Such a director would need at least two efficient permanent technical -assistants, as for instance, one to deal with the problems of Organic -Chemistry, and another competent to deal with the problems of Physical -Chemistry. Other assistants might be necessary, but it would probably -be desirable that the Institute should have the power of subsidising, -for a longer or shorter period, men who would undertake special -investigations in coördination with the general work, and who would -thus be, as it were, temporary assistants. This would be quite apart -from the general hospitality of the Laboratory offered by the Institute -to other investigators. - - - ESTIMATES FOR THE PROPOSED LABORATORY - - INITIAL OUTLAY - - Director $5,000 $5,000 - Permanent and Temporary Assistants 7,500 to 10,000 - Other General Maintenance 5,000 to 7,500 - ——————— —————— -— $17,500 $22,500 - -With regard to the second item, the permanent assistants would be -required at the outset, but the temporary assistants would be taken on -as opportunity offered. Less than even the lower estimate might suffice -at first. - -Regarding the third item, also, the maximum might not be required in -the beginning. - - - SUGGESTIONS AS TO DESIRABILITY OF LOCATION - -The place fitted for the establishment of an International Institute -should be one which can be reached with comparative facility by -investigators of the different nationalities. It must be one free -from the objections due to national susceptibilities. It should also -be, if possible, a place agreeable to live in; a place where work can -be carried on through the year; and a place where expenses, both the -personal expenses of the investigators, and the general expenses of -the Institute, are not excessive. Venice has been suggested as a place -fulfilling the above requirements. It can be reached readily from -all parts of Europe, and is as accessible to Americans as any other -European city. Living is very cheap, and, indeed, all expenses are very -moderate. - -On sea level itself, Venice is within near distance of very high -altitude, and hence offers facilities for the study of the effects -of climatic influence on nutrition. It is also sufficiently near the -Regina Margherita Laboratory, on Monte Rosa, to enable the observations -made at the two places to be coördinated. Venice is, moreover, a -cosmopolitan centre; and persons of many different nations and races -might readily be obtained as subjects for observation and experiment. - -On the other hand, it may be regarded as essential to the complete -success of the proposed Institute that both the director and those -engaged in investigation should have ample opportunities of ready and -frequent intercourse with eminent men engaged in investigation in -Physics, Chemistry, and the allied sciences. The help which is thus -gained by intercourse with men at the very head of various scientific -inquiry cannot be supplied in any other way. There is also an urgent -reason for ready access to a most thoroughly equipped scientific -library. It is also essential that the Institute should have facility -of obtaining, or of getting constructed, with the least possible delay -such apparatus as it might need. These essentials cannot be supplied -otherwhere than in great centres of scientific activity. A small -university cannot supply them. If they are insisted on, the Institute -must be located in a place which has metropolitan distinction and holds -not only a large but an active university. The choice of a situation, -from this point of view, in Europe, is thus almost limited to such -places as Paris, Berlin, Vienna, or London. Of these London probably -best recommends itself for international purposes. - -But, on the other hand, London is distinctly an expensive place to live -in. Indeed, all expenses there are great, and the same may be said of -any great metropolitan centre. Moreover, London cannot be reached from -the countries of Europe without sea transit. - -The choice between such a place as London and such a place as Venice -must depend upon the relative weight attached, on the one hand, to the -scientific advantages dwelt on above, and, on the other hand, to the -advantages other than scientific. - - - SUGGESTIONS AS TO MANAGEMENT OF THE PROPOSED INTERNATIONAL INSTITUTE - -It is proposed that: First, there should be a small body of trustees -who should undertake the financial responsibility; and, Second, a -board of scientific assessors, representing several nations, who, in -conjunction with the director, should exercise general supervision -of the work of the Institute. Such a board need meet only at rare -intervals, much being done by way of correspondence. The expenses which -the members incur in the exercise of their functions ought to be met -out of the funds of the Institute. - - -The following have expressed willingness to act as scientific -assessors:— - -[Illustration: Signatures] - - - - - NATIONALITY AND SCIENTIFIC TITLES OF OUR BOARD OF SCIENTIFIC ASSESSORS - - - SIR MICHAEL FOSTER, M.D., K.C.B., F.R.S., M.P., etc. Late Professor of - Physiology, University of Cambridge, England; Secretary of the Royal - Society; Permanent Honorary President of the International Congress of - Physiologists, etc. - - DR. PROFESSOR ANGELO MOSSO. Professor of Physiology, University of - Turin, Italy; Director of the Regina Margherita Biological Station on - the summit of Monte Rosa, etc. - - DR. PROFESSOR HUGO KRONECKER. Professor of Physiology, University of - Berne, Berne, Switzerland, etc. - - DR. PROFESSOR N. ZUNTZ. Professor of Physiology, Berlin, Germany, etc. - - DR. PROFESSOR PAUL HEGER. Professor of Physiology, Brussels, Belgium; - Director of the Solvay Sociological Institute, Brussels. - - DR. PROFESSOR A. DASTRE. Professor of Physiology, Universitie de la - Sorbonne, Paris, France, etc. - - DR. PROFESSOR HENRY PICKERING BOWDITCH, Professor of Physiology, - Harvard Medical School; Second President American Physiological - Society; President of the Children’s Aid Society, Boston, Mass., etc. - - PROFESSOR RUSSELL H. CHITTENDEN. Director Sheffield Scientific School - of Yale University; Professor of Physiological Chemistry in Yale; - Present President of the American Physiological Society, etc. - - DR. PROFESSOR WILLIAM H. WELCH. Professor of Pathology in Johns - Hopkins University, Baltimore, Maryland; President of the Rockefeller - Institute of Preventive Medicine, etc. - - DR. PROFESSOR J. P. PAWLOW. Director of the Department of Experimental - Physiology in the Russian Imperial Military School of Medicine, etc. - - - - - PERSISTENT SCIENTIFIC DOUBTS - - - [Notwithstanding the report of the Cambridge examination of the - claims for an economic nutrition advanced by the authors, American - physiologists were still doubtful if a nitrogenous economy like that - reported could be maintained, and the writer was invited to submit - to further tests at the Physiological Laboratory of Yale University, - under direction of Professor Russell H. Chittenden, Director of - the Sheffield Scientific School, and President of the American - Physiological Society, and Dr. Lafayette B. Mendel. - - The following article, first published in the _Popular Science - Monthly_, June, 1903, is a report of that test, and indicates a - desire to carry the investigation further to include a variety of - test-subjects. - - In response to Professor Chittenden’s request, the Trustees of the - Bache Fund of the National Academy of Sciences appropriated $1000 - towards a more extended inquiry; and other means having been assured, - a project of experiments was taken under consideration. - - One of the difficulties encountered was the control of test-subjects - for a sufficiently long time to make conclusive estimates relative - to the minimum needs of nitrogenous food in relation to the common - occupations of life. Few if any volunteers, with the leisure and - interest fortunately possessed by the writer, were available outside - the laboratory force itself, and there were serious objections to - using for test-subjects the same persons who did the chemical analyses - and estimated the results. - - In this dilemma the good fortune of a meeting with Surgeon-General - O’Reilly of the United States Army and with General Leonard Wood--the - former on his way to Madrid to attend a medical congress, and the - latter _en route_ to the Philippines to take command there--happened - to the writer on the S. S. _Commonwealth_, on a voyage to Italy in - April, 1903. - - Both these officers are medical men and research enthusiasts. They had - fought yellow fever together, in coöperation with martyr Dr. Major - Walter Reed, in Cuba, and the fame of their success was being talked - of as one of the great triumphs of pathologic, or hygienic, science at - the time of the meeting. - - There was ample time on the steamer to discuss a subject of such - mutual and general interest, and both officers had had, in service, - experiences that led them to believe that the results obtained by the - writer and his colleagues were the common possibilities of all persons - under right conditions of alimentation. - - General O’Reilly was of the opinion that the corps he commanded - could furnish intelligent and earnest test-subjects for nutrition - investigation, as it did in the yellow fever case. In the yellow fever - investigation privates and officers alike had volunteered to act as - test-subjects, even though their lives were at stake and many had - already been sacrificed. It is to their great honour, also, that they - refused to receive the bounty that was offered for test-subjects, - preferring to serve science and humanity freely as volunteers rather - than sell themselves as experimental risks. From such material General - O’Reilly was sure that capable assistants could be secured to test the - not at all dangerous or disagreeable economies of nutrition that the - projected inquiry wished to solve. - - Armed with letters of recommendation to the President and to - the Secretary of War from General Wood, and an invitation from - Surgeon-General O’Reilly to call on him if coöperation on his part - were desired, the writer returned to the United States and consulted - with Professors Chittenden and Bowditch relative to the desirability - of army coöperation. It was believed to be just the thing wanted to - facilitate the inquiry, and the writer proceeded to Washington to - effect the combination. - - General O’Reilly had already had the matter under consideration and - was quite ready to draw up a project for presentation to the Secretary - of War when Mr. Root should return to Washington from his summer - vacation. - - Twenty privates and three non-commissioned officers of the Hospital - Corps of the United States Army under command of Dr. Lieutenant - Wallace DeWitt are now quartered at New Haven in coöperation with - the staff of the Sheffield Scientific School. It is the intention - to learn, if possible, how little nitrogen is necessary to secure - the best human efficiency; and also, if possible, to ascertain some - measure of the evil effects of an excess of nitrogenous food as well - as excess of food in general upon human efficiency. - - The writer is grateful for the good fortune of being able to be of - service in a development of interest in a subject which is of vital - importance to the human race. He has enjoyed the benefits of an - economic nutrition and knows its value. - - The practical proof of a subject of personal application must come - from such personal application. Each person must be his own doctor and - his own scientist in the matter of his alimentation or he runs the - risk of running amuck in his health economy. There is not so much to - learn, neither is there very much to do to insure right alimentation, - perfect digestion, and continuous good health; but the little required - of us must be attended to with no lapses of attention.—HORACE - FLETCHER.] - - - - - PHYSIOLOGICAL ECONOMY IN NUTRITION - - BY RUSSELL H. CHITTENDEN - - _Director of the Sheffield Scientific School of Yale University_ - - -Among the many problems awaiting solution, none is of greater -importance for the welfare of the individual and of the race than -that which relates to the proper nutrition of the body. Man eats to -live and to gain strength for his daily work, and without sufficient -nutriment the machinery of the body cannot be run smoothly or with -proper efficiency. The taking of an excess of food, on the other hand, -is just as harmful as insufficient nourishment, involving, as it does, -not only wasteful expenditure but, what is even of greater moment, an -expenditure of energy on the part of the body, which may in the long -run prove disastrous. While it is the function of food to supply the -material from which the body can derive the necessary energy for its -varied activities, any excess of food over and above what is needed to -make good the loss incidental to life and daily activity is just so -much of an incubus, which is bound to detract from the smooth running -of the machinery and to diminish the fitness of the body for performing -its normal functions. - -A proper physiological condition begets a moral, mental, and physical -fitness which cannot be attained in any other way. Further, it must be -remembered that lack of a proper physiological condition of the body -is more broadly responsible for moral, social, mental, and physical -ills than any other factor that can be named. Poverty and vice on -ultimate analysis may often be traced to a perversion of nutrition. -A healthy state of the body is a necessary concomitant of mental and -moral vigour, as well as of physical strength. Abnormal methods of -living are often the accompaniment or forerunner of vicious tastes -that might never have been developed under more strictly physiological -conditions. Health, strength (mental and physical), and moral tone -alike depend upon the proper fulfilment of the laws of nature, and it -is the manifest duty of a people hoping for the fullest development -of physical, mental, and moral strength to ascertain the character of -these laws with a view to their proper observance. Poverty, crime, -physical ills, and a blunted or perverted moral sense are the penalties -we may be called upon to pay for the disobedience to Nature’s laws; -penalties which not only _we_ may have to pay, but which may be passed -down to succeeding generations, thereby influencing the lives of those -yet unborn. - -There is to-day great need for a thorough physiological study of those -laws of nutrition which constitute the foundation of good living. -It is a subject full of interest and promise for the sociologist -and economist, as well as for the physiologist. We need a far more -complete knowledge than we possess at present of the laws governing -nutrition; we need fuller knowledge of the methods by which the most -complete, satisfactory, and economical utilisation of the diet can be -obtained; we need to know more concerning the minimum diet and the -minimum amount of proteid or albuminous foods on which health, mental -and physical vigour can be permanently maintained; we need to know -more fully concerning the influence of various forms of food on growth -and recuperative power; we need more complete knowledge regarding the -rôle of various dietetic and digestive habits, fixed or acquired; the -effects of thorough mastication, insalivation, and the influence of -two versus three meals a day upon the utilisation of food and hence -upon the bodily health. Further, we need more concise information as -to the effect of the mental state upon digestion and nutrition. These -and many other problems of a like nature confront us when we attempt -to trace the influence of a proper nutrition upon the condition of the -body. These problems, however, all admit of solution, and in their -solution undoubtedly lies the remedy for many of the personal ills of -mankind. - -The foregoing thoughts have been suggested by observations recently -made in the writer’s laboratory on the amount and character of the -food actually required by a healthy man in the maintenance of bodily -equilibrium in periods of rest and physical work. Our ideas at present -are based primarily upon observations as to what civilised peoples are -accustomed to do, and not upon what they need to do in order to meet -the demands made upon the body. Sir William Roberts has well said that -the palate is the dietetic conscience, but he adds that there are many -misfit palates, and we may well query whether our dietetic consciences -have not become generally perverted through a false mode of living. The -well-nigh universal habit of catering to our appetite on all occasions, -of bowing to the fancied dictates of our palates even to the extent of -satiety, and without regard to the physiological needs of the body, -may quite naturally have resulted in a false standard of living, in -which we have departed widely from the proper laws of nutrition. -Statistical studies carried out on large groups of individuals by -various physiologists have led to the general acceptance of dietary -standards, such as those proposed by Voit, of Munich, and Atwater in -this country. Thus the Voit diet for a man doing moderate work is 118 -grams of proteid or albuminous food, 56 grams of fat, and 500 grams -of carbohydrates, such as sugar and starch, with a total fuel value -of 3,055 large calories or heat units per day. With hard work, Voit -increases the daily requirement to 145 grams of proteid, 160 grams of -fat, and 450 grams of carbohydrates, with a total fuel value of 3,370 -large calories. Atwater, on the other hand, from his large number of -observations, is inclined to place the daily proteid requirement at -125 grams, with sufficient fat and carbohydrate to equal a total fuel -value of 3,500 large calories for a man doing a moderate amount of -work; while for a man at hard work the daily diet is increased to 150 -grams of proteid, and with fats and carbohydrates to yield a total -fuel value of 4,500 large calories. These standards are very generally -accepted as being the requirement for the average individual under the -given conditions of work, and it may be that these figures actually -represent the daily needs of the body. Suppose, on the other hand, that -we have in these figures false standards, or, in other words, that the -quantities of food-stuffs called for are altogether larger than the -actual demands of the body require. In this case there is a positive -waste of valuable food material which we may calculate in dollars -and cents; a loss of income incurred daily which might be expended -more profitably in other directions. To the wage-earner with a large -family, who must of necessity husband his resources, there is in our -hypothesis a suggestion of material gain not to be disregarded. The -money thus saved might be expended for the education of the children, -for the purchase of household treasures tending to elevate the moral -and mental state of the occupants, or in many other ways that the -imagination can easily supply. This kind of saving, however, is purely -a question of economy, and in some strata of society would be objected -to as indicative of a condition of sordidness. It has come to be a -part of our personal pride to have a well-supplied table, and to eat -largely and freely of the good things provided. The poorer man takes -pride in furnishing his family with a diet rich in expensive articles -of food, and imagines that by so doing he is inciting them to heartier -consumption and to increased health and strength. He would be ashamed -to save in this way, under the honest belief that by so doing he -might endanger the health of his dear ones. But let us suppose that -this hypothetical waste of food is not merely uneconomical, that it is -undesirable for other and weightier reasons. Indeed, let us suppose -that this unnecessary consumption of food is distinctly harmful to the -body, that it is physiologically uneconomical, and that in our efforts -to maintain a high degree of efficiency we are in reality putting upon -the machinery of the body a heavy and entirely uncalled-for strain, -which is bound to prove more or less detrimental. If there is truth in -this assumption, our hypothesis takes on a deeper significance, and we -may well inquire whether there are any reasonable grounds for doubting -the accuracy of our present dietary standards. - -In this connection it is to be remembered that the food of mankind may -be classified under three heads, viz., _proteid or albuminous_, such -as meat, eggs, casein of milk, gluten of bread, and various vegetable -proteids; _carbohydrates_, as sugar and the starches of our cereals, -and _fats_, including those of both animal and vegetable origin. The -proteids are characterised by containing nitrogen (about 16 per cent), -while the fats and carbohydrates contain only carbon, hydrogen, and -oxygen. The two latter classes of food-stuffs are burned up in the -body, when completely utilised, to carbonic acid (a gas) and water, -while the proteid foods, beside yielding carbonic acid and water, -give off practically all of their nitrogen in the form of crystalline -nitrogenous products in the excreta of the body. Proteid foods have a -particular function to perform, viz., to supply the waste of proteid -matter from the active tissues of the body, and this function can be -performed only by the proteid foods; hence the latter are essential -food-stuffs without which the body cannot long survive. Fats and -carbohydrates, on the other hand, are mainly of value for the energy -they yield on oxidation, and in this connection it is to be remembered -that the fuel value of fats per gram is much larger than that of -carbohydrates, viz., 9.3: 4.1, or more than twice as great. Further, -it is to be noted that the various food-stuffs cannot be utilised -directly by the body, but they must first be digested, then absorbed -and assimilated, after which they gradually, in their changed form, -undergo decomposition with liberation of their contained energy, which -may manifest itself in the form of heat or of mechanical work. The -thoroughness with which foods are digested and utilised in the body -must therefore count for a great deal in determining their dietetic or -nutritive value. Moreover, it is easy to see how an excess of proteid -food will give rise to a large proportion of nitrogenous waste matter, -which, floating through the system prior to excretion, may, by acting -on the nervous system and other parts of the body, produce disagreeable -results. A mere excess of food, even of the non-nitrogenous variety, -must entail a large amount of unnecessary work, thereby using up -a proportional amount of energy for its own disposal, since once -introduced into the body it must be digested and absorbed, otherwise it -undergoes fermentation and putrefaction in the stomach and intestines, -causing countless troubles. When absorbed in quantities beyond the real -needs of the body, it may be temporarily deposited as fat; but why -load up the system with unnecessary material, thereby interfering with -the free running of the machinery? In other words, it is very evident -that the taking in of food in quantities beyond the physiological -requirements is undesirable, and may prove exceedingly injurious. It -is truly uneconomical, and defeats the very ends we aim to attain. -Instead of adding to the bodily vigour and increasing the fitness of -the organism to do its daily work, we are really hampering the delicate -mechanism, upon the smooth running of which so much depends. - -Why, now, should we assume that a daily diet of over 100 grams of -proteid, with fats and carbohydrates sufficient to make up a fuel -value of over 3,000 large calories, is a necessary requisite for -bodily vigour and physical and mental fitness? Mainly because of the -supposition that true dietary standards may be learned by observing -the relative amounts of nutrients actually consumed by a large number -of individuals so situated that the choice of food is unrestricted. -But this does not constitute very sound evidence. It certainly is not -above criticism. We may well ask ourselves whether man has yet learned -wisdom with regard to himself, and whether his instincts or appetites -are to be entirely trusted as safe guides to follow in the matter -of his own nutrition. The experiments of Kumagawa, Sivén, and other -physiologists, have certainly shown that men may live and thrive, for -a time at least, on amounts of proteid per day equal to only one-half -and one-quarter the amount called for in the Voit standard. Sivén’s -experiments, in particular, certainly indicate that the human organism -can maintain itself in nitrogenous equilibrium with far smaller amounts -of proteid in the diet than is ordinarily taught, and, further, that -this condition can be attained without unduly increasing the total -calories of the food intake. Such investigations, however, have always -called forth critical comment from writers on nutrition, indicating -a reluctance to depart from the current doctrines of the Voit or -Munich school; and, indeed, it may justly be claimed that the ordinary -nutrition experiments, extending over short periods of time, are not -entirely adequate to prove the effect of a given set of conditions when -the latter are continued for months or years. Thus, Schäfer writes: -“It may be doubted whether a diet which includes considerably less -proteid than 100 grams for the twenty-four hours could maintain a man -of average size and weight for an indefinite time. It has frequently -been asserted that many Asiatics consume a very much smaller proportion -of proteid than is the case with Europeans. The inhabitants of India, -Japan, and China chiefly consume rice as the normal constituent of -their diet, which contains relatively little proteid; and this has -been advanced as an argument in favour of the view that the minimal -amount of proteid is much less than that ordinarily given as essential -to the maintenance of nutritive equilibrium. It must, however, be -stated that we have no definite statistics to show that, in proportion -to their body-weight, Asiatics doing the same amount of work as -Europeans require a less amount of proteids; indeed such evidence as is -forthcoming is rather in favor of the opposite view.” This statement is -typical of the attitude of physiologists in general on this important -subject. Why not candidly admit that the matter is in doubt, and, -with a due recognition of the importance of the subject, attempt to -ascertain the real truth of the matter? - -The writer has had in his laboratory for several months past a -gentleman (H. F.) who has for some five years, in pursuit of a study -of the subject of human nutrition, practised a certain degree of -abstinence in the taking of food and attained important economy with, -as he believes, great gain in bodily and mental vigour, and with marked -improvement in his general health. Under his new method of living he -finds himself possessed of a peculiar fitness for work of all kinds, -and with freedom from the ordinary fatigue incidental to extra physical -exertion. In using the word abstinence possibly a wrong impression -is given, for the habits of life now followed have resulted in the -disappearance of the ordinary craving for food. In other words, the -gentleman in question fully satisfies his appetite, but no longer -desires the amount of food consumed by most individuals. - -For a period of thirteen days, in January, he was under observation in -the writer’s laboratory, his excretions being analysed daily with a -view to ascertaining the exact amount of proteid consumed. The results -showed that the average daily amount of proteid metabolised was 41.25 -grams, the body-weight (165 pounds) remaining practically constant. -Especially noteworthy, also, was the very complete utilisation of the -proteid food during this period of observation. It will be observed -here that the daily amount of proteid food taken was less than one half -that of the minimum Voit standard, and it should also be mentioned that -this apparent deficiency in proteid food was not made good by any large -consumption of fats or carbohydrates. Further, there was no restriction -in diet. On the contrary, there was perfect freedom of choice, and the -instructions given were to follow his usual dietetic habits. Analysis -of the excretions showed an output of nitrogen equal to the breaking -down of 41.25 grams of proteid per day as an average, the extremes -being 33.06 grams and 47.05 grams of proteid. - -In February a more thorough series of observations was made, involving -a careful analysis of the daily diet, together with analysis of -the excreta, so that not alone the proteid consumption might be -ascertained, but likewise the total intake of fats and carbohydrates. -The diet consumed was quite simple, and consisted merely of a prepared -cereal food, milk, and maple sugar. This diet was taken twice a day -for seven days, and was selected by the subject as giving sufficient -variety for his needs and quite in accord with his taste. No attempt -was made to conform to any given standard of quantity, but the subject -took each day such amounts of the above foods as his appetite craved. -Each portion taken, however, was carefully weighed in the laboratory, -the chemical composition of the food determined, and the fuel value -calculated by the usual methods. - -The following table gives the daily intake of proteids, fats, and -carbohydrates for six days, together with the calculated fuel value, -and also the nitrogen intake, together with the nitrogen output through -the excreta. Many other data were obtained showing diminished excretion -of uric acid, ethereal sulphates, phosphoric acid, etc., but they need -not be discussed here. - - ═════════╤════════════════════════════════════════╤═══════════════════ - │ Intake │ Output of Nitrogen - ├————————┬————-┬——————-┬————————┬————————┼—————┼——————-┼————— - │Proteids│Fats │Carbohy│Calories│Nitrogen│Urine│ Fæces │Total - ————————-┼————————┼—————┼——————-┼————————┼————————┼————-┼——————-┼————- - │ Grams │Grams│ Grams │ │ Grams │Grams│ Grams │Grams - Feb. 2 │ 31.3 │25.3 │ 125.4 │ 900 │ 5.02 │5.27 │0.18 │5.45 - 3 │ 46.8 │40.4 │ 266.2 │ 1690 │ 7.50 │6.24 │0.81* │7.05 - 4 │ 48.0 │38.1 │ 283.0 │ 1747 │ 7.70 │5.53 │0.81* │6.34 - 5 │ 50.0 │40.6 │ 269.0 │ 1711 │ 8.00 │6.44 │0.81* │7.25 - 6 │ 47.0 │41.5 │ 267.0 │ 1737 │ 7.49 │6.83 │0.81* │7.64 - 7 │ 46.5 │39.8 │ 307.3 │ 1852 │ 7.44 │7.50 │0.17 │7.67 - ————————-┼————————┼—————┼——————-┼————————┼————————┼————-┼——————-┼————— - Daily Av.│ 44.9 │38.0 │ 253.0 │ 1606 │ 7.19 │6.30 │0.60 │6.90 - ═════════╧════════╧═════╧═══════╧════════╧════════╧═════╧═══════╧═════ - *Average of the four days. - -The main things to be noted in these results are, first, that the -total daily consumption of proteid amounted on an average to only 45 -grams, and that the fat and carbohydrate were taken in quantities -only sufficient to bring the total fuel value of the daily food up to -a little more than 1,600 large calories. If, however, we eliminate -the first day, when for some reason the subject took an unusually -small amount of food, these figures are increased somewhat, but they -are ridiculously low compared with the ordinarily accepted dietary -standards. When we recall that the Voit standard demands at least 118 -grams of proteid and a total fuel value of 3,000 large calories daily, -we appreciate at once the full significance of the above figures. But -it may be asked, was this diet at all adequate for the needs of the -body--sufficient for a man weighing 165 pounds? In reply, it may be -said that the appetite was satisfied, and that the subject had full -freedom to take more food if he so desired. To give a physiological -answer, it may be said that the body-weight remained practically -constant throughout the seven days' period, and further, it will be -observed by comparing the figures of the table that the nitrogen of -the intake and the total nitrogen of the output were not far apart. -In other words, there was a close approach to what the physiologist -calls nitrogenous equilibrium. In fact, it will be noted that on -several days the nitrogen output was slightly less than the nitrogen -taken in. We are, therefore, apparently justified in saying that the -above diet, simple though it was in variety, and in quantity far below -the usually accepted requirement, was quite adequate for the needs -of the body. In this connection it may be asked, what were the needs -of the body during this seven days' period? This is obviously a very -important point. Can a man on such a diet, even though it suffices to -keep up body-weight and apparently also physiological equilibrium, -do work to any extent? Will there be under such condition a proper -degree of fitness for physical work of any kind? In order to ascertain -this point, the subject was invited to do physical work at the Yale -University Gymnasium, and placed under the guidance of the director of -the gymnasium, Dr. William G. Anderson. The results of the observations -there made are here given, taken verbatim from Dr. Anderson’s report to -the writer. - - On the 4th, 5th, 6th, and 7th of February, 1903, I gave to Mr. Horace - Fletcher the same kind of exercises we give to the Varsity Crew. They - are drastic and fatiguing and cannot be done by beginners without - soreness and pain resulting. The exercises he was asked to take were - of a character to tax the heart and lungs, as well as to try the - muscles of the limbs and trunk. I should not give these exercises to - Freshmen on account of their severity. - - Mr. Fletcher has taken these movements with an ease that is unlooked - for. He gives evidence of no soreness or lameness, and the large - groups of muscles respond the second day without evidence of being - poisoned by Carbon dioxide. There is no evidence of distress after or - during the endurance test, _i. e._, the long run. The heart is fast - but regular. It comes back to its normal beat quicker than does the - heart of other men of his weight and age. - - The case is unusual, and I am surprised that Mr. Fletcher can do - the work of trained athletes and not give marked evidences of - over-exertion. As I am in almost constant training I have gone over - the same exercises, and in about the same way, and have given the - results for a standard of comparison. [The figures are not given here.] - - My conclusion, given in condensed form, is this: Mr. Fletcher performs - this work with greater ease and with fewer noticeable bad results than - any man of his age and condition I have ever worked with. - -To appreciate the full significance of this report, it must be -remembered that Mr. Fletcher had for several months past taken -practically no exercise other than that involved in daily walks about -town. - -In view of the strenuous work imposed during the above four days, it is -quite evident that the body had need of a certain amount of nutritive -material. Yet the work was done without apparently drawing upon any -reserve the body may have possessed. The diet, small though it was, and -with only half the accepted requirement in fuel value, still sufficed -to furnish the requisite energy. The work was accomplished with perfect -ease, without strain, without the usual resultant lameness, without -taxing the heart or lungs, and without loss of body-weight. In other -words, in Mr. Fletcher’s case at least, the body machinery was kept in -perfect fitness without the consumption of any such quantities of fuel -as has generally been considered necessary. - -Just here it may be instructive to observe that the food consumed -by Mr. Fletcher during this seven days' period--and which has been -shown to be entirely adequate for his bodily needs during strenuous -activity--cost eleven cents daily, thus making the total cost for -the seven days seventy-seven cents! If we contrast this figure with -the amounts generally paid for average nourishment for a like period -of time, there is certainly food for serious thought. Mr. Fletcher -avers that he has followed his present plan of living for nearly five -years; he usually takes two meals a day; has been led to a strong -liking for sugar and carbohydrates in general and away from a meat -diet; is always in perfect health, and is constantly in a condition of -fitness for work. He practises thorough mastication, with more complete -insalivation of the food (liquid as well as solid) than is usual, -thereby insuring more complete and ready digestion and a more thorough -utilisation of the nutritive portions of the food. - -In view of these results, are we not justified in asking ourselves -whether we have yet attained a clear comprehension of the real -requirements of the body in the matter of daily nutriment? Whether we -fully comprehend the best and most economical method of maintaining the -body in a state of physiological fitness? The case of Mr. Fletcher, -just described; the results noted in connection with certain Asiatic -peoples; the fruitarians and _nut_arians in our own country recently -studied by Professor Jaffa, of the University of California; all -suggest the possibility of much greater physiological economy than we -as a race are wont to practise. If these are merely exceptional cases, -we need to know it; but if, on the other hand, it is possible for -mankind in general to maintain proper nutritive conditions on dietary -standards far below those now accepted as necessary, it is time for us -to ascertain that fact. For, if our standards are now unnecessarily -high, then surely we are not only practising an uneconomical method -of sustaining life, but we are subjecting ourselves to conditions the -reverse of physiological, and which must of necessity be inimical to -our well-being. The possibility of more scientific knowledge of the -natural requirements of a healthy nutrition is made brighter by the -fact that the economic results noted in connection with our metabolism -examination of Mr. Fletcher is confirmatory of similar results -obtained under the direction and scrutiny of Sir Michael Foster at the -University of Cambridge, England, during the autumn and winter of last -year; and by Dr. Ernest Van Someren, Mr. Fletcher’s _collaborateur_, -in Venice, on subjects of various ages and of both sexes, some account -of which has already been presented to the British Medical Association -and to the International Congress of Physiologists at its last meeting -at Turin, Italy. At the same time emphasis must be laid upon the fact -that no definite and positive conclusions can be arrived at, except as -the result of careful experiments and observations on many individuals -covering long periods of time. This, however, the writer hopes to do -in the very near future, with the coöperation of a corps of interested -observers. - -The problem is far-reaching. It involves not alone the individual, but -society as a whole, for beyond the individual lies the broader field -of the community, and what proves helpful for the one will eventually -react for the betterment of society, and for the improvement of mankind -in general. - - - - - INTRODUCTION TO DR. HARRY CAMPBELL’S CONTRIBUTION ON THE IMPORTANCE - - OF MASTICATION - - - [Since the publication of Van Someren’s paper, “Was Luigi Cornaro - Right?”, read before the British Medical Association, and reprinted - elsewhere in this volume, much more attention has been given to - the study of mastication than had been previously reported. Mr. - Gladstone’s advice to his children, which was commonly current and was - repeated whenever mastication was mentioned, was usually accompanied - and met by an amused smile that showed that the full importance of - better mouth-treatment of food was not appreciated. _Glutton or - Epicure_, a little book by the present writer, published in 1898, - insisted on thorough use of the functions of the mouth in alimentation - but did not go into the anatomical, physiological and dental details. - - Dr. Harry Campbell of Northwest London Hospital has performed this - latter service to science and humanity, with splendid carefulness, and - must have devoted much time and study to the collection of evidence - and suggestion which is given here following in full, reprinted from - the _London Lancet_. - - The authors acknowledge with much gratitude, the courteous permission - of both Dr. Campbell and of the editor of the _Lancet_, to reprint all - four articles which composed the series. - - In our own study of the subject of mouth-treatment of food we have - been led to give more credit to the chemical feature of preparation - than Dr. Campbell yet attributes to the chemical side of the problem. - Comminution of hard food is of first importance, undoubtedly, but - insalivation and neutralisation or alkalinisation are, seemingly, - much more easily and quickly accomplished in the mouth than farther - on in the alimentary canal. The intestines _can_ do all in the way - of digestion, even if the mouth and stomach are passed and their - assistance in the digestive process is entirely neglected, but it is - done at tremendous disadvantage in the supplementary digestive tract - of the intestines. We have proven the economy of letting the mouth - do _all it can_, by the insalivation (sipping and tasting) of liquids - that have taste up to the point of compulsory swallowing (a sucking-up - by the Swallowing Impulse which naturally occurs in the course of - treatment in the mouth if not fought against too strongly). If Dr. - Campbell will extend his observations to liquids, say milk, and for - a sufficiently long time to measure results by continued economy of - assimilation and saving of solid excreta, he will find that it pays - to let the mouth do all it can do, and that while it _cannot do too - much_ it _may do too little_. The natural instincts of the mouth, or - those that attach to the mouth, become much more discriminating also - if exercised on liquids as well as on solids. This they do not learn - to do so well if sapid liquids are habitually rushed past their field - of discrimination. - - Taste enjoyed in the mouth is good, and a good part of the pleasure of - living comes from taste gratification, but taste that returns from the - stomach and is belched by eructation or is lingeringly reminiscent in - the mouth or nose is indicative of indigestion. - - Hence it is better to dissipate taste in the mouth, which is the sole - region of taste. Spirits tasted into absorption in this way leave - no odour upon the breath, and asparagus munched and tasted to the - limit in the mouth, carries no odour to the urine. Even the stale and - disagreeable odour of onion or garlic can be neutralised by saliva and - killed in the mouth. - - It is extremely difficult to get observers to practise tasting taste - out of liquids as the wine tasters do, and as the tea tasters _have to - do or die_; or, at least, become useless in their profession. Once the - efficacy of the liquid-tasting precaution in digestion is understood, - however, to swallow anything but pure water without tasting it into - absorption produces a shock. This care becomes instinctive quite - easily and regulates itself automatically. It is also a distinct gain - to the gustatory possibilities, which are very limited at best. - - When the body will tolerate spirits tasted into it--not poured into - it--at all, which is not often when the nutrition is normal (only in - damp or cold weather, as a general thing, and then in the case of - the writer only at rare intervals, say two or three times a year), - the spirit will mix quickly with the saliva and become neutralised - sufficiently to excite the Swallowing Impulse. Continue sipping the - spirit for a time and you will note that there comes a point where the - saliva and the spirit do not mix, do not neutralise; the mouth becomes - unduly full of liquid without any relaxation or invitation of the - Swallowing Impulse; and the really instinctive inclination will be to - _spit it out_. It is a clear indication that the body-_toleration_ has - been fully taxed; there is no longer any bodily need for alcohol--in - fact, there is no longer natural toleration--and the secretion sent - down into the mouth is evidently mucous for a washing-out process, and - is not alkaline saliva for assisting in a utilisation function. - - It is quite uncanny to observe the nicety of mouth-discrimination and - the consistency of it as related to similar substances under similar - conditions, if one learn to read it with precision and intelligence. - - With increased ease of digestion, which comes with more thorough - attention to solid foods alone, the ordinary observer will think - that he has accomplished the whole of the possible benefit. It is - only when he gives sufficient time to liquids also, to get the added - delight and relief that salivary respect of them brings, that the - whole of the beneficence of mouth-service is realised. Follow this - discrimination and care to a comparative measurement of the waste of - digestion, the solid excreta, and note the increased proportionate - gain in assimilation and the value of the economy will be appreciated. - Try the different treatments on milk for a month; fifteen days with - drinking and fifteen days insalivating (sipping and tasting) the milk - to the limit, and keep account of quantity of intake required to - satisfy appetite and maintain body-weight; and also note carefully the - condition and quantity of the fæces. In the one case you will find - the waste to be _fæces_ indeed, and unmistakably worthy of the name; - but in the case of sipping, tasting and insalivating the milk to the - full satisfaction of the appetite, the _digestion-ash_ will assume - quite a different amount and character and deserve a change of name. - The proportions of the saving in our own experiments have approximated - the difference between three and ten; that is, on a reduction of only - one-third the quantity of food commonly ingested, but fully satisfying - the sipping and tasting appetite, the quantity of solid excreta was - only one-tenth of the other and of quite a different character, - æsthetically considered. - - While these suggestions do not discredit or affect the value of the - purely mechanical side of the treatment as given by Dr. Campbell, - and are not intended to be controversial, they are ventured as an - amendment to be worked out in regard to liquids, which are, in fact, - only an extreme of the pultaceous foods against which Dr. Campbell - warns us as being subtly dangerous. - - There is another point in our experiences and observations of the - largest importance that may appropriately be introduced here: The - treatment of all liquids in the manner suggested prevents intemperance - of drinking as effectively as it does intemperance of eating. - - When food is filtered into the body after having become liquified - and made alkaline, or, at least neutral, by saliva, the appetite is - given a chance to measure the needs of the body and to discriminate - against excess. As soon as the point of complete saturation of any one - deficiency is reached, the appetite is cut off, as short as possible - to imagine, with no indication of stomach fullness. It will welcome - a little of proteid in beans, cheese, eggs, or in some other of its - richer forms, and then turn to sugar or fat in some of their numerous - forms. Thirst for water will assert itself for a moment, sometimes - asking but for a drop and again for a full glass, and afterwards, when - near the point of complete saturation, appetite will hesitate for a - moment, as if searching around for some rare substance, and may find - its final satisfaction in a single spoonful of a sweet or a sip of - something in sight. - - The appetite satisfied by the infiltering process is a sweetly - appeased appetite, calm, rested, contented, normal. There is no danger - from the flooding of intemperance, for there is not even toleration - of excess either of more food or of more drink, and this contented - appetite will remain in the condition of contentment until another - need has really been earned by evaporation or destructive katabolism. - - In the teaching of this physiology and psychology of alimentation to - the children of England, lies the only true solution of the drink - question, which is now the curse of the nation. - - Dr. Campbell has made such a splendid case for the mechanical side - of mouth work, that it is the hope of the writer that he will give - equally careful consideration to the chemical and psychological - sides, and in a completeness of observation render inestimable service - to his country, to science, and humanity. A decade of trial on the - inmates of an infant orphan asylum will show the possibilities for the - nation in a single generation, if broadly applied. It might lead to - an effective intemperance, inhibition, or quarantine, and that is all - any nation needs of advantage to make it independent of the world and - truly great.—HORACE FLETCHER.] - - - - - OBSERVATIONS ON MASTICATION - - BY HARRY CAMPBELL, M.D., F.R.C.P. (Lond.) - - _Physician to the Northwest London Hospital_ - - [London _Lancet_, July 11, 18, 25, and August 8, 1903] - - - SECTION I. From _London Lancet_, July 11, 1903 - - THE EFFECTS OF MASTICATION - -The primary object of mastication is to break up the food so as (1) -to facilitate the swallowing of it, and (2), still more important, -to insure its intimate admixture with the digestive juices, not -only within the mouth, but throughout the entire digestive tract. -Mastication has, however, other important and far-reaching effects. -Thus it promotes the flow of saliva and, when properly performed, -secures a due insalivation of the food; it increases the quantity of -alkaline saliva passing into the stomach; it stimulates the heart and -circulation; and it finally influences the nutrition of the jaws and -their appendages by stimulating the local blood and lymph circulation. -Now to consider these various objects and effects of mastication. - -_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. Dry food needs first to be well moistened; and -it is not surprising that it promotes a more abundant flow of saliva -than moist food, though the secretion thus excited may be poor in -ferment. Hence it follows that if we desire to give foods which compel -mastication, they should be tough or dry. On the whole, vegetable foods -necessitate more thorough mastication than animal. The carnivora can -scarcely be said to masticate at all the flesh which they consume; they -simply tear off portions, and forthwith swallow them whole. Cooked -flesh, however, does require mastication, owing to the coagulation of -its proteids. The herbivora, on the other hand, unlike the carnivora, -have to subject their food to considerable mastication before it can be -swallowed; but they generally masticate it far more than is needful to -render swallowing mechanically possible, as is exemplified in the act -of rumination, the object here being to facilitate the admixture of the -digestive juices with the food. - -According to Van Someren, if the habit of masticating efficiently -is once acquired, the food is not swallowed before it is converted -into the liquid state, the swallowing of unmasticated lumps being -effectually prevented by a pharyngeal reflex. - -_Mastication, by breaking the food up into small particles, enables it -to be brought into intimate contact with the digestive juices._--Such -comminution is especially needful in the case of raw vegetable foods -of the tougher kind, in order to break up their cellulose framework, -and to set free the contained starch, proteids, and fats. Foods of -this kind, unless masticated, yield practically no nutriment to the -organism. I cannot too strongly emphasise the fact that before man -learned to break up the cellulose framework of his vegetable food by -cooking he was compelled to subject it to laborious mastication. But, -while thorough comminution is especially needed for vegetable food -when raw, it is also needed for many cooked forms of it also,--as, for -example, solid batter pudding and new underbaked bread, heavy lumps -of which, passing into the stomach, may seriously hamper the work of -that organ. Such substances are indigestible essentially by virtue -of their impermeability to the digestive juices, and they gain in -digestibility in proportion as they are comminuted. The indigestibility -of new bread would appear to be wholly due, not to any peculiarity -of chemical composition, but to its tendency to elude the teeth and -form a sodden mass impermeable to the digestive juices, while the more -powdery stale bread is more easily broken up both in the mouth and -within the stomach. Cabbage, again, owes its indigestibility to the -fact that it is allowed to pass into the stomach in large masses, while -the well-known digestibility of cauliflower and minced spinach is due -to the fineness of their division; were cabbage as finely minced as -spinach usually is it would be equally digestible. - -Turning now to animal food it has to be remarked that while in the -raw state it may be readily digestible with little or no previous -mastication, since massive pieces of it are readily attacked by the -digestive juices, the like is much less true of animal food the -proteids of which have been coagulated and rendered less permeable by -cooking. Large lumps of hard-boiled egg or overdone meat, for instance, -may obstinately resist gastric digestion; indeed, as with vegetable -so with animal foods, their relative digestibility depends more upon -physical consistence than chemical composition; beef is generally more -indigestible than mutton and pork or veal than either, not so much -by virtue of chemical composition as of physical consistence; the -indigestibility of cheese illustrates the same truth; the individual -nutritive ingredients of this substance--the proteids and fats--are not -in themselves indigestible; casein in the form of protein or plasmon is -known to be easy of digestion, and butter is one of the most digestible -of fats; but in cheese the two are welded together into a comparatively -impermeable mass, which is apt to escape comminution by the teeth and -to pass down into the stomach in the form of solid lumps. A plain, -wholesome cheese well masticated or intimately mixed with other foods, -as in macaroni cheese, is quite easily digested by the majority. - -I do not, of course, deny the influence of the chemical factor. -Undoubtedly food may disturb digestion by virtue of its chemical -composition, apart altogether from its physical characters; thus, while -cooked goose-fat sets up violent irritation in some, others cannot -tolerate eggs in any shape or form, and innumerable idiosyncrasies in -respect of special articles of diet are met with which are essentially -referable to chemical composition; but making due allowance for -this chemical influence there can, I think, be little doubt that the -digestibility of the more common articles of diet, both animal and -vegetable, depends in the main upon their physical constitution, _all -of them tending to be equally digestible when reduced to the same -degree of comminution_. This, if true, is, I need scarcely say, a fact -of the greatest practical importance, for it amounts to this: that we -may often allow to those with very weak digestions foods which are -generally considered indigestible, provided that they be thoroughly -comminuted, whether by mastication or artificial means. - -_Mastication promotes the flow of saliva and the insalivation of the -food._--The more efficiently food is masticated the greater is the -salivary flow, and the more intimately is it mixed with the saliva, -or, as we say, insalivated. The saliva has apparently no effect on -fats; whether it acts on proteids seems more doubtful, though by some -authorities the penetration of these by the alkali of this fluid is -said to aid in their subsequent digestion; on starch, however, the -saliva acts very potently, and hence mastication plays a special -part in promoting the digestion of starchy foods. Indeed, if only -mastication be persisted in long enough, starch may be wholly converted -into maltose within the mouth, and it need scarcely be said that it is -better for the individual himself to manufacture his maltose in this -way than that he should take it ready made for him in the form of one -of the many “malt extracts” on the market. Patients are often forbidden -starchy food, while they are allowed the maltose which they can quite -well manufacture in their own mouths. Provided they be sufficiently -insalivated, there are few starchy foods which are indigestible, not -even excepting the proverbially indigestible new potato. These remarks -are especially applicable to children, as will be more particularly -insisted on later. - -_Mastication increases the amount of alkaline saliva passing into the -stomach_, and this not only prolongs the period of starch digestion -within this organ but, by its influence upon the reaction of the -gastric contents, influences all the digestive processes taking place -there. I shall have occasion to point out later that a deficient supply -of alkaline saliva in the stomach predisposes to certain forms of -indigestion. - -_Mastication acts reflexly upon the stomach._--It is now known that -the act of mastication influences the stomach reflexly, promoting the -flow of gastric juice and thus preparing the stomach for the entrance -of food into it. If the œsophagus of a dog is cut so as to allow the -swallowed food to escape instead of passing into the stomach, it is -found that the mastication of food causes a considerable flow of -gastric juice. Food introduced into the stomach unaccompanied by -mastication is less effective in promoting the gastric flow. It is -probable that the influence of mastication on the flow of gastric juice -is largely produced through the medium of psychic influences, for the -more efficient the mastication the more is the sense of taste affected. - -_Mastication stimulates the heart and so promotes the general -circulation._--This stimulating action may be partly due to its local -action on the flow of blood and lymph in the jaws and accessory parts, -and partly to a reflex influence, but whatever the explanation there -can be no doubt of the fact. Hence the mere chewing of a non-nutritive -substance, such as gum arabic, is stimulating, and, doubtless, the -stimulating effects induced by the chewing of such articles as tobacco -and betel are largely to be explained in this way. - - -THE INFLUENCE OF MASTICATION ON THE JAWS AND ADJACENT STRUCTURES - -This subject is of such importance that it needs to be dealt with in -some detail. By “adjacent structures” I mean the masticatory muscles, -tongue, teeth, salivary glands, the nasal passages and sinuses -pertaining thereto, the naso-pharynx, soft palate, and tonsils. - -_The muscles of mastication._--Let me at the outset draw attention -to certain anatomical points, in connection with the muscles of -mastication. These are (_a_) their massiveness; (_b_) the very close -relation of the pterygoids to the naso-pharynx; and (_c_) the outward -direction of the pterygoids. - -(_a_) It is not until one studies the muscles of mastication closely -that one comes to realise their massiveness. Their large size, in -relation to the bony structures in connection with them, is well shown -in a vertical transverse section of the head carried through the -ascending ramus of the mandible[7] (see Fig. 1). It is evident that -the functional activity of so large a mass of muscle tissue cannot but -exercise considerable influence on the nutrition of the neighbouring -parts. - -[Illustration: - - FIGURE 1.--Vertical transverse (slightly oblique) section through the - head on a level with the epiglottis. The massiveness of the system of - masticatory muscles is apparent.] - -(_b_) The pterygoid muscles, springing as they do from the internal -pterygoid plates, must necessarily be in close relation with the -naso-pharynx, especially the internal pair, which take their origin -from the internal aspect of the internal plates. I would further -point out that the external pair, although they diverge from the -naso-pharynx on their way to the mandibular condyles, yet remain on a -level with that cavity. This close relation of the pterygoids to the -naso-pharynx is, if I mistake not, of great importance in relation to -the etiology of “adenoids.” - -(_c_) Of the two pairs of pterygoids the external pair pass in the more -outward direction, forming with the sagittal plane of the head an angle -of 45° (see Figs. 1 and 2). In consequence of this direction they tend -by their contraction to pull the pterygoid plates and posterior parts -of the maxilla away from the sagittal plane of the head, and thus to -secure the normal width of the posterior nares. It is these muscles -which bring about the lateral movements of the mandible, causing the -lower teeth to move laterally and sagittally across the upper, the food -being in this way far more effectually ground than by a mere vertical -pressure of the teeth against one another. These lateral movements are, -as we shall see, less pronounced among the moderns than among primitive -peoples. - -[Illustration: - FIGURE 2.--Portion of horizontal section of head about an inch below - the condyles of the lower jaw. The outward direction of the external - pterygoids is well shown; also the close relation of the levatores and - tensores palati with the internal pterygoids.] - -_The influence of the contraction of the masticatory muscles on the -local circulation of blood and lymph._--When a muscle is at rest the -blood flows sluggishly through it, while there is a complete, or -all but complete, stagnation of the lymph current; if a lymphatic -trunk of a limb at rest be cut no lymph escapes from it. Rhythmic -muscle contractions, however, stimulate the flow both of blood and -lymph (_a_), in the contracting muscles themselves and (_b_) in the -neighbouring parts. (_a_) Not only are the muscle arteries dilated -during rhythmic contractions, but the blood is vigorously squirted out -of the muscle veins, so that much more blood flows through a muscle -during its rhythmic contraction than during rest. The flow of lymph is -even more markedly stimulated,--this fluid, which, while the muscle is -at rest, is stagnant or all but so, being during contraction driven -actively along the lymphatic trunks. (_b_) How greatly rhythmic muscle -contractions influence the circulation of fluids in the neighbouring -parts is shown by the flushing of the skin and the swelling of the soft -parts generally of a limb which is being exercised. We thus see how -profoundly the exercise of the masticatory muscles--and among these we -must not forget to include the tongue--influences not only their own -nutrition but that of the important structures adjacent to them--that -is to say, of the jaw-bones, salivary glands, buccal mucous membrane, -soft palate, faucial tonsils, pharynx, and naso-pharynx, as well as -of the nasal cavities and their accessory sinuses. All these parts -are during mastication copiously flushed with blood and lymph, from -which it is evident that efficient mastication must stimulate their -nutrition and favour their proper development. Hence, in one who has -from childhood upwards been accustomed to masticate efficiently, we -generally find these parts well developed, the jaws large and shapely, -the teeth regular and straight, the tongue and salivary glands large, -the nasal and naso-pharyngeal passages spacious, and the mucous -membrane of the buccal and adjoining cavities healthy. - -_Influence of mastication on the jaw-bones._--It is well known that the -size of a bone is largely determined by the degree to which the muscles -attached to it are exercised. That the jaws do not grow to their normal -size, if not adequately exercised during their period of growth, is -strikingly shown by the overcrowding of the teeth, which takes place -in those brought up on soft foods, and this even though there be no -contraction of the jaws resulting from mouth-breathing. The dependence -of the size of the jaws upon the degree to which they are exercised is -also shown by the smallness of the modern jaw, as compared with that -of primitive peoples, a difference which, as we shall see, is in part -congenital and in part due to the comparative disuse of the former. -Mastication influences not only the size but also the shape of the -jaws (_a_), through its influence on the size of the tongue, which by -pressing against the teeth tends, as Sim Wallace has shown, to expand -the jaws; (_b_) by the pressure of opposing teeth against one another, -which has a similar effect; and (_c_) by the outward pull of the -pterygoids, which tends to widen the maxilla posteriorly and to broaden -the posterior nares. - -_Influence of mastication on the teeth._--The teeth being developed -within the jaw-bones and remaining, even after eruption, in close -anatomical and physiological association with them, must necessarily -share in their nutritive tendencies. If these bones are efficiently -exercised during the formation of the teeth--and my remarks apply -especially to the permanent set--the tooth-germs will be abundantly -flushed with blood, while the ample growth of the jaws themselves -will provide the germs with plenty of room in which to grow and to -develop, and the more perfect their growth and development the more -resistant should we expect them to be to the ravages of caries. Who can -contemplate the jaw-bones of a six-years-old child, dissected so as to -display all the imbedded teeth, without being assured of the effect of -mastication upon dental development? Fifty-two teeth meet the view: -the whole region from the orbital rims to the inferior border of the -mandible is literally paved with them, and I can hardly doubt that -they collectively weigh more than the bone in which they are imbedded. -Surely no one can examine such a dissection without being convinced of -the urgent necessity, if the teeth are to grow and to develop normally, -of giving the child’s jaws from infancy onwards plenty of work to do. - -The ample development of the jaws, which efficient mastication brings -about, has a further beneficial effect as regards the teeth, in that -it enables them to take up their proper places in the alveolar ridges, -thus securing all the advantages of a good “bite.” These I now proceed -to consider. The teeth during mastication, and especially when the bite -is good and the food of a kind necessitating vigorous and sustained -mastication, are made to move in their sockets both vertically and -horizontally; the effect of this is to stimulate the circulation in the -tooth-pulp, the alveolar periosteum (and hence also in the cementum and -alveolar walls which are supplied by it), and the circumjacent mucous -membrane of the gum. All this makes for the health of the teeth; not -only does it promote the nutrition of the tooth itself and of its bony -socket, thus maintaining a firm dental setting, but it also tends to -secure a healthy environment for the exposed part of the tooth--that -part, namely, wherein caries begins--by maintaining a healthy state of -the surrounding and, indeed, of the entire buccal mucous membrane, as -well as of the various secretions which bathe the mouth. Wherefore it -is not surprising to find that those who masticate efficiently suffer -much less from dental caries and its complications (such as abscess at -the root) and disease of the periodontal membrane (_e.g._, pyorrhœa -alveolaris and loosening of the teeth) than those who are accustomed to -bolt their food. - -A few words as to the influence of mastication in wearing down the -teeth. In those races which masticate vigorously the teeth in quite -early adult life show signs of wearing away, while in later life it is -quite common for the biting surfaces to be worn flat; sometimes the -crown of the molars is worn away so that its surface shelves downwards -and inwards and not infrequently it is concave, having a scooped-out -appearance; often the dentine is exposed in this way; and yet among -many hundreds of skulls examined I do not remember to have seen one -single case where caries has started on the biting surface thus worn -down. - -I had always attributed this wearing down of the teeth to the friction -of coarse food against them. Primitive races eat coarse vegetable -food, which frequently contains grit, and this doubtless helps to grind -the teeth down, but they may be markedly ground down even in those -living on soft food, and in such cases the grinding away can obviously -only be due to the friction of opposing teeth against one another. -I, indeed, believe this to be the essential cause of the phenomenon, -both in civilised races living on soft food and in primitive races -whose coarse food necessitates prolonged and vigorous mastication and -a corresponding amount of attrition between the biting surfaces of -opposing teeth. In order that this attrition may occur two things are -requisite: the upper and lower teeth must be well opposed--there must -be a good bite--and mastication must be vigorous and of the right kind. -Mere vertical pressure of the teeth against one another will not wear -away the opposing surfaces; there must be friction of these surfaces -against one another--a transverse and sagittal movement of the lower -teeth against the upper by means of the pterygoids. Mainly to this do -I attribute the marked wearing down of the teeth observed in primitive -peoples, and I am gratified to know that so competent an authority on -dental pathology as Sim Wallace is a convert to this view. - -That all the teeth may be worn down just as we observe in primitive -people, even in those who have lived all their lives on the ordinary -fare of the moderns, is proved by a case I have under observation. It -is that of a man in his fiftieth year, who was brought up in Belgium -but who has resided in London for the last thirty years. When he came -to my out-patient room I was not a little surprised to find that -all his teeth were sound--a very unusual occurrence, I need hardly -say, among the London poor at his age. In seeking for an explanation -I elicited the fact that he was unable to swallow his food without -chewing it very thoroughly, and on giving him a moderate-sized piece -of bread, with the request that he should chew it in the ordinary way, -I found that he subjected it to one hundred and twenty separate bites -before swallowing it, and in the steady, deliberate way he went to work -and in his extensive lateral movements of the mandible he reminded one -for all the world of a cow chewing its cud. The temporals and masseters -of this man are enormous, and the like is no doubt true of the -pterygoids; he has well-developed nasal passages, has never suffered -from nasal obstruction, while his buccal mucous membrane is unusually -healthy for one of his years and circumstances. May we not attribute -this healthy state of the mouth, teeth, and nose to the good effects -upon them of efficient chewing? Here is a man who has lived for thirty -years in London on the same kind of food as the average poor Londoner, -but instead of finding his mouth full of carious, tartar-coated teeth, -and spongy, receding, pus-exuding gums, we find thirty-two sound teeth -firmly set in healthy gums and all but devoid of tartar. - -A word as to the wearing down of the teeth in the anthropoid apes. -In this respect the gorilla differs markedly from the orang and the -chimpanzee. In all the skulls of these latter which I have examined the -teeth show signs of wearing away, while I have found the teeth of the -gorilla, with the exception of the tusk-like canines, but little worn. -From this we should expect the latter animal to be mainly carnivorous, -and the orang and chimpanzee to be largely herbivorous. - - - SECTION II. From _London Lancet_, July 18, 1903 - - CHANGES WHICH THE JAWS AND TEETH OF MAN HAVE UNDERGONE DURING MAN’S - EVOLUTION FROM HIS ANTHROPOID ANCESTORS - -During man’s progress upwards from the anthropoid his diet has -undergone a progressive change, and a parallel adaptation has taken -place in his jaws and teeth. Dietetically considered, we may divide -his evolutionary career into the following epochs[8]: (1) the -anthropoid stage; (2) the pre-cooking human stage; (3) the cooking -pre-agricultural stage; (4) the early agricultural stage; and (5) the -late agricultural stage. - -1. _The anthropoid stage._--The diet of man’s anthropoid ancestors -was probably much the same as is that of existing anthropoid apes; it -consisted, namely, of raw vegetable and animal food, necessitating a -vigorous use of the maxillary apparatus. This latter, we may assume, -was of the type belonging to the anthropoids--_i. e._, the jaws were -massive and markedly prognathic; the denture was the same as it is in -existing man, but the teeth were larger, especially the upper canines, -which served as weapons of offence and defence; the third molars (the -wisdom teeth) were as large as the other molars and were provided with -three fangs, and there was an ample portion of alveolar ridge behind -them; there was no chin. No doubt the massiveness and the marked -prognathism, which characterised the jaws at this stage, served other -ends than that of mastication; it is obvious that projecting jaws and -teeth are much more effectual for seizing and lacerating prey than are -the orthognathic jaws of modern man. - -2. _The pre-cooking human stage_ extends from the time man’s ancestors -first assumed the human form till they learned to apply fire in the -preparation of their food. During all this period the jaws and teeth -were probably used as much, or almost as much, for mastication as -during the anthropoid stage; raw animal food had to be torn from -the bones, the latter had to be crunched, while the bulk of the -raw vegetable food needed then no less than it needs now prolonged -and vigorous mastication in order to liberate the starch and other -nutritive ingredients from their undigestible cellulose envelopes.[9] -Nevertheless, the jaws and teeth underwent considerable change during -this period, for not only were they with every advance in intelligence -called less and less into requisition for purposes of offence and -defence, but the jaws, at least, became materially modified in -correlation with the expanding cranial cavity and in connection with -the assumption of the erect posture. It is, I think, rather for these -reasons than in consequence of alterations in the nature of the food -that the masticatory apparatus now gradually lost its more bestial -aspect and assumed an essentially human type, becoming towards the -close of the period much the same as may be observed among the most -primitive peoples now living. - -3. _The pre-agricultural cooking period._--The characters of the -maxillary apparatus belonging to this period are still available for -study, the aboriginal Australians, the Bushmen, Negritos, and many -Esquimaux not having yet emerged from it. So far as mastication is -concerned, cooking influences vegetable far more than animal food, for -it not only softens it but by rupturing the undigestible cellulose -chambers and liberating their contents relieves mastication of one -of its essential functions. Wherefore, with the advent of cooking, -man’s jaws and teeth began to get smaller, and they have continued to -diminish in size up to the present time. No great diminution, however, -took place at first, inasmuch as the diet still continued to be largely -animal (and prior to the use of knives and forks such food had to be -torn by the teeth), while the coarse vegetable food of this date, even -when cooked, still needed laborious mastication. The chief differences -between the maxillary apparatus of this early cooking age as compared -with that of the present day are as follows: the jaws of the earlier -period--_e. g._, in the aboriginal Australian--are more massive, and -their sagittal diameter is greater, giving rise to decided prognathism, -the teeth for the most part are larger and stronger, the third molars -being nearly, if not quite, as big as the other molars, and provided -with three fangs, while there is a considerable portion of alveolar -ridge behind them. The third molars, however, show a decided tendency -to be smaller than the rest, and the alveolar ridge behind them is less -marked than in the previous period, features, I doubt not, attributable -to the influence of cooking in diminishing mastication. Dental caries -is rare and is chiefly met with in the third molars. - -4. _The early agricultural age._--All the existing primitive races -which have attained to the cultivation of the soil may be regarded as -belonging to this period. Previously to it man was mainly carnivorous, -owing to the comparatively limited quantity of vegetable food -available, so long as the supply was left to nature alone; but when by -cultivation this supply was increased and, at the same time, rendered -more constant and certain, he gradually became less carnivorous and -more vegetarian in his diet. The result of agriculture, however, is -not only to increase the supply of vegetable food, but to diminish its -fibrous, cellulosic ingredients, and thus to render it more easily -masticated. Hence at this stage we find the maxillary apparatus -becoming smaller than in the previous period, although the difference -as shown--_e. g._, by the examinations of the skulls of the African -negroes and the Melanesians--is less pronounced than we might perhaps -have anticipated; prognathism is not so decided, the jaws are smaller, -also the teeth, especially the third molars, which now for the first -time show a tendency to be furnished with two instead of three fangs, -while the alveolar ridge behind them is distinctly shorter than in -the preceding period. Dental caries, hitherto rare, now becomes more -frequent. - -5. _The late agricultural period._--A mid-agricultural period might be -described, but I shall take no account of it here, but pass on to a -consideration of the late agricultural period--that, namely, in which -we ourselves live. The chief characteristic of the food of this period -is its softness. Cooked animal food requires, indeed, more mastication -than raw, but the vegetable food of to-day, owing to the combined -effects of improved agriculture, and skilful milling and cooking, is so -soft as to excite comparatively little mastication. The present may, -in fact, be described as the _age of pap_. Hence the jaws and teeth -are now called upon to perform far less work than in any earlier stage -of our evolution, and there has taken place in consequence a great -diminution in their size, more especially in the size of the jaws, so -that there is now often no room for the teeth to take up their normal -positions, and there is generally a complete absence of alveolar ridge -behind the last molars. The latter are, moreover, apt to be very small -or even absent, while dental caries is alarmingly frequent. - -It will thus be seen that from the period of the anthropoids to the -present time, a progressive change in the size and shape of the jaws -and teeth has been taking place, a change which is to be explained -by (1) the cessation of the need for using them for offensive and -defensive purposes; (2) the growing capacity of the cranium and the -assumption of the erect position; (3) the progressive alteration in -man’s diet; and probably also (4) considerations of beauty. The first -three factors have operated through natural selection, the last through -sexual selection, which has come into play, I would suggest, chiefly -within recent times. Probably the most pronounced change which has -taken place in the jaws during the agricultural periods has been the -suppression of prognathism which, in the woman especially, is very -unsightly, and tends to diminish the likelihood of marriage. - - -INSTANCES OF THE VIGOROUS USE TO WHICH THE JAWS AND TEETH ARE PUT AMONG - EXISTING PRIMITIVE PEOPLES - -A study of existing primitive peoples brings forcibly home to the -mind how laboriously the jaws and teeth of our primitive ancestors -were used. I have already shown how in pre-agricultural and early -agricultural times the nature of the food compelled a sustained and -vigorous exercise of these structures, and I wish here only to refer -to a few specific and peculiar instances of laborious mastication -exercised by primitive races now or recently living.[10] Among some -of these mastication has been promoted almost to the position of an -industrial art. - -_The chewing of very tough substances in order to extract therefrom -liquid or nourishment._--The recently extinct Tasmanians included -among their articles of diet a species of sea-weed which, even when -cooked, was so tough as to require long-sustained mastication in order -to extract its nutrient elements. The Indians of North California chew -kelp, which is “as tough as white leather” (_i. e._, leather dressed -with alum). “A young fellow with good teeth will masticate a piece -of it a whole day.” Again Featherman[11] tells how when the Bushmen -are short of food in the winter they steep an old dried gnu-skin in -water and, having rubbed off the hair, boil it, and proceed to gnaw the -tough morsel until their very jaws ache. The Modoc Indians are said to -munch the raw kais root all day long.[12] Among the Esquimaux it is a -universal custom to chew the raw skin of the whale, the porpoise, and -the seal for the blubber it contains, and the skin being as tough as -india-rubber, it requires, as may be imagined, a good deal of chewing. -The Lower Californians also chew deer-skin and ox-skin (Bayert). The -more southern Esquimaux, according to Nansen, preserve the stalks of -_angelica_ by steeping them in a mixture of chewed blubber and saliva. -Finally, I may refer to the habit of chewing the sugar-cane, a practice -which is prevalent among the natives in all countries where the cane -grows, and affords, it need scarcely be said, abundant exercise for the -jaws and teeth. - -_Mastication in the preparation of beverages._--I find that among -widely separated aboriginal peoples chewing is resorted to in the -preparation of beverages, both intoxicating and non-intoxicating. -The Gran Chaco Indians make an intoxicating drink by chewing the -algarroba bean and then spitting into a receptacle. In other parts of -South America berries are chewed with the same object. In some of the -Pacific Islands boys and girls with good teeth are selected to chew a -root (kava), from which they then prepare a drink. In New Guinea drinks -are similarly prepared from roots. Boiled cassava root is chewed by -the Indians of Nicaragua for the same purpose. In British Guiana the -natives make a drink by adding chewed maize and saliva to sweet potato, -maize, and sugar-cane. The Indians in Honduras, after steeping cassava -cake or carbonised bread in hot water, chew a portion and mix it with -the rest. - -_Mastication in the industries._--Even among moderns teeth are used -for many purposes other than mastication--_e. g._, for holding pins -and needles and for severing cotton; also in some industries--_e. -g._, among diamond workers--where it is the custom for girls to hold -the diamond between their front teeth, which in consequence get much -worn away, as I have myself seen. It is only among primitive peoples, -however, that the jaws and teeth actually play the part of implements -for use in the arts. The Australian women make lines, nets, and bags -by chewing various kinds of fibre, a process which wears down their -teeth considerably and may cause them to be tender.[13] The Esquimaux -are still more dependent upon the use of their teeth as implements, -especially in the preparation of skins for their clothing, boats, and -lines. The teeth are used to hold the skins, while the latter are -being scraped, the mouth constituting, in fact, “a third hand;” and -the front teeth of Esquimaux women are often by this means worn away -to the merest stumps.[14] The garments of the Esquimaux, even to the -boots, are made up of skins which have been laboriously chewed for this -purpose by the women “inch by inch,” till they acquire a beautiful -softness and flexibility, and are often, indeed, chewed again after -having been dried. And we are told that the women have no objection -to the task, while the children are eager to help in it on account of -the blubber the skin contains; also, that in bad times the men do not -object to join in the work. The lines for harpooning are prepared in -a similar way from the skin of the bearded seal, and in very large -quantities.[15] When we think of the quantity of skins needed for these -lines, for their dress, including boots and gloves, and for their -boats (although for the latter some skins are used without having -first undergone chewing), it is clear that enormous quantities must be -chewed. The Esquimaux men also use their teeth considerably in other -work--_e. g._, in lashing the sledges together.[16] The Indians of -North California use their teeth for stripping the bark from the fresh -shoots employed in making their wickerwork utensils, and they also -employ their teeth in making strings, cords, and nets. - - - THE INSTINCT TO MASTICATE - -Seeing that the maxillary apparatus of man has for long ages past been -put to vigorous use, it is not surprising that the need to exercise it -should express itself as a powerful instinct. This instinct manifests -itself in many and curious ways, some of which I will now consider. -During the early months of life the natural function of feeding at -the breast provides the infant’s jaws, tongue, and lips with all the -needful exercise. This bottle-feeding fails to do, and we frequently -find bottle-fed children seeking to satisfy the natural instinct by -sucking their thumb, fingers, or any convenient object to hand. The -teeth are a provision for biting hard foods, but even before they -actually appear we find the child seeking to exercise his toothless -gums on any hard substance he can lay hold of, and there can be no -doubt that exercise of this kind tends to facilitate the eruption of -the teeth, a truth, indeed, recognised universally, whether by the -primitive mother who strings the tooth of some wild animal round the -neck of her infant, or the up-to-date parent who provides her child -with a bejewelled ivory or coral bauble. When the teeth have erupted, -the masticatory instinct finds among primitive peoples abundant -satisfaction in the chewing of the coarse, hard foods which constitute -their dietary; but among us moderns, subsisting as we do mainly on soft -foods, affording but little exercise for the masticatory apparatus, -it does not find its proper expression, and thus tends to die out. -Nevertheless, it dies a hard death, and long continues to assert -itself; witness the tendency of children to bite their pencils and -pen-holders; I have known a child to gnaw through a bone pen-holder, -much in the same way as a carnivorous animal gnaws at a bone. - -This instinct to chew for chewing’s sake manifests itself all over -the world. In our own country not only do children bite pencils and -pen-holders, but they will chew small pieces of india-rubber for hours -together. The practice of gum-chewing, so common among our American -cousins, evidently comes down from far-off times, for the primitive -Australians chew several kinds of gum, attributing to them nutrient -qualities,[17] and the Patagonians are said to keep their teeth white -and clean by chewing _matri_, a gum which exudes from the incense bush, -and is carefully collected by the women and children.[18] - -A widespread custom in the East is betel-chewing, which is met with in -India, Malay, Melanesia, and Polynesia, and even among the primitive -Veddahs of Ceylon. This article is composed of the pungent leaf of -the betel plant, the areca nut and lime rolled together, and when -chewed yields a reddish juice which stains the mouth and teeth. The -Veddahs, failing to get the genuine article, manufacture a quid from -the leaves of an aromatic plant, the barks of one or two kinds of tree, -and calcined small shells.[19] The compound must possess some strange -attraction, for otherwise such pains would not be taken to secure it. -What is the attraction? Doubtless betel has stimulating properties, -and it must, moreover, be remembered that the mere mechanical act -of mastication stimulates the circulation, a fact which helps to -explain the tendency for man, all the world over, to chew non-nutrient -substances. Tobacco-chewing is common in many parts of the world, and -here, again, the effect for the time is stimulating. Pitcherie is -extensively chewed among the aboriginal Australians; it consists of -twigs of about the thickness of rye-grass stems, which are first chewed -into a mass, then mixed with the ash of gum trees, and made into a -paste, which is chewed for its stimulating and narcotic effects.[20] - -I may allude in passing to the grinding of the teeth, which takes -place during sleep in disturbed states of the nervous system. It is -a true masticatory act, in which the normal lateral movement of the -mandible is well marked, and it may thus be regarded as a perverted -manifestation of the masticatory instinct. - - - THE CAUSATION OF INEFFICIENT MASTICATION - -The effects for good upon the organism of efficient mastication being -profound and far-reaching, it follows that inefficient mastication must -lead to many evils. What these are we have now to consider; but first -it will be well to inquire into the causes of the defective mastication -which prevails among moderns. - -1. _Softness of food._--By far the most important of these lies -in the nature of the food taken. The food of to-day--of the late -agricultural age period, as I have termed it--is for the most part -soft and pappy, of a kind which does not compel thorough mastication; -so much so, indeed, that, as I have already said, we may speak of this -as the age of pap. This feature is especially noticeable in the case -of children’s diet: under the modern system children are kept on a -liquid, or semi-liquid, diet, not merely during the first months, but -during the first years of life, and at the seventh or eighth month all -kinds of artificial saccharide foods in liquid or semi-liquid form are -poured into the child’s stomach; thereafter he is fed on such viands -as mashed potatoes and gravy, rusks soaked in milk, milk puddings, -bread dipped in bacon fat, pounded mutton, thin bread-and-butter, -and the like; and we are told that this is the kind of diet best -suited to the young human, from the time of weaning to the end of the -second year! The same pernicious methods are adopted subsequently. -“Perhaps the great majority of children after they have got their -complete set of temporary teeth have,” writes Dr. Sim Wallace,[21] -“a dietary such as the following. Breakfast: bread-and-milk or -porridge, milk, tea, coffee, or cocoa, bread-and-butter, perhaps an -egg. Dinner: potatoes and gravy, or meat, milk pudding. Tea: milk -or tea with bread-and-butter, jam, cakes. Supper: bread or biscuit -and milk.” Now food of this kind does not invite mastication, and it -finds its way into the stomach all too readily. Hence the instinct to -masticate has little opportunity of exercise and, not being properly -exercised, tends, as I have said, to die out. Small wonder that the -child nourished on such pappy food acquires the habit of bolting -it, and learns to reject hard, coarse foods in favour of the softer -kinds; everything nowadays must be tender, pultaceous, or “short.” -Given a choice between a food compelling little or no mastication -and one necessitating prolonged mastication--as between, say, fresh -Vienna bread and an Abernethy biscuit--and in nineteen cases out of -twenty the one which gives the least trouble in eating will be chosen. -To such absurd lengths has this harmful custom been pushed that -even bread crust is avoided by many. Witness the fashion of eating -bread-and-butter with a minimum of crust; order bread-and-butter at -any place of refreshment, and the last thing you will be served with -is a plateful of crusts of bread. Many establishments, indeed, make -a regular practice of giving away their crusts as unsaleable. Thus, -the rectangular loaves used for bread-and-butter in the “Aërated -bread-shops” are cut transversely into slices, each loaf thus yielding -two end crusts which are put into baskets for the poor, only the soft -crumby pieces being reserved for the customers, to be, in due course, -no doubt washed down by copious libations of tea and coffee. - -When we trace the diet of the modern from childhood upwards we find the -same story: it tends to remain soft and pappy to the end. Animal food, -especially as it comes to the tables of the well-to-do, necessitates -very little mastication. It is the coarser varieties of vegetable food -alone which call out the full functional activity of the masticatory -apparatus, but the vegetable food of to-day is rarely of a kind to do -this; cooked vegetables, such as potatoes, greens, peas, and beans, -can be, and generally are, swallowed after little or no preliminary -mastication, and our flour is so carefully deprived of its fibrous -portions and so cunningly dealt with in the bakehouse and kitchen in -the making of bread, cakes, and pastry which shall eat light and short -that these articles get very little chewing; while such vegetable -products as rice, vermicelli, tapioca, and macaroni are, as served at -table, so soft that they slip down into the stomach almost as readily -as simple milk. Let any one run through his dietary of any one day, -and he will realise how very little work his masticatory apparatus is -called upon to perform. It will read something like the following. -Breakfast: porridge and milk, eggs, bacon, bread, and marmalade. Lunch: -fish, tender meat, boiled vegetables, bread, some “sweet,” and cheese. -Tea: bread, butter, and cake. Dinner: much the same as lunch. What -opportunity, I ask, does such a bill-of-fare afford for the development -of teeth and jaws, and for the proper functional activity of the -salivary glands? - -2. _Defective masticatory apparatus._--Another potent cause of -inefficient mastication is some defect in the masticatory apparatus, -and defects of this kind are very common in those who have not been -accustomed to masticate thoroughly in early life. Foremost among these -are irregularities of the teeth leading to faulty “bite” and caries of -the teeth which causes them to be tender or to break away, if it does -not lead to their actual extraction. Mastication cannot be thorough -where the bite is defective, for this not only leads to imperfect -opposition of the upper and lower teeth, but renders the lower ones -incapable of that ample lateral movement, against the upper which is -needful to normal mastication. - -3. _Idiosyncrasy._--Some are temperamentally more disposed to hurry -over their meals than others. The katabolic, restless, nervous -individual is more apt to swallow his food hastily than is his more -deliberate and phlegmatic brother. Individual differences in this -respect are even observed among the lower animals. Thus, one of a pair -of horses of about the same age and build is nervous and excitable -and inclined to bolt its food, while its companion of more stolid -temperament is a thorough and efficient masticator. The former shows -comparatively little wearing down of the teeth, and often suffers -from indigestion, a large portion of corn grains passing through -his digestive canal intact; in the latter the teeth are well worn, -indigestion never occurs, and but very few grains pass through the -digestive tract unchanged. It may be objected here that we cannot -help temperament, and to a large extent this is true; but much can be -done towards modifying it, and it is something to know where dangers, -temperamental dangers, among others, lie. - -4. _Circumstances of life._--Again, in this hurrying, strenuous age -people are much less deliberate than in the easy, slow-going days of -long ago. A meal is too often regarded as something to be got through -quickly, as taking up time which might be devoted to something more -profitable. Especially is this true of breakfast and lunch; it is no -uncommon thing for a business man to hurry through his breakfast in a -few minutes, preparatory to rushing off to his train, and his lunch -as likely as not is as hastily swallowed in his office or at a bar. -Tradesmen are apt to take their meals in mere snatches; apprentices, -shop girls, and other “hands” are often not allowed sufficient time -for their meals; while, to come to the professions, we all know how -the busy medical man, for instance, is often obliged to take a hurried -snack in the short intervals between seeing his patients. No wonder -that thus circumstanced people acquire the habit of bolting their food. -A meal should be regarded as an end, and an important end, in itself. -It should be taken at leisure, body and mind being, for the time being, -given up to it, and to agreeable social intercourse. If this rule were -always observed a most important source of inefficient mastication -would be removed. - - - SECTION III. From _London Lancet_, July 25, 1903 - - EVILS RESULTING FROM INEFFICIENT MASTICATION - -_Too much food is eaten._--Inefficient mastication conduces to -excessive eating. Now it is obvious that soft foods, and these -constitute the bulk of our modern dietary, pass much more readily into -the stomach than coarse, hard foods which compel a certain amount of -preliminary mastication, and for this reason the former predispose to -excessive eating: hence a danger at all periods of life, not only in -grown-ups but in children, even infants; brought up as the latter are, -mainly on liquid and pappy foods, many of them consume not only far -more than is needful, but far more than is healthful, their stomachs -being literally deluged with nutriment. - -When the food is of a kind necessitating abundant mastication it is -much less likely to be taken in excess, for the longer the time spent -in mastication the less will the individual be tempted to consume; -even in the case of soft food, less will probably be eaten if it be -thoroughly masticated and insalivated than if it be bolted. Thorough -mastication, however, not only tends to diminish the amount of food -consumed on account of the time and labour which it entails; it -actually reduces the amount needful to constitute a sufficiency, for -the more perfectly the food is chewed the more perfectly is it digested -and the more economically is it disposed of in the system; the less, -moreover, is the tendency to that morbid craving for food which is so -frequent an accompaniment of defective digestion. It is certain that -appetite and the needs of the system are sooner satisfied when food is -well masticated and digested than when it is swallowed whole. - -_A mass of unmasticated food may lodge in the throat and cause fatal -suffocation._--This may seem to be a very exceptional kind of evil, -but I am informed by one whose experience makes him an authority -on the ways of the British soldier that it is by no means uncommon -for soldiers in barracks to die from this cause. Usually it is when -they are under the influence of alcohol that fatal results occur, -post-mortem examination disclosing large undigested masses of food in -the stomach. A like experience is also frequently met with in the case -of men killed by accident. - -_The presence of masses of imperfectly masticated food in the stomach -may cause disturbance either mechanically or by reason of their -imperviousness to the gastric juices._--We have already seen that the -digestibility of a food is largely determined by its consistence, and -that many articles of diet, such as cheese, hard-boiled egg, cocoa-nut, -lobster, and new bread, which have the reputation of being very -indigestible, can, if finely comminuted by chewing or otherwise, be -rendered quite digestible. Such articles are indigestible essentially -by reason of their compactness; the compact lumps, but little pervious -to the gastric juice, tend to undergo abnormal chemical change in the -stomach, and may in this way cause violent local irritation, even to -the extent of setting up acute gastritis; or they may paralyse the -nerves of the stomach and check gastric secretion and movement, and -thus remain _in loco_ wholly undigested for hours or even days; or, -again, more distant nervous effects may be produced, such as frontal -headache, which may be felt almost immediately after ingestion of -the peccant substance, being of reflex rather than toxic origin, -and presumably in some cases, at least, due to the mere mechanical -irritation of the stomach. The passage of imperfectly digested food -into the bowel may still further aggravate matters. It does not seem -improbable that the habitual bolting of food, by the prolonged local -irritation to which it gives rise, may predispose to cancer of the -stomach: Napoleon was a notorious fast eater and it is well known that -he died from this disease. - -While, however, the bolting of food readily sets up disturbance in -some, it must be conceded that in many it seems to cause little or no -inconvenience; especially is this the case in the young with vigorous -muscular stomachs capable of triturating the food, and thus doing duty -for the teeth. The human stomach is, indeed, a long-suffering organ, -and wonderfully tolerant of ill-treatment, sometimes almost rivalling -in its hardiness the gizzard of the bird. Nor is this surprising when -we reflect that it is, in the ordinary course of nature, constantly -exposed to the entrance of noxious substances. In this respect it -stands in marked contrast to the intestines, for not only are highly -irritant substances often vomited rather than passed onwards, but in -ordinary circumstances the gastric contents are not allowed to pass -the pylorus, until they have been duly prepared by the stomach; the -pylorus, in fact, stands guard over the entrance to the bowel and is -jealous of anything passing it which is likely to injure that canal. - -And just as the pylorus protects the bowel so, in exceptional cases, -may the œsophagus protect the stomach, regurgitating, after the fashion -of the ruminants, insufficiently masticated bits of food, in order -that they may be re-masticated. I have myself met with cases in point. -Sometimes, in cases of this kind, the œsophagus may be dilated into a -sort of proventriculus, which is capable of temporarily lodging a large -quantity of food. Such a proventriculus is said to have developed in -an apprentice who, not being allowed sufficient time for his dinner, -rapidly bolted it, to regurgitate it after working hours and to chew -the cud at leisure. Whether in these cases the food is ever returned -from the stomach itself I am unable to say. - -While the stomach is the organ especially liable to be injured by the -swallowing of lumps of unmasticated food, the bowel may also suffer, -especially the cæcum and vermiform appendix. And here we come to one of -the most serious indictments against the bolting of food; though man -has doubtless always suffered from appendicitis, there can be little -doubt that this malady is more common now than it used to be; and -there is equally little doubt, in my own mind at least, that the cause -of its greater frequency is related to his food. I do not propose to -discuss here in detail how food is capable of causing appendicitis, -but will merely refer to one of the ways in which it may do so. I had -already come to the conclusion that the habit of bolting food is a -potent cause, when I read Sir Frederick Treves’s Cavendish Lecture in -which he makes that contention. Sir Frederick Treves points out that -in this rushing age people, especially business men, are apt to hurry -over their meals and to take them at irregular times and often while -standing at a bar; even when there is more leisure, food is rarely -masticated nowadays in the same thorough way that it was in the old -time, when it was of a coarser nature: hence solid lumps, especially -in the case of such articles as pine-apple, preserved ginger, nuts, -tough meat, and lobster, are apt to pass beyond the pylorus and, -escaping intestinal digestion, to lodge in the cæcum and precipitate an -attack of appendicitis, the most common predisposing cause of which is -a loaded cæcum, often preceded by constipation. Sir Frederick Treves -contends that this distended state of the cæcum encourages catarrh of -the appendix by dragging upon it and blocking its orifice, as well as -by twisting it and thus interfering with its blood-supply.[22] - -_An excess of starch is apt to pass into the stomach._--We have just -seen that inefficient mastication tends to promote over-eating, and -what has been said on this head applies to all kinds of food, starchy -foods among others. It leads, however, to a further evil as regards -these latter; not only does it tend unduly to increase the quantity of -them consumed, but it too often causes the stomach and intestines to -become flooded with starch in a wholly undigested form. I cannot too -frequently repeat that in ancient times, especially in the pre-cooking -age, laborious mastication was needed in the case of all starchy -foods, partly because they were coarse and fibrous, but chiefly because -the starch and other nutritive ingredients had, in order to become -available for nutrition, to be liberated from their undigestible -cellulose envelopes. In these days of prepared, soft, starchy foods, -however, mastication is very little required for these purposes, but in -other respects it is as needful as ever, indeed more needful, if the -large quantities of starch which are now consumed are to be insalivated -effectually. The laborious and sustained mastication to which primitive -man was compelled to subject _his limited supplies of uncooked starchy -food, went far to effect complete digestion of the starch within the -mouth_, for raw starch is freely digested by the saliva,[23] and hence -in his case _very little passed into the stomach in a wholly undigested -form_. How different is the case with us moderns. Since the opening -of the era of agriculture and cooking, man has enormously multiplied -his supplies of saccharide, and he now consumes large quantities of -starch which has been freed from its cellulose framework by cooking, -milling, grinding, and the like, and reduced to a soft or pappy form, -such as milk puddings, porridge, boiled potatoes, and new bread, all -of which can be swallowed with little or no preliminary chewing; and -when food can be swallowed easily, without mastication, few will take -the trouble to masticate it. In these circumstances the starch does not -undergo adequate salivary digestion, and a large quantity passes wholly -undigested into, and out of, the stomach, not beginning to be digested -until it reaches the bowel. Small wonder that the latter should rebel -again this invasion and that flatulence, pain, and other dyspeptic -evils should result. - -It is especially in young children that these evils are observed. Too -often the stomach of the child, semi-carnivorous, remember, by its -ancestry, is literally deluged with pure starch. At the seventh or -eighth month, or even earlier, for many of the patent infant foods -contain it, this substance is poured into the stomach without being -afforded any opportunity of undergoing salivary digestion; and for a -long time after infancy large quantities are given in the liquid or -pultaceous form, such as rusks soaked in milk, puddings, and mashed -potatoes. This practice of deluging the digestive organs with starch, -besides leading to the more immediate troubles connected with flatulent -dyspepsia, gives rise to abundant formation of toxins which, by -irritating the alimentary mucous membrane, set up gastro-intestinal -catarrh; this, again, intensifies the dyspepsia already existing and -causes a still further production of toxins, so that the motions -become intensely fœtid. These poisons being absorbed into the blood -the tissues become saturated with them and the nutrition of the entire -organism is disturbed, the faulty metabolism manifesting itself by a -diminished resistance to pathogenic agencies, by a tendency on the part -of the tissues to inflame (as shown by a liability in children thus fed -to bronchitis, rhinitis, naso-pharyngitis, and tonsillitis), by their -proneness to tuberculosis, and finally by a disposition to rickets, -which I little doubt is essentially of toxæmic origin. - -Besides the above-mentioned troubles an excess of starch in the stomach -may set up hyperchlorhydria--_i. e._, that form of dyspepsia in which -there is excessive secretion of hydrochloric acid. This affection -occurs during the most vigorous years of life and is apparently due -to excessive activity on the part of the gastric glands. The excess -of acid does not give rise to any symptoms so long as there is any -unsatisfied proteid in the stomach to unite with it, but directly all -the proteid is satisfied and free acid is present in the stomach, pain, -heartburn, and distention are apt to be felt; hence these symptoms -are generally removed temporarily by a meal, the food ingested seizing -upon the free acid, and tend to recur in the course of an hour or -two. Other symptoms are mental and bodily lassitude and great mental -depression, while, if the condition is long-continued, gastric catarrh -and dilatation ensue. Eructation of the acrid mass, its removal with a -tube, or its dilution or neutralisation by an alkali, causes relief of -the symptoms. Now Dr. William Russell, who has recently studied this -form of dyspepsia, has shown, and the fact is most significant from -our present point of view, that in it starch is the last constituent -to leave the stomach; that when this organ has so far emptied itself -as to contain but one or two ounces of very acrid material the -residue consists chiefly of finely divided undigested starch, which -continues to stimulate the gastric secretion; “and, there being no more -proteid with which to combine, the secretion accumulates and leads to -hyperacidity.”[24] Inasmuch, then, as inefficient mastication leads to -an excess of starch in the stomach, we see how it may predispose to -hyperchlorhydria and we shall presently see that there is yet another -reason why it should do so. - -It will be gathered from the foregoing that thorough mastication is -the most effective way of securing efficient starch digestion. This -simple fact has been most strangely overlooked. Thus “van Valzah -considers that not a little of the difficulty of the digestion of -starches and cereals can be overcome by more thorough cooking. Patients -who cannot eat potatoes after ordinary cooking are [he urges] often -able to digest them very readily if they are doubly cooked before -being served. Cereals, as a rule, should [he contends] be allowed to -simmer all night and then be thoroughly cooked for a half hour in the -morning before being eaten.”[25] This is an admirable illustration of -the modern tendency to cheat the mouth of its proper work. A much more -rational way of facilitating starch digestion in those who experience a -difficulty in this respect is by efficient mastication. - -_Evils resulting from an insufficient quantity of alkali in the -stomach._--I doubt if it is adequately realised what a large amount -of alkaline saliva passes into the stomach as the result of prolonged -mastication. Its presence there serves the useful purpose of prolonging -the period of starch digestion within the stomach, while it further -aids gastric digestion not only by exciting the secretion of gastric -juice, but also by its influence on the reaction of the gastric -contents; it can scarcely be doubted that the effect is on the -whole one favourable to digestion in general. We have just seen that -defective mastication may predispose to hyperchlorhydria by allowing an -excess of pure starch to pass into the stomach, and I suggest that it -may further operate in the same direction by cheating the stomach of -its due supply of alkaline saliva. Now the saliva in this affection is -apt, as was pointed out by Sir William Roberts, to be superalkaline, -and for this reason he recommended his acid-dyspeptics to excite the -flow of it by chewing gum-mastic with the object of neutralising the -gastric hyperacidity. That relief can thus be obtained there can be no -doubt; but it is surely more rational to get the patient to stimulate -his salivary glands by masticating actual food, by which we secure -the additional advantages accruing from its complete insalivation and -comminution as well as from the reflex gastric effects. Actuated by -these considerations, I have long been in the habit of recommending -hyperchlorhydriacs to subject their food to prolonged mastication, this -being, in my belief, the most rational and effective way of breaking -the stomach of its vicious habit. In extreme cases we must insist that -each morsel of food should be chewed at least one hundred times and not -permit any relaxation of this severe discipline, until the stomach has -been schooled into healthier ways. _Evils in connection with the jaws -and their appendages and the adjacent structures: the nasal passages, -naso-pharynx, and faucial tonsils._--In those who do not masticate -properly in early life these parts fail to develop as they should, -and they are on this account alone predisposed to disease; their -resistance to disease is still further lowered by the fact of their -blood and lymph flow not being adequately stimulated by the vigorous -exercise of the masticatory muscles. Now we have seen that the great -cause of defective mastication in children is the softness of the food -given them and that the feeding of them upon an excess of soft food, -especially the starchy kind, disturbs digestion, induces toxæmia, and -in this way evokes a catarrhal tendency. In children thus fed we have -therefore several conditions which make for disease in the parts under -consideration--defective development, sluggish circulation, and toxic -saturation. Is it any wonder that the modern child should be liable -to disease in these regions, that he should so frequently suffer from -rhinitis, naso-pharyngitis, tonsillitis, and from hypertrophy of the -pharyngeal tonsil (“adenoids”) and of the faucial tonsils? - -It is in this way that I would explain the frequency of adenoids among -the children of civilised communities. I claim, in fact, that this -disease is largely dietetic in origin. I submit that a child whose -nasal apparatus and naso-pharynx are well-grown and habitually bathed -by a stream of pure blood and lymph, periodically accelerated by an -ample and vigorous use of the masticatory muscles, is unlikely to -contract adenoids. On the other hand, I contend that a child in whom -these parts are ill-developed and bathed by an habitually sluggish -stream of tainted blood and lymph--one, _i. e._, that is not only -poisoned, but rarely, if ever, hurried along its lazy course by due -exercise of the muscles of mastication--I submit that such a child -runs great risk of contracting the disease. The influence in setting -up adenoids of toxic saturation with its resulting catarrhal tendency -is shown by the frequency with which this affection follows upon the -rhinitis and naso-pharyngitis of measles and diphtheria, and in order -to realise how greatly the circulation of blood and lymph in the walls -of the naso-pharynx must be influenced by mastication, one has but to -remember how very closely the pterygoids are related to this region; in -exploring it for adenoids they can, indeed, often be felt to stand out -prominently.[26] - -This, then, is my explanation of the truly fearful prevalence of -adenoids among the moderns. It is essentially a disease of pap-fed -peoples. A child may, with the one exception that he is fed on a pappy, -super-saccharide diet, be brought up under ideal health conditions. He -may live in the heart of a dry, open country, far from the darkness, -dust, and tainted atmosphere of the town, sleep with the windows open -all night, live out of doors all day, be fed on the most nourishing -(too nourishing, it may be) food, be clothed after the most approved -methods, and yet, in spite of all this, we may find his naso-pharynx -packed with adenoids. This disease is, in fact, scarcely less prevalent -in the country than in the towns, scarcely less common among the rich -than among the poor. Yet in primitive communities it is practically -unknown. And what, I would ask, is the one condition in the material -environment of my supposititious child differing from that of the -primitive child? What but the factor of diet? Therefore, I say, the -prevalence of adenoids among moderns must be the result of the modern -system of feeding children, and the defective mastication which goes -along with it. - -That the foregoing is a grave indictment against that system, it -need scarcely be said. For adenoid disease is fraught with many -evils, among them mental hebetude, blocking of the Eustachian tubes, -and manifold other auditory troubles, gastro-intestinal disturbances -from the passage into the stomach of unhealthy discharges, and, most -serious of all, nasal obstruction and consequent mouth-breathing. -So serious are the evils connected with this latter habit that they -demand more than a passing reference. Pronounced adenoid disease is -always associated with mouth-breathing, and there can be no doubt that -in the majority of these cases, the nasal obstruction is not in the -nasal passages primarily, but is due to a blockage of the posterior -nares by the adenoid growths, for it generally happens that nasal -breathing is rapidly re-established after their removal, though in a -certain proportion of cases the obstruction still persists, and has to -be dealt with by treatment directed to the nasal passages themselves. -Some have, indeed, contended that a primary nasal obstruction is one -important factor in the induction of adenoids, leading as it does to a -dry-cupping of the naso-pharynx during inspiration and to a consequent -congestion of its lining membrane. I am quite ready to allow that this -mechanism may play some part in causation, and such an assumption is -in entire harmony with my main contention that adenoid disease is of -dietetic origin, for nasal obstruction in children, other than that -caused by adenoids, is mainly due to defective development of the nasal -passages coupled with inflammation of their lining membrane, both of -which conditions may, as we have seen, be essentially the outcome of -defective diet. - -Coming now to the evils resulting from mouth-breathing, we have first -to remember that normally the air is inhaled through the nose, and -is thus warmed, moistened, and filtered before being allowed to pass -into the lungs; but in the mouth-breather the air, which may be dry, -cold, and dust-laden, passes at once unprepared through the mouth into -the lungs, impinging in its passage against the pharynx, thus drying -and mechanically irritating the mouth, pharynx, larynx, and bronchial -tubes, all of which are thereby predisposed to disease. In this way -laryngitis and bronchitis, nay, even phthisis, may be induced. Dental -caries is also predisposed to by the habit of breathing through the -mouth. Mouth-breathing further interferes with the proper development -of the cranial bones, but especially of the maxilla, giving rise to -what may be termed the “mouth-breather’s jaw,” so characteristic is -it I do not propose to discuss here the mechanism by which this -deformity is produced, interesting though the question is; suffice it -to say that nasal breathing is essential to the normal development of -the jaws. The deformity in question, though it involves the maxilla -chiefly, affects also the mandible from the fact of its being, to a -large extent, moulded on the maxilla; in typical cases the maxilla is -small and its alveolar ridge does not attain its normal length, but is -compressed laterally towards the sagittal plane, giving rise to the -false appearance of a “high arch” and often thrusting the anterior -portion of the ridge forwards; the teeth, the growth of which is not so -much interfered with as that of the imbedding bone, are thus prevented -from taking up their proper positions and show irregularity, sometimes -extreme. Dental irregularity may also, as we shall see, result from -inadequate use of the jaws in mastication, but not to the extent which -is frequently observed in the mouth-breather’s jaws, and therefore -pronounced dental irregularity always shows that there has been -protracted nasal obstruction, and this in the vast majority of cases -implies the existence of adenoids, past or present; I say in the “vast -majority,” for in a few rare cases long-continued nasal obstruction in -children originates primarily in the nose and may lead to the typical -mouth-breather’s jaw, with the resulting dental irregularity. - -_The tongue._--If the tongue is not properly exercised in childhood -and youth, we find it imperfectly developed; hence in inefficient -masticators it is generally small. It must not be forgotten in this -connection that this organ is considerably exercised when the infant -is at the breast, from which the milk is obtained, not by suction, -but by a vigorous tugging and squeezing of the nipple (in which the -tongue takes considerable part), whereby the gland is reflexly excited -to secrete. When, on the other hand, the child feeds at the bottle he -obtains his milk by actual suction, and generally through an orifice -of such ample dimensions as to allow the bottle to be rapidly emptied -with comparatively little exercise of the lips and tongue. In short, -the breast-fed infant has to do some work for his living, and that of a -sort calculated to promote the health of the jaws and their appendages, -while the bottle-fed child can glut himself by doing very little more -than opening his mouth; wherefore we find the tongue and adjacent parts -less developed in the latter than in the former. It may be thought to -be a matter of indifference whether the tongue develops to its normal -proportions or remains small, but such is by no means the case, for, as -Dr. J. Sim Wallace has shown, the pressure of this structure against -the teeth promotes the normal development of the jaws, especially of -the mandible, and when it is small they are apt to be so too. - -_The salivary glands._--Just as mastication increases the functional -activity of the salivary glands and buccal glands and favours their -normal development, so, contrariwise, inefficient mastication during -early life fails to call forth their normal functional activity and -to secure their adequate development. Thus we find that a child who -has been brought up on hard, starchy foods, necessitating abundant -mastication has much larger and more active salivary glands than -one who has been fed on soft foods which slip down into the stomach -before they have had the chance of being properly masticated, and it -is needless to say that the more efficient these glands are the more -likely is digestion to be carried out satisfactorily. - -_The jaw-bones._--If the jaws are not adequately exercised in youth -by mastication they fail to grow to their normal size and shape, and -there is apt in consequence to be overcrowding of the teeth. The main -defect of the jaws in such cases is their smallness; they do not -present that pronounced lateral compression and anterior protrusion -which characterise the mouth-breather’s jaw, nor such extreme dental -irregularity, the most common being overlapping of the incisors, -displacement of the canines, and difficulties in regard to the eruption -of the wisdom teeth from shortness of the alveolar ridge. I have -already referred to the progressive shortening in the post-molar ridge, -which has been taking place during man’s evolution from the anthropoid -in correspondence with the alteration in his diet. - -We thus see that defective use of the jaws leads to irregularity of -the teeth (1) directly and (2) indirectly through the induction of -adenoids. This irregularity is not only unsightly but leads to certain -evils which thus primarily owe their origin, in large measure at least, -to defective mastication. What, then, are these evils? In the first -place, dental irregularity predisposes to dental caries by favouring -the lodgement of food between the teeth; in the next place, it leads to -defective “bite.” Now when the bite is defective adequate mastication -is impossible, for not only is it impossible in these circumstances -to oppose the teeth properly, but also, owing to their interlocking, -to accomplish that free lateral movement of the lower teeth against -the upper, which belongs to normal mastication. I do not say that -defective bite is the sole cause of this imperfect lateral movement; -it may, indeed, be observed in most moderns brought up on soft pappy -food, whether the bite be good or not. Normal mastication is, in fact, -becoming a lost art; the average modern masticates mainly by a vertical -compression of the lower teeth against the upper, and in only a small -degree by a lateral frictional movement which, it is needless to say, -is the more effective method for grinding purposes; and it is, I doubt -not, chiefly for this reason that the teeth of modern man are so much -less worn down than those of primitive peoples. - -_The teeth._--Imperfect use of the teeth leads to many ills. When -adequately exercised and made to execute for one or two hours every day -a lively dance in their sockets, during which the circulation of blood -and lymph in the tooth-pulp, periodontal membrane, and surrounding -tissue of the gum is vigorously stimulated, and the cavity of the mouth -is bathed in a copious flow of salivary and other buccal secretions, we -have conditions which make alike for the health of the buccal mucous -membrane, of the teeth, and of the periodontal membrane and alveoli; -but when the circulation is not duly stimulated in this way the teeth -do not develop properly, while the secretions of the mouth are apt to -be scanty and unhealthy, both of which conditions predispose to caries. -How far dental caries is due to inherent dental weakness and how far -to faulty conditions outside the teeth we need not stop to inquire; Dr. -Wallace attributes little influence to the former factor, contending -that caries depends essentially upon faulty dental environment; and -one can scarcely doubt that the state of the gums and of the oral -secretions profoundly influences the growth of bacteria in the mouth, -upon the acid yielded by which organisms the corrosion of the dental -enamel essentially depends. Faulty conditions of the oral secretions -likewise favour the deposit of tartar. - -Another result of imperfect use of the teeth is undue thinness of -the alveolar walls and periodontal membrane, in consequence of which -the teeth are not so firmly held in their sockets as they should be. -This is, I believe, one of the reasons why they are prone to fall -out prematurely among the moderns: we know that the teeth tend to -drop out in old people owing to a senile atrophy of the alveolar -walls; the Haversian canals get smaller and may, indeed, disappear -entirely, and it stands to reason that this atrophy must be hastened by -inefficient exercise of the teeth. So far as I am able to gather from -an examination of skulls in museums, the teeth are rarely shed among -primitive peoples before extreme old age, while among moderns they -frequently fall out long ere this is attained. - -A still worse evil attaching to insufficient use of the teeth is -pyorrhœa alveolaris or Riggs’s disease, which, in conjunction with the -deposit of tartar, is the great cause of the premature loosening and -shedding of the teeth observed among latter-day civilised peoples. -This affection consists of a purulent inflammation of the periodontal -membrane, owing to the invasion of it by pyogenic cocci, so that pus -wells up on pressing the gum against the teeth. Now, when by a vigorous -use of the teeth the buccal cavity is kept well flushed with healthy -secretions, the growth of micro-organisms within this chamber is kept -down, and when, by the same means, the vitality of the periodontal -membrane and adjacent tissues of the gum is periodically stimulated, -these tissues offer stout resistance to the invasion of pathogenic -organisms; but when, contrariwise, the teeth are little used, the -secretions of the mouth are in consequence defective both as to -quality and quantity, and the growth of organisms in the buccal cavity -is promoted; and when, further, the circulation in the periodontal -membrane and adjacent soft tissues is not adequately stimulated by -vigorous mastication, their vitality is poor and they offer but a -feeble resistance to parasitic invasion. We can thus, I think, safely -infer that inefficient mastication is a potent cause of pyorrhœa -alveolaris; and the chief cause of inefficient mastication being the -eating of soft foods, we must also conclude that the latter practice -is chiefly responsible for the disease in question; such foods further -predispose to this affection in that they are apt to lodge between -the teeth and by undergoing decomposition there to favour the growth -of micro-organisms within the mouth. The condition of the teeth and -gums among the civilised poor is, alas, little calculated to make us -proud of our boasted civilisation--the spongy pus-exuding gums, the -lengthening, loose, tartar-covered, carious teeth, and the putrescent -breath constitute a damning indictment against our modern system of -living on a soft, pappy diet, and not giving the teeth the work for -which they are designed. I never examine such a mouth without being -impressed with, and I may add oppressed by, this fact. - -I am not, of course, contending that pyorrhœa alveolaris only occurs -in those who masticate inefficiently; whatever causes an unhealthy -condition of the gums and saliva predisposes to it, but it is surely -much less common in those who masticate well than in those who -masticate ill. Confirmatory of this statement is the fact that it is -more frequent in those with irregular teeth than in those with a good -bite, who are thus able to put their teeth to more effective use. This -affection is very common among the carnivora of menageries as well as -among dogs and cats; indeed, one seldom fails to find it in dogs over -four years of age, and in old dogs it is generally rampant. Doubtless -in all these cases the general conditions of life play some part in -the causation of the disease, but I do not think that we can eliminate -from it the factor of defective use of the jaws and teeth, for it is -certain that dogs and cats are fed largely on pappy foods and are often -insufficiently supplied with bones. - -_The causation of dental caries._--Dr. Wallace, in his philosophical -work on “The Cause and Prevention of Decay in Teeth,” contends that -the cause of the prevalence of dental caries is that the natural -food-stuffs are, to a large extent, ridded of their accompanying -fibrous parts and consumed in a form which renders them liable to -lodge and to undergo acid fermentation in the mouth; while from the -same cause and the induced conditions the micro-organisms of the mouth -lodge and multiply and augment the rapidity and intensity of the acid -fermentation. I am perfectly at one with Dr. Wallace in believing -that the removal of the fibrous portions of food is the main cause of -the prevalence of caries among moderns, and I can hardly doubt that -foods so prepared tend to promote caries in the way indicated, but I -venture to think that they do this even more by failing to call forth -the normal degree of mastication. I cannot but think that if these same -soft foods were as laboriously masticated as they would need to be if -they retained their fibrous ingredients, dental caries would be much -less common than it actually is. I have endeavoured to show how very -different the local conditions are in the efficient from what they are -in the inefficient masticator--how in the former the jaws and teeth -are wont to be well developed, the bite to be good, and the secretions -which bathe the teeth to be of a kind calculated to promote their -health; and how in the latter an entirely opposite set of conditions is -wont to prevail. That it is possible to maintain a fine set of healthy -teeth till past middle life on ordinary civilised diet, provided the -food be habitually subjected to efficient mastication, is shown in the -case of the man already referred to, and by numerous other cases which -I have observed. - -Since the application of cooking to food there has been a progressive -lessening in the work of the jaws and teeth and, parallel with this, -a diminution in their size and an incursion of dental caries. Among -the anthropoids in their natural state caries is practically unknown, -and I think we may conclude that the same was true of man before he -learnt to cook. In the pre-agricultural races, such as the aboriginal -Australians, the effect of cooking the food is shown in the lessening -in the size of the wisdom teeth and of the post-wisdom alveolar -ridge; dental caries, though rare among these people, does occur, and -especially in the wisdom teeth.[27] In the early agricultural period, -owing to the increasing softness of the vegetable food, the jaws and -teeth show a tendency to be smaller than in the previous periods; the -wisdom teeth are decidedly smaller and more prone to caries, while -caries of the other teeth is by no means rare. In the late agricultural -period the jaws and teeth often show very decided defects of -development, while dental caries is, as we know but too well, rampant. - -What has been said concerning the relative prevalence of caries in -different diet epochs applies to many other diseases of the teeth; -thus, along with the increase of caries, there has been a parallel -increase in the prevalence of pyorrhœa alveolaris. - - - - - CONCLUDING REMARKS - - -I have now set forth some of the evils resulting from inefficient -mastication. They are many and serious. The immediate evils, such -as over-eating, indigestion, adenoids, dental caries, and pyorrhœa -alveolaris, are bad enough, but when we consider the secondary evils -to which these primary ones give rise,--and I have only mentioned a -few of them,--we must come to the conclusion that an appalling amount -of misery and suffering may be saved by the simple expedient of -inculcating the habit of efficient mastication. How this end can best -be accomplished will be considered in the next section. - - - SECTION IV. From _London Lancet_, August 8, 1903 - - MEANS OF INSURING ADEQUATE MASTICATION - - -In order to secure the full advantages accruing from the use of the -jaws and their appendages, it is, above all, necessary for them to be -adequately exercised during the period of development. If this is done, -not only will the tendency to dental caries, adenoids, indigestion, -and other evils be greatly diminished, but the masticatory instinct -will establish itself as a permanent force, so that the individual -will tend for the rest of his life to subject even soft foods to -thorough mastication. The tongue, the lips, and the jaws of the newly -born child find their natural exercise at the mother’s breast, and -we should, therefore, do our utmost to get the mother to suckle her -child, the bottle affording neither the same kind nor the same amount -of exercise. If, unhappily, we fail in this, we must see that the teat -of the feeding-bottle is so constructed as to compel the child to -earn his meal by, at any rate, some exercise. This kind of exercise -promotes the growth of the tongue and thus of the jaws, especially of -the mandible. Directly the infant shows a disposition to bite hard -things the instinct should be gratified. We may observe a tendency in -this direction as early as the third or fourth month, and it becomes -more and more pronounced when, the time for the eruption of the teeth -approaching, the gums begin to swell up and to get tender, and saliva -begins to flow from the mouth; it is now, more than ever, necessary to -provide the child with hard substances on which to exercise the jaws -and the gums, and a great deal of the trouble of teething is due to -the failure to recognise this fact. What, then, are we to employ for -this purpose? I am convinced that it is a mistake to rely solely, or -even mainly, upon baubles of ivory, coral, and the like useful though -these may be in their way; it is far better to give the child something -which is not only hard but nutrient and pleasant to the taste, -something which will at one and the same time exercise the maxillary -apparatus, excite the gustatory organs, and provide a certain amount -of nutriment. To this end we may, as the teething time approaches, -give a chop or chicken bone, from which most of the meat has been -removed; by powdering the bone with white sugar or salt we may increase -its attractiveness. From such bones a good deal of nutriment can be -extracted, and this of a kind which is most acceptable to the infant -stomach, for it must be remembered that the young human is in the -main carnivorous. Indeed, since milk is a purely animal diet, all the -mammals must be regarded as essentially carnivorous during the period -of suckling, while man, as already observed, from the time he emerged -from the anthropoid until he learned to cook his food, was throughout -life mainly an animal feeder. Therefore we should not hesitate to allow -the teething infant animal food in the form suggested. Chicken and -chop bones, yielding as they do before the pressure on the gums, are, -moreover, just of the right degree of consistence for the purpose in -view, while they afford abundant exercise for the tongue; ivory, coral, -and the like are, on the other hand, too hard and unyielding, and lack, -moreover, the attractiveness belonging to sapidity. - -By thus providing the maxillary apparatus with suitable exercise we -shall do much to facilitate the eruption of the teeth and to favour the -growth of the jaws and their appendages, including the salivary glands, -and so to prepare the mouth for the reception of vegetable food. This -should, of course, not be given till the teeth appear. The order in -which these make their appearance gives some indication as to the -order in which vegetable food should be administered to the child. The -first teeth to penetrate the gums are the lower incisors which appear -from the seventh to the eighth month; then follow the upper incisors -from the seventh to the tenth month. These teeth enable the child to -_bite_, but not, be it observed, to _masticate_, for which function -the molars are necessary. Now the first molars do not appear till the -twelfth or fourteenth month; the second molars not till between the -fourteenth and the twentieth month; and it seems to me certain that -our primitive ancestors could not have obtained starch in any quantity -until they reached this age; at the best, pre-cooking man was but -scantily supplied with starch, and such slender supply as he had -could only be rendered accessible to the digestive juices by vigorous -mastication, which broke up the indigestible cellulose framework in -which all vegetable starch is contained; hence, until the young human -cut his molars, he had little opportunity of securing any starch. -These considerations strongly suggest the desirability of giving but -small quantities of starch before the twelfth month, and though the -facts, that ptyaline appears in the saliva about the time the first -incisors are cut, and that pancreatic juice develops its amylolytic -ferment at the same time, show that the digestive organs are ready for -the reception of some starch at the seventh or eighth month, yet I -believe the quantity should be strictly limited. I am ready to admit -that the modern child may have, indeed probably has, a greater power of -digesting starch than his remote pre-agricultural ancestor; but even -so, I am convinced that we should be on our guard not to over-gorge -infants with this substance. Only a small quantity should be given -before the twelfth month, and it should be gradually increased up to -the twentieth month. - -I have said that the pre-agricultural infant was unable to secure -starch in any quantity by means of his incisors. These teeth enabled -him, however, to obtain some soluble nutriment from fruits, and -Dr. Sim Wallace has suggested that the early eruption of the lower -incisors is for the purpose of enabling the infant to pierce the -outer covering of fruits so as to permit him to extract the soluble -contents by suction; and, accordingly, when these teeth are cut we -may allow the child to bite at such vegetable substances as apples, -oranges, and sugar-cane. The latter is a useful article of diet for -children, for it provides soluble saccharide in a diluted form, and -it is advisable that the child should receive his cane sugar well -diluted, for it must be remembered that before the agricultural period -man’s supply of pure sugar was limited to wild honey which, consisting -as it does almost entirely of mono-saccharide (grape sugar and fruit -sugar), is very easily disposed of by the digestive organs. Nowadays, -the less digestible cane sugar (which is a di-saccharide) is very -largely consumed in the undiluted state, in which it is apt to set up -disturbance. When, however, it is obtained by chewing the sugar-cane, -it is diluted both by the water in the cane and by the saliva, and I -should like to see children obtain most of their cane sugar in this way. - -The consideration of the conditions obtaining for pre-agricultural man -not only strongly suggests that the young human of to-day should be -given starch in very moderate quantities up to the twelfth month, but -it points an even more important lesson--viz., that this substance -should be given not, as is the custom, as liquid or pap, but in a form -compelling vigorous mastication, for it is certain that early man, from -the time he emerged from the ape till he discovered how to cook his -vegetable food, obtained practically all his starch in such a form; -it cannot too often be repeated that uncooked starch in the natural -state, locked up as it is in chambers of indigestible cellulose, has no -nutritive value; these chambers need first to be broken up by prolonged -and energetic chewing, and in this way much or most of the starch is -converted in the mouth into dextrines and maltose, very little passing -into the stomach in the crude state to set up disturbance in that -organ and later in the bowel. If it is given as liquid or pap it will -pass down as starch into the stomach, while if it is administered in -a form which obliges the child to chew it properly, not only will the -jaws, the teeth, and the gums obtain the exercise which they crave, -and without which they cannot develop normally, but the starch will be -so thoroughly insalivated that much of it will be converted within the -mouth into maltose. How foolish to upset the child’s digestive system -by deluging it with liquid starch, and then to endeavour to correct -matters by giving the malt extract which the child can and should -himself manufacture within the laboratory of his buccal cavity. - -Clearly, then, the child should make his first acquaintance with -starch, not in the form of a liquid or pappy patent food, but in a -solid and somewhat tough form. The best means of achieving this end -is occupying my attention, and I hope soon to publish the results of -my investigation. Meanwhile, I would point out that hard, well-baked -crusts constitute a convenient form in which to administer starch to -children. A piece of crust may be put in the oven and re-baked; this -not only hardens it but helps to convert the starch into dextrine, -which is a stage on the road to maltose. If the crust be then cut -into a suitable shape and spread with bacon fat or fresh butter, it -constitutes a most agreeable morsel. Later, we may give hard plain -biscuits. The same principle should be acted upon during later -childhood and youth: we should always give, as far as possible, the -starch in a form compelling abundant mastication. Loaves should be -shaped so as to give a maximum of crust and a minimum of crumb, -and should be baked hard. Such loaves are quite as nutritious as -the ordinary ones, and much more digestible, containing as they do -an abundance of dextrine and not a little maltose, and compelling -efficient mastication, especially if eaten, as they should be, without -any fluid. A lady who has the catering for a large number of girls -gives the bread in this way, and she tells me that there is keen -competition for the most crusty portions. - -I do not say that starch in the liquid and pappy form should find no -place whatever in man’s dietary at the present day, for this would -imply the prohibition of porridge, boiled potatoes, milk puddings, -and the like. We cannot put back the hand of time and return to the -food of our primitive ancestors, nor is it desirable that we should; -but we can, at least, arrange matters so that a large proportion -of the starch we consume shall be in a form inviting mastication, -such as crusts, stale bread, stale cake, biscuits, and so forth. The -less children eat of pastry, or, indeed, of any luxurious foods, the -better; if brought up on a healthy dietary and under healthy conditions -generally, they will relish their simple fare more than the choicest -dishes of the epicure. I do not, I say, object to the child consuming -a certain proportion of starch in the liquid or pultaceous form, for -if, by bringing him up on a rational dietary, his instinct to masticate -be afforded due opportunity to develop he will be likely to subject -even soft vegetable food to something like adequate mastication; this -will tend to mitigate the evils associated with such food, not only by -facilitating the digestion of starch, but by flushing the mouth and -promoting the health of the teeth and buccal mucous membrane. - -The question how far children should be allowed to crack nuts may here -be considered. If the child has been brought up on pappy food, and has -in consequence brittle and ill-developed teeth, the cracking of hard -nuts will be likely to injure them, and this is _a fortiori_ true if -any of the teeth are carious or “filled.” And not only nuts but hard -food of any kind, such as ship’s biscuits, may in these circumstances -injure the teeth, as many of those who went through the recent South -African campaign can testify. But if, on the other hand, the child has -from the beginning been fed on coarse, hard foods, so that the teeth -have been allowed to grow dense and strong, no harm is likely to ensue -from cracking such nuts as filberts and Spanish nuts. If a squirrel -or a monkey weighing a few pounds can do so with impunity, surely the -young human should be able to also. The cracking should, however, be -done by the molars, while such hard nuts as Brazils had best not be -tackled at all. - -Animal food does not need the same amount of mastication as vegetable -food, since it is not digested in the mouth, though some contend that -the mixture of proteid with alkaline saliva facilitates its subsequent -peptonisation. Cooked animal food is, however, all the better for some -mastication, owing to the coagulation of the proteids, and, in order -to insure the efficient mastication of meat, fish, and poultry, Dr. -Sim Wallace recommends that they should be given in large pieces cut -thin. “Flat pieces about one inch square generally _necessitate_ a -certain amount of mastication. It is difficult to swallow large flat -pieces of meat without mastication, but when finely minced little or no -mastication is called forth.” The younger the child the more underdone -should the meat be. - - - EXAMINATION OF THE MOUTH AND ADJACENT PARTS - -If a child be brought up on the lines indicated and under healthy -conditions generally, it is tolerably certain that the maxillary -apparatus will develop normally, that the teeth will be strong and -well opposed, and show little tendency to disease; but, inasmuch as -the methods advocated are but seldom put into practice, disorders of -the teeth, more especially caries and irregularities, are common, and -hence with a view to promote more efficient mastication it is always -advisable to examine our patient’s teeth. - -Each individual tooth should be inspected in a good light for the -presence of caries, and careful note should be taken of the “bite,” -a normal bite implying not only a proper opposition of the two rows -of teeth but the capacity of the lower ones to move freely across the -upper; mere vertical movement of the mandible does not constitute -efficient mastication. In this connection it must not be forgotten that -an unopposed molar is useless for purposes of mastication, and it is by -no means rare to find in a mouth several sound unopposed molars which -are for this reason absolutely functionless. Nay, more than this, it -may happen that teeth, perfectly sound ones, too, far from helping, may -actually interfere with mastication; thus, among the poor, we sometimes -find all the teeth gone save the upper canines and the lower incisors, -and the teeth and gums being alike unable to come into contact, nothing -worthy of the name of mastication is possible; it would be far better -to be without any teeth whatever, for the toothless gums would then be -permitted to come into contact along their entire extent, under which -condition they gradually harden and come to be quite efficient grinding -agents. - -Next the gums, the alveoli, and the roots of the teeth must be -examined, especially for the presence of erosion, tartar, and pyorrhœa -alveolaris, this latter condition being evidenced by the welling-up of -pus upon pressing the gums against the sides of the teeth. - -If our examination of the mouth discloses anything likely to interfere -with mastication the aid of the dentist should at once be sought, but -every physician should be so far acquainted with disorders of the -teeth as to be able to say, in the majority of cases, at all events, -when this is necessary. I am convinced that far more illness than is -generally supposed is attributable to dental defects, and this even -among the more leisured classes. With regard to pyorrhœa alveolaris, it -has to be remembered that it not only does harm by causing loosening, -lengthening, and shedding of the teeth, and thus interfering with -mastication, but also by contaminating the stomach and the blood and -thus upsetting the digestion and causing constitutional diseases, such -as anæmia and arthritis; and inasmuch as poisonous discharges from -the nose, the naso-pharynx, the pharynx, and the tonsils may act in a -similar way, these parts also should be inspected in connection with -the examination of the teeth. In the dust-laden atmosphere of towns -they are very liable to disease, and even when healthy are necessarily -dirtied; some go so far as to advise all town dwellers daily to wash -out the nasal passages and to gargle the throat; but, whatever may be -thought of this, it is certain that under existing dietetic conditions -special means are needed in order to keep the mouth and teeth clean. -When man fed on raw food this was not necessary, the food itself -and the copious flow of saliva, induced by prolonged mastication, -effectually cleansing these parts; but, under present conditions, food -tends to remain within the mouth, especially between the teeth and in -their crevices, and therefore special means are needed to remove it. -This is done by “cleaning the teeth” and by rinsing the mouth. - -_The tooth-brush._--Probably the ideal method of cleaning the teeth -is that adopted by many primitive and not a few semi-civilised -peoples--viz., rubbing them with a twig of wood which has been teased -out at one end so as to form a sort of brush by means of which the -teeth can be burnished and food dislodged from them. The modern -tooth-brush requires to be used with great caution, as it is capable of -doing much harm, not only by removing the mucoid film, which, according -to Dr. Wallace, protects the teeth from corroding agencies,[28] but -probably also by injuring the edge of the gum and the neck of the -teeth, and thus setting up the condition known as “erosion.” Certain -it is that some of the best sets of teeth I have encountered have been -wholly unacquainted with the tooth-brush. In any case the brush should -be employed with great care; it should be soft, and should always be -drawn away from the gums both on the inner and outer aspect of the -teeth towards the biting surface, as well as across the latter, never -transversely across the outer surfaces, as so frequently is done. The -object of these procedures is to dislodge any particles of food that -may have collected between the teeth or in their crevices. For this -purpose the toothpick may also be employed judiciously. In order to -render the enamel of the teeth white it is better to rub each tooth -carefully with some soft material, such as chamois leather, rather -than to scrub them with a brush. Tooth-powders should not be used as -a matter of routine, but only occasionally and for appearance rather -than for cleanliness, and should consist of some simple non-irritant -material. Antiseptic powders and washes are to be scrupulously avoided, -for it is neither desirable nor possible to render the buccal cavity -aseptic; myriads of bacteria flourish within it, many of which play -a useful part as scavengers. The time of all others for cleaning -the teeth is just before going to bed, so that the food shall not be -allowed to decompose in the mouth during the night. There will then be -no need to use the tooth-brush in the morning. - -_Rinsing the mouth._--The mouth should be rinsed out as a matter of -routine after each meal and on rising, and care should be taken to do -this before the early cup of tea, so as not to contaminate the stomach -with the buccal secretions which have accumulated during the night. -Inasmuch as raw vegetable food has a cleansing effect on the teeth, it -is often a wise plan, especially in the case of children, to finish a -meal with some kind of fruit, such as an apple or an orange. It hardly -seems necessary to insist upon the necessity for keeping all artificial -dentures thoroughly clean. - - - - - PROFESSOR PAWLOW’S DEMONSTRATIONS OF PSYCHIC INFLUENCE IN DIGESTION - - - [In presenting a theory of human alimentation involving mental or - nervous as well as mechanical and chemical factors which influence - it for good, it is not often that an author is able to enlist the - assistance of a complete battery of scientific confirmation to fortify - his own crude observations taken direct from personal experience in - the study of natural requirements. - - Professor Pawlow, with his marvellously skilful investigation of the - workings of the digestive secretions, and Dr. Cannon of the Harvard - Medical School, by aid of persistent and patient X-ray studies, - explain how it is that earned appetite and thorough mouth-treatment - of food are preliminary necessities of easy digestion, and that - disturbance or shock of any sort during the process stop digestive - proceedings and endanger health. They show also that when the mouth is - used to do _all that it can do_ in the work of digestion all the rest - is easily accomplished by the NATURAL AUTOMATIC PROCESSES within the - body. - - They both show that we have, each of us, a certain responsibility in - the matter of right digestion and healthy nutrition, and that all - this personal responsibility is located in the head, in the mind, and - in the mouth, and that while the alimentation is proceeding it is a - sacred duty to do our part _right_, according to the intelligence that - these most valuable demonstrations teach. - - Professor Pawlow has allowed publication of his lectures in Russian - and German, and recently Professor W. H. Thompson of the Physiological - Department of Trinity College, Dublin, has made an English translation - which is issued by Charles Griffin & Company of London and J. B. - Lippincott of Philadelphia. - - The author has to express special gratitude to Professor Pawlow, - Professor Thompson, Messrs Griffin and Lippincott for permission to - reprint herein some entire lectures and extracts that bear especially - on the practical understanding of our subject. - - Professor Pawlow is one of the Board of Scientific Assessors mentioned - in the REPORT of a PLAN for an INTERNATIONAL INQUIRY into the subject - of HUMAN NUTRITION. - - In one of the lectures, not here reprinted, Professor Pawlow gives - merited recognition of the early statements of the French physiologist - Blondlot relative to psychic influence on the digestive secretions - made some half century ago, but discredited by physiologists since - that time, owing to insufficiency of evidence brought forward in - support of the statements. - - Professor Pawlow’s acknowledgment is so gracefully rendered that it is - here given as a model of scientific courtesy. - - “I have depicted the work of the gastric glands as we have seen it - in our experiments, and as it has developed under our hands. Is the - picture a new one? In its details, yes; but not in its fundamental - features. However singular it may appear, the sketch of this - picture was more than fifty years ago outlined by physiology. May - this constitute another reason for our science relinquishing its - characteristic shyness of new things and for its conversion to our - interpretation of the phenomena under consideration! - - “The talented author of the _Traité Analytique de la - Digestion_--Blondlot--spoke in plain words of the importance of taking - food, and of the specific excitability of the gastric mucous membrane. - The facts adduced in the working up of his theory were naturally - insufficient, but we must not forget that the first experiments on - dogs with artificial gastric fistulæ had only just been performed. - It is truly incomprehensible that the researches of Blondlot and his - views upon the secretion of gastric juice have experienced during the - past fifty years no completion, no additions, but, on the contrary, - have passed out of sight, thanks to the faulty experiments and - erroneous representations of later authors. Only in the works of a - few writers--and those mostly French--has Blondlot’s theory survived. - Of other investigators we must give mention to Heidenhain, who has - enriched the physiology of absorption in general, but more especially, - in connection with the secretory work of the stomach, has discovered - many important facts and has given birth to many fruitful ideas. From - him proceed the subdivision of the secretory process according to - periods and exciting agencies, as well as the suggestion that it would - be important to investigate the individual food-stuffs in relation - to the work of the stomach. Heidenhain’s results are contained in - his well-known article on the secretion of the cardiac glands of the - stomach, published in the year 1879 in PFLÜGER’S ARCHIVES. The work of - Blondlot and the additions of Heidenhain comprise almost everything - of importance which was accomplished by physiology in fifty years - concerning the conditions and mechanism of the secretory work of the - stomach during digestion. Full of moment, however, for our subject was - the obvious error that mechanical stimulation constituted an effective - excitant of the gastric glands, and this error was in its turn a - result of faulty methods.”—HORACE FLETCHER.] - - - - - LECTURE IV - - GENERAL SCHEME OF AN INNERVATION MECHANISM--THE WORK OF THE NERVOUS - APPARATUS OF THE SALIVARY GLANDS--APPETITE, THE FIRST AND MOST POTENT - EXCITER OF THE GASTRIC SECRETION - - Constituent parts of a complete innervation mechanism--The special - duty of the peripheral terminations of afferent nerves--The specific - qualities of nerve cells--Analogy between the innervation mechanism - of the salivary glands and that of the deeper-lying glands of - digestion--The exciting agencies of the nervous mechanism of the - salivary glands; their particular properties--Differences between - the exciting agencies of the different salivary glands--Discussion - of the sham feeding experiment--Mechanical and chemical stimulation - of the cavity of the mouth has no effect on the gastric glands--The - experiment of Bidder and Schmidt relative to psychic excitation of - the gastric secretion--Conditions for success in this experiment--The - passionate longing for food--the appetite--alone brings on the - secretory effect in the sham feeding experiment. - - -GENTLEMEN,--As you have learned in the last lecture, and also in part -have seen by direct experiment, the nervous system can influence the -work of our glands in the most diverse ways. The vagus nerve, already -burdened with many duties, has, in addition, proved itself to be an -undoubted exciter of the gastric glands and of the pancreas. But we -must also assign to the sympathetic nerve a similar _rôle_. This is a -matter which cannot be doubted, so far as the pancreas is concerned, -and is highly probable as regards the stomach. We also saw good reason -for believing that these two nerves contained two different classes -of fibres, secretory and trophic, a condition which had already been -proved to exist by Heidenhain for the nerves of the salivary glands. -As a hypothesis we might even have proceeded a step farther and have -divided Heidenhain’s trophic nerves into separate classes of secretory -fibres. Lastly, we advanced important experimental evidence to show -the existence of special inhibitory fibres to the glands, and these -fibres also run in the vagus, the list of whose functions seems almost -interminable. - -We obtained these results by division and artificial excitation of -the nerves which run to the glands. But when, how, and by what means -these nerves are thrown into activity during the normal course of -physiological events remains a question. - -In order to avoid repetition, and at the same time impart the utmost -clearness to our representation, it may be useful to bring before your -minds at once the plan of innervation of a given organ, all the more -since this scheme is seldom completely followed out or adequately -described in physiological text-books. Consequently, it is not borne in -mind with sufficient precision by the majority of medical men. - -A complete innervation mechanism consists of the peripheral endings of -the centripetal (afferent) nerves, the centripetal nerves themselves, -the nerve cells (a group of nerve cells connected with each other is -termed a “nerve centre”), the centrifugal (efferent) nerves, and, -lastly, their peripheral terminations. Physiology now accepts it as a -settled fact, that nerve fibres serve only as _conductors_ of nervous -impulses, which come in from contiguous links of the nervous chain. -Only the peripheral endings of nerves and the nerve cells themselves -have the power of transforming the external stimulus[29] into a -nervous impulse. In other words, in the intact organism these alone -constitute the normal receiving apparatus of the nervous system. -Whether the peripheral ends of centrifugal (efferent) nerves are -likewise able to function as normal sites for the application of -external stimuli has still to be answered. Consequently, when any -external agency excites the peripheral terminations--the receiving -stations--of centripetal nerves in this or that organ, the effect -of the stimulus will be conveyed through the centripetal nerves, as -through a receiving wire, to the central station--the nerve cells. Here -it becomes changed into a definite impulse and now comes back along the -centrifugal nerves--the outgoing wires. - -The utmost importance is to be attached to the fact that only the -peripheral endings of centripetal (afferent) nerves, in contrast to -nerve fibres themselves, respond to _specific_ stimuli; that is to -say, are able to transform definite kinds of external stimuli into -nervous impulses. The function of the end organs with which they are -connected is therefore of a purposive nature; in other words, these -organs are only called into play by certain definite conditions, and -impart the idea of being aware of their purpose, of being conscious -of their duty. We have long known that the peripheral endings of -sensory nerves are possessed of a high degree of speciality, and cannot -therefore have any doubt regarding the specific nature of the end -organs of other centripetal nerves. This is a sore point in present-day -physiology. But, notwithstanding our knowledge of the separate parts -of the animal body, we shall only be able to form a true conception -of the motive agencies of the whole complicated machine, when we have -established the specific excitability of the end apparatus of every -centripetal nerve, and have discovered all the mechanical, chemical, -and other factors which throw this or that end apparatus into an active -condition. I always look upon it as a period of scientific inadequacy -so long as the effects of the most diverse external agencies upon any -normal physiological process are admitted to be indistinguishable. As -the work of the digestive canal is now represented in the majority of -text-books, and consequently presented to the mind of the physician, -it bears the impress of this period. To impart to the physician a more -correct conception of this matter was my chief object in giving these -lectures. I hope, indeed, to furnish you with evidence sufficiently -convincing, that the alimentary canal is endowed not with mere general -excitability; that is to say, does not respond to every conceivable -form of agency, but only to special conditions which are different -for the different portions of its length. Just as men and animals in -the world are only able to maintain their existence and constantly -adapt themselves to changing circumstances by aid of the peripheral -endings of their sensory nerves, so every organ, indeed every cell -of every organ, can only maintain its place in the animal microcosm, -and adapt itself to the activity of innumerable associates, as well -as to the general life of the whole, by virtue of the fact that the -peripheral end apparatus of its centripetal nerves possesses a specific -excitability. - -The same applies to the nerve cells: obviously they are endowed -with specific sensibility. Irrespective of the excitations which -are communicated to them from centripetal nerves, they respond, as -originators of nervous impulses, only or at least mainly to definite -forms of mechanical, chemical, or other stimuli arising in the -organism. This follows not alone from a number of physiological facts -but also from various pharmacological data. Thus we learn that various -drugs excite or annul the activity of definite portions of the nervous -system, at least in the earlier phases of their effects. This specific -excitability of nerve cells, just as much as the same property of -peripheral end organs, lies at the bottom of the purposive action of -these organs. - -Hence, our next duty is to endeavour to discover the normal exciting -conditions of the centripetal nerves belonging to the glands which -we had under consideration in our last lecture, or, more correctly, -to find out the conditions which excite the centres, as well as the -peripheral endings of the different nerves, which form parts of the -nervous apparatus of these glands. We have, therefore, for each phase -of the work of secretion, to find out that portion of the nervous -mechanism which is for the time being under excitation, and to -discover the primary agency by which this condition is elicited. This -would include an exact analysis of the stimulating influence which -mastication and food exert upon the nervous mechanism of these glands. -We shall also be able more fully to comprehend the inner mechanism -underlying the facts which formed the subject of the second lecture. -This, of course, is an ideal programme which we can only follow out -as far as the present state of physiology permits. It may now be -instructive, and, for our further conclusions, advantageous, to glance -shortly at the nervous control of the salivary glands. - -The salivary glands, whose innervation has long ago been investigated, -have generally been accepted as types of the deeper-lying digestive -glands, and when it became necessary to form a conception of the mode -of activity of the latter, medical science resorted to a bold analogy -and thought of the nervous apparatus of the salivary glands. But -the attempts of investigators to apply rigidly to others the scheme -of innervation which holds good for the salivary glands, have done -considerable harm to the usefulness of the analogy and have prevented -our arriving at a correct idea of the plan of innervation of the -abdominal glands. We have already had an example of this nature before -us. In the salivary glands we have no clearly marked indications of -nervous inhibition, and this circumstance has decidedly retarded -the due development of our knowledge of the nervous control of the -abdominal glands. Authors naturally expected to see a simple and -prompt stimulation-effect from the same conditions of experiment which -sufficed for the salivary glands, and the failure of this gave them, -as they thought, the right to deny the existence of any extrinsic -nervous influence upon the abdominal glands. The error is now obvious; -the abdominal glands behave in some ways different from the salivary -glands, and for their successful investigation, other conditions of -experiment are necessary than those which held good for the former. In -the working of the abdominal glands nervous inhibitory processes play -a large part, but they are almost wholly absent in the case of the -salivary glands. This is an additional warning that one must never push -the conclusions drawn from analogy too far, but must constantly bear in -mind that the life-functions of all organs are extremely complicated, -and that the work of even the most apparently similar organs should -be submitted to separate and careful observation. To me it appears -that the unjustified analogy drawn between the abdominal and salivary -glands has to be credited with another important misapprehension. -And precisely for this reason I think it desirable to bring under -consideration, if only in brief fashion, the conditions of work of the -salivary glands, especially since Dr. Glinski has instituted in the -laboratory some easily performed experiments which bear upon the matter. - -The experiences of daily life teach us from the outset, that the -activity of the salivary glands begins even before the introduction -of food into the mouth. With an empty stomach, the sight of food or -even the thought of it is sufficient to set the salivary glands at -once into activity; indeed, the well-known expression, “to make one’s -mouth water,” is based upon this fact. Hence a psychic event, the eager -longing for food, must be accepted as an undoubted excitant of the -nervous centre for the salivary glands. On the other hand, the same -every-day experience, as well as numerous experiments upon animals, -teach us that a number of substances, when brought into contact with -the mucous membrane of the mouth, are likewise able to call forth a -secretion of saliva. One even acquires the impression that everything -brought into the mouth may reflexly influence these glands, the only -difference being a gradual shading off in the effect, dependent upon -the strength of the stimulation which the substance introduced is able -to exert, and it appears to me that it is precisely this impression -which has driven the idea into the background, that the peripheral -end apparatus of the centripetal nerves of the digestive canal are -specifically excitable. The facts were here correctly observed, but -their indications erroneously interpreted. - -The great multiplicity of excitants of salivary secretion, has without -doubt, some connection with the complicated physiological functions -of the saliva. This is the first fluid encountered by everything -which enters the alimentary canal. It must, therefore, in a sense -play the part of host to every substance taken in--moisten the dry, -dissolve the soluble, envelop the hard and bulky with mucus in order to -facilitate its passage down the narrow œsophagus; and submit certain -forms of food material, such as starch, to a process of chemical -elaboration. Nor is its duty by any means ended here. The saliva is -secreted in the first compartment of the alimentary canal, which is at -the same time the sorting-room of the organism. Much of what enters the -mouth may prove in the testing process to be useless, or even noxious, -and must either have its deleterious properties neutralised or be -completely rejected. The saliva is secreted in the first instance to -obviate injurious effects in some way; thus, for example, a strong acid -is to a certain degree neutralised, while other corroding substances -may be simply diluted, and by mere reduction of concentration have -their harmfulness diminished. - -In the second place, when the injurious substances have to be wholly -removed, the saliva plays the _rôle_ of a washing-out fluid; otherwise -the material, by clinging to the mucous membrane of the mouth, might in -longer or shorter time gain entry into the blood and there develop its -noxious influence. This last function of the fluid is hardly taken into -account at all in physiology, and yet it is evident that the saliva, -as a cleansing fluid, must have a wide importance. If you only think -of how often we are impelled to expectorate, that is, to wash out the -mouth with saliva after something unpleasant, this will be clear. -Such a view finds additional support when we reflect that a feeling -of disgust produces almost as strong a flow of saliva as the sight -of a tasty meal. In both cases the secretion performs the office of -forerunner: in the first it prepares for the washing out of the mouth, -in the second for the requisite elaboration of the food. Think how -often, when something disagreeable enters the mouth, with what rapidity -the saliva is poured out, even after the unpleasant substance has been -for a considerable time removed, and not a trace more is apparent to -the sense of taste. Indeed, long afterwards one has only to recall -the circumstances to mind in order to bring on anew the secretion of -saliva. Apparently the psychic excitation of the nerves of salivary -secretion also ushers in the act of vomiting, which, as is well known, -can be called forth by mental influence. Further, the function of the -saliva just mentioned is probably the true physiological explanation of -the feeling of disgust which many persons experience at the sight of -the secretion itself. - -Hence I hold that substances which obtain entry to the mouth set up a -secretion of saliva only because we have here the seat of a definite -physiological sense, and not because the peripheral terminations of the -buccal nerves are devoid of specific excitability, and capable of being -thrown into action by every desired form of stimulus. In other words, -the specific excitability of the peripheral endings of the salivary -nerves is very comprehensive and widely extended. This is no picture -of the imagination, for it can be supported by facts. To say nothing -of the testimony of earlier authors, that the salivary glands have -each particular exciting agencies to which they specially respond, we -can demonstrate the following facts from the material collected in our -laboratory. - -Dr. Glinski isolated the orifices of the salivary glands in dogs with -portions of the adjoining mucous membrane, brought them out of the oral -cavity, and caused them to heal into the edges of the skin wounds. In -his first animal the ducts of the submaxillary gland were thus led -outwards. By means of a Mendeljeff’s clip, the wide end of a conical -funnel of waterproof material was attached to the skin surrounding -the orifice. To the narrow end a small test-tube, which served to -collect the saliva, was attached by a wire. I now offer such an animal -a piece of flesh, and, as you see, the tube fills up at once with -saliva. I stop tempting the dog, hang on a new test-tube, and give it -a few pieces of flesh to eat; once more a strong secretion of saliva -results. A new tube is now attached to the funnel, the dog’s mouth is -opened, and a pinch of fine sand thrown in; again there is a flow of -saliva. Once more a new test-tube; and now I apply to the buccal mucous -membrane, the plume of a feather dipped in acid solution, with the -result that I obtain a strong flow of saliva. One may employ a number -of substances in this way, when a similar effect is always produced. -You see, in this, such a comprehensive excitability of the innervation -apparatus of the salivary glands that you might readily interpret it as -meaning the power of response to all and sundry forms of stimulation. -We now proceed, however, to another dog, whose parotid duct has in -a similar manner been diverted outwards. The saliva is collected in -the same way. We tempt the dog with a piece of flesh, but to our -astonishment no saliva flows, and yet the animal is most eager for the -savoury meal offered. Now we give it some raw flesh to eat; again the -secretion of saliva is as good as absent; only when I come near can I -detect one or two drops of saliva running down the sides of the tube. -Probably you will say there is something wrong, either with the method -or with the glands of the animal. But wait a little. I now give the dog -finely powdered dry flesh, and obtain at once an abundant secretion. -Should any one happen to think that the variation in the result is -dependent, not on a different specific activity of the glands, but on -individual differences in the dogs, I respond that Dr. Glinski has had -an animal with double parotid and submaxillary fistulæ, and was able to -observe on one and the same dog, a like behaviour on the part of the -glands to that which we have just seen in two different individuals. An -analogous experiment with bread was also carried out by Dr. Glinski. -The eating of fresh moist bread produced no secretion worth mentioning, -while dry bread, on the other hand, caused the saliva to flow in large -quantities. The results of this experiment permit us to draw extremely -instructive conclusions. In the first place, the several salivary -glands are, as a matter of fact, very sharply differentiated in the -conditions necessary for their activity--that is to say, in respect -to the agencies which excite their nervous mechanisms. Secondly, the -innervation apparatus of the parotid manifests a very sharp selective -power in the choice, so to speak, of an adequate stimulus. The -mechanical effect of large pieces of flesh is naturally much greater -than that of the finely powdered material, and yet it was precisely -to the latter that the glands responded. The stimulus is, therefore, -not due to the mechanical, but to some other property of the food. -This other property is obviously the dryness of the material. Our -example illustrates how that which we may term “purposiveness” comes -into play in the working of our glands and also how erroneous is the -opinion that the mechanical stimulus is all potent. Indeed, previous -authors have already pointed out that dry substances cause a specially -free secretion of saliva, and yet physiological opinion throughout the -length and breadth of the land, as expressed in text-books, has chosen -to recognise a _universal_ instead of a _specific_ excitability. Dr. -Wulfson, who is at present carrying on the investigation of salivary -secretion in our laboratory, has added a very interesting observation -to the results of Dr. Glinski already related. The parotid gland, which -is hardly, if at all, excited when one offers fresh meat to the animal, -responds with a very active secretion, when dry food (bread or powdered -meat) is offered. This phenomenon is all the more surprising since the -desire of the animal for eating is much more strongly excited by flesh -than by dry bread. I am quite convinced that an exact study of the -exciting agencies of the three salivary glands will furnish a number of -new data bearing upon the question in hand. - -The second reagent which is poured out on the raw material in the -digestive canal is the gastric juice. How, in the normal course of -events, is the work of the gastric glands, which prepare this juice, -called into play? With the first, and manifestly important factor, -which has a relation thereto, you are already acquainted, and, indeed, -have already seen. I refer to the production of gastric juice in the -empty stomach, as a result merely of the swallowing of food in the -so-called sham feeding of an œsophagotomised dog. When one takes -into consideration the absolute independence of this factor, and the -intensity of the effect, which makes itself evident in the secretion of -a large quantity of juice of high digestive power, the exciting agency -which brings about such secretion must be recognised as one of the most -important and effective processes in gastric digestion. But in what -does it consist? At first sight it appears--and when I previously drew -your attention to the fact I expressed the opinion--that there is here -a simple reflex effect from the cavity of the mouth upon the secretory -nerves of the stomach, similar to the reflex excitation, _e.g._, of the -parotid gland, by finely powdered flesh thrown into the mouth. Now, -however, I assert quite emphatically that this is not the case. We -have, it is true, in the activity of the salivary glands an analogous -phenomenon to indicate--not, however, that of which we have just -spoken. We might apply every conceivable form of stimulus which could -possibly come into play in the act of eating, and yet would not obtain -the slightest indication of secretory activity in the stomach. In this -dog with a gastric fistula, and with also a divided œsophagus, I will -try such an experiment, using the most effective chemical stimulus to -the buccal mucous membrane, viz., acid solution. - -The secretion of saliva begins at once, as you see; the acid is, -therefore, effective. From the stomach, however, in spite of continued -excitation, no secretion results, although the acid, mixed with the -saliva, is swallowed and flows out again from the upper segment of the -œsophagus--that is to say, passes along precisely the same path that -the food takes in sham feeding. - -We could experiment in the same way with a number of other substances: -saline, bitters, pepper (strong local excitation), mustard, and so -on, and always with the same results; a free secretion of saliva, but -perfect quiescence of the gastric glands. We may even, with the same -object, employ the soluble constituents of flesh in the form of a -decoction, and likewise observe, in most cases at least, no sign of -activity on the part of the gastric glands. - -With the chemical we may also combine a mechanical stimulus. We can, -for example, wipe out the mouth with a sponge soaked in the solution -to be experimented with, but always with the same negative result. -We may finally give such pieces of sponge, or even smooth stones of -considerable size, to the dog to swallow, passing them back behind the -anterior pillars of the fauces and allowing them to fall out again, -from the upper portion of œsophagus. It may be added that a well-taught -dog puts up with all these procedures without the slightest protest. -You see that all the manipulations in this case are carried out with -bare hands and without instrumental aid. One can easily train a dog -to swallow stones which are placed in the anterior part of the buccal -cavity. It simply makes a few chewing movements and swallows them down. -The dog on which the acid experiment has just been made serves also for -the swallowing of the stones. The attendant now places some pebbles in -the front part of the mouth, when the animal rolls them round, as if -chewing and gnawing them, and then swallows them. The stones fall out, -as you see, from the œsophagus, and drop with an audible sound upon -the table. This play with the stones has now lasted fifteen or twenty -minutes (in the laboratory we have often kept it up for hours), and yet -not a drop of gastric juice is to be seen. - -In order to prove that the dog is perfectly healthy and normal, we lay -aside the stones and proceed to our old experiment of sham feeding. As -you see, the first drop of gastric juice makes its appearance precisely -at the end of five minutes, and after a further five minutes we have -collected more than 15 c.c. of the fluid; consequently there can be no -doubt that in this dog both gastric glands and nerves are uninjured -and function in normal manner. At one time we even had a dog which -voluntarily took the stones out of one’s hand and swallowed them; the -sagacious creature had seen our object in previous experiments and -learned to perform it of its own accord! But in this case also the -result was negative. - -Clearly, therefore, neither chemical nor mechanical stimulation of -the buccal mucous membrane is capable of reflexly exciting the nerves -of the stomach. Further, it is obvious that the excitation of these -nerves in sham feeding is not the result of a stimulation coincidently -produced; that is to say, the excitement of the chewing and swallowing -centres does not imply simultaneous action of the secretory centre of -the gastric glands. In what, then, does this influence consist which -is intrinsic to the sham feeding, but which we have not been able to -reproduce in our analytical investigation? There is only one thing -to think of, namely, the eager desire for food, and the feeling of -satisfaction and contentment derived from its enjoyment. - -It has, indeed, been known for forty years, thanks to the experiments -of Bidder and Schmidt, that at times, the offering of food to a -hungry dog, in other words, the excitement of a keen desire for -it, is sufficient to cause a flow of gastric juice from the empty -stomach. We shall presently have occasion to observe the force of this -physiological factor. Here I bring before you another dog, likewise -having a gastric fistula with divided œsophagus. The stomach has been -washed out half an hour ago, and since then not a drop of gastric juice -has escaped. We begin to get ready a meal of flesh and sausage before -the animal as if we meant to feed it. We take the pieces of flesh from -one place, chop them up, and lay them in another, passing them in front -of the dog’s nose, and so on. The animal, as you see, manifests the -liveliest interest in our proceedings, stretches and distends itself, -endeavours to get out of its cage and come to the food, chatters its -teeth together, swallows saliva, and so on. Precisely five minutes -after we began to tease the animal in this way the first drops of -gastric juice appear in the fistula The secretion grows ever stronger -and stronger, till it flows in a considerable stream. After the -lapse of a few minutes we can count the number of cubic centimetres -by tens. The meaning of this experiment is so clear as to require no -explanation; the passionate longing for food, and this alone, has -called forth under our eyes a most intense activity of the gastric -glands. If the experiment be frequently repeated, one can easily -observe that the keener and more eager the desire on the part of the -dog for the food, the more certain and intense is the secretory effect. -In extreme cases there is even a quantitative relationship between this -effect and that of the sham feeding. - -Here is an experiment of Professor Ssanozki, in which the secretory -effect of the mere tempting of the animal with the sight of food is -compared with that of sham feeding. A few threads of alkaline mucus -had just escaped from the stomach, and then the excitation of the dog -with flesh was begun. After six minutes the secretion commenced and -continued as follows: - - Duration of the flow. Quantity of the juice. - 8 minutes 10 c.c. - 4 ” 10 ” - 4 ” 10 ” - 10 ” 10 ” - 10 ” 10 ” - 8 ” 10 ” - 8 ” 10 ” - 19 ” 10 ” - 19 ” 3 ” - -Then followed a sham feeding for six minutes. - - Duration of the flow. Quantity of the juice. - 17 minutes 10 c.c. - 9 ” 10 ” - 8 ” 10 ” - -It is clear that in this case the tempting, instead of being less -effective than the sham feeding, on the contrary excelled it. - -Consequently, the observation of Bidder and Schmidt was perfectly -correct. It cannot, however, be said that it received general -recognition in physiology, or that it was sufficiently appreciated. -There are authors who could never convince themselves of its reality, -and in many physiological text-books it is not once mentioned. By -way of explanation, we shall now consider how this matter must be -dealt with by those who wish to observe the effect. It is only under -certain conditions that it can be seen. Firstly, the animal must be -healthy and vigorous; it must have a perfectly uninjured gastric -mucous membrane; and this, from the description in the case of many -authors who obtained a negative result, was not the case. Secondly, -the success of the experiment, as stated above, is dependent upon the -intensity of the desire for eating, and this, again, is dependent -upon how freely and how long beforehand the dog had eaten, and also -upon what it is tempted with, whether with a dish that excites its -desire or leaves its interest unawakened. It is known that dogs have -very different tastes, just as men have. Thirdly, one may find among -the dogs positively careless, indifferent creatures, incapable of -being perturbed in this way by anything which has not actually reached -their mouths, and patiently waiting till the food is given them. Hence -for success in the experiment, eager, impressionable, and excitable -animals are necessary. Fourthly, one has to reckon with the sense and -cunning of the dog, a factor which is not lightly to be disregarded. -Often the animals perceive at once that they are only being teased -with the food, become annoyed thereat, and turn away offended at what -is being done before them. We must, therefore, so arrange matters as -if the animals were not going to be disappointed but fed in reality. -If attention be paid to these conditions the experiment of “psychic -excitation of the gastric secretion,” as we usually term it, will be -found to be as reliable as the experiment of sham feeding. When one is -occupied for a length of time with the study of the gastric secretion -under different conditions, one becomes convinced of what a dangerous -source of error this psychic excitability may become in the different -experiments. We must constantly fight, so to speak, against this -factor, keep it ever in view, and guard against it. If the dog has not -eaten for a long time, every movement,--the going out of the room, the -appearance of the attendant who ordinarily feeds the animal--in word, -every little triviality may give rise to excitation of the gastric -glands. The minutest attention is necessary in order to avoid such -sources of error, and we should not be far wrong if we said that much -which has been ascribed in former investigations to the effect of this -or that agency was in reality a result of unobserved psychic influence. -Consequently, in order to verify our own conclusions concerning the -effects of this or that condition, we have performed many of our -experiments on sleeping animals, having beforehand convinced ourselves -by frequent repetition that sleep exercises no restraining influence on -the working of the gastric glands. - -When we recall to mind the failure of our attempts to obtain a -secretion of gastric juice by any stimulation whatever of the buccal -mucous membrane, and at the same time see how constant and intense the -action of this psychic impression is, we are forced to the inevitable -conclusion that in our sham feeding experiment the whole secretory -effect is due to the psychic stimulus, that is to say, to the keen -desire on the part of the animal for food and the satisfaction of -enjoying it. - -In view of the importance of the act of eating, which even now is -apparent, but which will become still more obvious when the succeeding -periods of secretion are investigated, we have spared neither time nor -trouble to arrive at a correct explanation of the mechanism of this -factor. We have, therefore, taken in hand a number of modifications of -the sham feeding experiment, and these investigations have confirmed -the opinion at which we had arrived. If, for instance, the dog has -been prepared by a long fast of two to three days, a very intense -secretion of gastric juice will always be obtained by the sham feeding -experiment, no matter what may be given it to eat, whether boiled or -raw flesh, bread or coagulated egg-white, etc. The dog, however, which -has not fasted, that is to say has been fed fifteen to twenty hours -before, will pick and choose amongst the different foods, eating one -with great greed, tolerating another, and refusing altogether a third, -and, corresponding therewith, the amount and quality of the gastric -juice will manifest wide variations. The more eagerly the dog eats -the more juice will be secreted and the greater the digestive power -which it possesses. The majority of dogs prefer flesh to bread, and -correspondingly less juice will be produced by sham feeding with bread -than with flesh. Sometimes, however, we find dogs which will devour -bread with greater appetite than flesh. In these cases one obtains -more and stronger juice in sham feeding with bread than with flesh. -Here is a case in point: a dog is given boiled meat which has been -cut into pieces of definite size, and the pieces follow each other -at regular intervals of time. The animal eats, but soon, from its -behaviour, you see that it develops no particular greed for the meal, -and this observation is confirmed by the fact that after fifteen to -twenty minutes it ceases taking the flesh. The secretion of juice has -meanwhile either not begun at all, or only after a longer interval -than five minutes, and remains scanty to the end. Now wait till the -secretion has stopped and give the same dog raw flesh, either forthwith -or next day, in pieces of the same size and at the same rate as -before. The raw meat tastes excellently to the dog; it eats for hours -at a time; the secretion of gastric juice begins precisely after five -minutes and is very active. With another dog which prefers boiled to -raw meat exactly the reverse occurs. Broth, soup, milk--towards which -dogs are usually more indifferent than towards solid food--often -produce in sham feeding either no secretion at all or only very little, -although broth, for instance has essentially the same taste as flesh. - -It is therefore clear that in sham feeding the psychic effect may -readily become an absolute and independent factor. All the conditions -which we enumerated above, and which are necessary for the successful -production of the psychic effect, hold good in combined form for the -sham feeding experiment. The dog eats with greed before one’s eyes; -the food which it receives is pleasant; it not only imagines food but -actually eats it, and has therefore no reason to feel offended, for -naturally the idea does not occur to any of the dogs that all their -trouble is in vain. - -Consequently, in the sham feeding experiment, by the act of eating, -the excitation of the nerves of the gastric glands depends upon a -psychical factor which has here grown into a physiological one, that -is to say, is just as much a matter of course, and appears quite as -regularly under given conditions as any other physiological result. -Regarded from the purely physiological side, the process may be said -to be a complicated reflex act. Its complexity arises from this, that -the ultimate object is attained by the joint working of many separate -organic functions. The material to be digested--the food--is only found -outside the organism in the surrounding world. It is acquired not -alone by the exercise of muscular force, but also by the intervention -of higher functions, such as judgment, will, desire. Hence the -simultaneous excitation of the different sense organs, of sight, of -hearing, of smell and taste, is the first and strongest impulse towards -the activity of the gastric glands. This especially applies to the two -latter senses, since they are only excited when the food has already -entered the organism, or at least has arrived very near it. It is by -the establishment of this passionate desire for eating that unerring -and untiring nature has linked the seeking and finding of food with the -commencement of the work of digestion. That this factor, which we have -now carefully analysed, stands in closest connection with an every-day -phenomenon of human life, namely, appetite, may easily be predicated. -This agency, which is so important to life and so full of mystery to -science, becomes here at length incorporated into flesh and blood, -transformed from a subjective sensation into a concrete factor of the -physiological laboratory. - -We are therefore justified in saying that the appetite is the first -and mightiest exciter of the secretory nerves of the stomach, a factor -which embodies in itself a something capable of impelling the empty -stomach of the dog in the sham feeding experiment to secrete large -quantities of the strongest juice. A good appetite in eating is -equivalent from the outset to a vigorous secretion of the strongest -juice; where there is no appetite this juice is also absent. To restore -appetite to a man means to secure him a large stock of gastric juice -wherewith to begin the digestion of the meal. - - - - - LECTURE V - - PERIOD OF OCCURRENCE AND IMPORTANCE OF THE PSYCHIC OR APPETITE JUICE - IN THE SECRETORY WORK OF THE STOMACH--THE INEFFICIENCY OF MECHANICAL - STIMULATION OF THE NERVOUS APPARATUS OF THE GASTRIC GLANDS - - The psychic secretion is the normal commencement, in the majority of - cases, of secretory activity on the part of the gastric glands. If - the meal be subdivided and administered at intervals, the psychic - juice appears each time--Demonstration of “appetite juice” in a dog - with an isolated gastric _cul-de-sac_. The work of the gastric glands - if appetite juice be avoided by introducing food through a gastric - fistula unperceived by the animal--Digestion of flesh by the stomach - with and without sham feeding--Duration of the secretory influence of - sham feeding--After the cessation of the psychic effect, how is the - secretory work of the stomach maintained?--Experiments to prove the - ineffectiveness of mechanical stimulation: excitation of the mucous - membrane by means of a glass rod, a feather, a puff of sand, and by - rhythmic dilatation of an india-rubber ball--Contact between the food - and the stomach-wall may indirectly call the activity of the glands - into play by awakening or increasing the desire for food. - - -GENTLEMEN,--On the last occasion we made ourselves acquainted with -the first normal impulse which, in the natural course of events, -calls into activity the innervation apparatus of the gastric glands. -This impulse is a mental one, and consists in a passionate longing -for food, that which in every-day life, and in the practice of the -physician, is called “appetite,” and which everybody, both medical -and lay, endeavours carefully to promote. We may now venture to say -explicitly, APPETITE IS JUICE, a fact which at once displays the -pre-eminent importance of the sensation. Medical science endeavours to -assist the debilitated stomach by introducing the active constituent of -gastric juice--pepsin--from without, or by prescribing other remedies -believed to promote its secretion. It is, however, of interest to -follow our experimental investigation still farther. What position is -to be assigned to the “psychic” or “appetite-juice”[30] in the course -of normal gastric digestion? Is any definite _rôle_ to be attributed -to it? What course does gastric digestion take when it is absent? -Fortunately to all these important questions satisfactory answers are -forthcoming by experiment. We have only to regret that these answers -come so late. - -Let us recall to memory how the secretion of gastric juice proceeded -after feeding with flesh or bread in the case of our dog with the -isolated miniature stomach. The following are the quantities and -digestive capabilities of the first two hourly portions of juice after -the administration of 200 grams of flesh or bread (experiments by Dr. -Chigin): - - ═════╤═══════════════════╦═══════════════════ - │ Flesh. ║ Bread. - Hour.├————————-┬————————-╫—————————┬————————— - │Quantity │Digestive║Quantity │Digestive - │of juice.│ power. ║of juice.│ power. - —————┼————————-┼————————-╫————————-┼————————— - 1st │12.4 c.c.│ 5.43 mm.║13.4 c.c.│ 5.37 mm. - 2nd │13.5 ” │ 3.63 ” ║ 7.4 ” │ 6.50 ” - ————-┴—————————┴————————-╨—————————┴————————— - -You see at once that the secretion of the first hour is identical in -the two cases both as regards quantity and digestive power, and only in -the second is the secretory work differentiated according to the nature -of the food. How are we to explain the secretion which takes place at -the commencement? Is it not the same which we have already seen in the -sham feeding experiments? Is not this first onrush of the stream of -secretion the preliminary psychic juice? Unquestionably, gentlemen, -this is the case, and we may convince ourselves of the fact in the -most diverse ways. Above all, the following is clear: whatever occurs -in the so-called sham feeding cannot wholly be absent in the case of -normal feeding, since the former is nothing else than the isolated -commencement of normal digestion. This justifiable inference is fully -confirmed, if the secretion of the first hours after the administration -of flesh and bread be compared with that after simple sham feeding. In -the case of feeding with flesh and bread, the identically similar and -high digestive power of the first hourly portions is striking, and this -power coincides with what we have met in sham feeding. Further, if the -quantity of juice from the miniature stomach during the first hour be -compared with that produced by the non-resected part of the organ,--to -do which we must multiply it by ten, since the resected _cul-de-sac_ -is approximately one-tenth of the whole organ,--it is here again found -that the quantity approximately corresponds to the mean values obtained -by sham feeding. Finally, the depression in digestive power or quantity -of juice (with flesh, decrease of digestive power; with bread, decline -in the quantity of juice), which sets in soon after the taking of food, -indicates that the two conditions are connected with the ingestion -of food--_i. e._, with a transitory factor which soon passes away -and gives place to other conditions. Our explanation becomes still -more convincing when we take into consideration the effects of other -foods. If you give the dog, for example, something else to eat which -does not interest it to the same degree as flesh or bread, you will -find the initial increase in quantity and strength of juice does not -appear. Offer the animal milk, for example, which in sham feeding, -especially if it does not last long, calls forth, as a rule, no -secretion, or at all events only very little, and the rapid flow of the -commencement--the already-mentioned initial rise--absolutely fails to -appear. You have already seen the figures which deal with this matter; -I think it necessary, however, to bring them forward again in order -that you may be better able to compare them with the secretion after -flesh and bread. - -The dog was given 600 c.c. of milk (experiment by Dr. Chigin). - - Hour. Quantity of juice. Digestive power. - 1st 4.2 c.c. 3.57 mm. - 2nd 12.4 ” 2.63 ” - -We have now begun the analytical examination of the variations of our -secretory curve. But owing to the importance of the matter we did not -confine ourselves to conclusions which might be drawn from earlier -investigations. We turned to new forms of experiment for further proof. - -Thus we divided the ordinary ration of flesh given to our dogs--400 -grams--into four equal parts, which were administered at intervals of -an hour and a half. (Experiments by Privat docent Kotljar and Dr. -Lobassoff.) Each time after the dog received its 100 grams of flesh we -were able to detect a rise both in the quantity and in the digestive -power of the juice. The following table shows the figures in question: - - ══════════╤═══════════╤═══════════╤═══════════════════════ - Half-hour │ Quantity │ Digestive │ - periods. │ of juice. │ power. │ Remarks. - ——————————┼———————————┼——————————-┼——————————————————————— - 1st │ 3.1 c.c. │ 5.13 mm. │ 100 grms. flesh given. - 2nd │ 5.0 ” │ 4.63 ” │ - 3rd │ 4.7 ” │ 4.50 ” │ - 4th │ 5.4 ” │ 4.88 ” │ 100 grms. ” ” - 5th │ 5.5 ” │ 3.38 ” │ - 6th │ 4.7 ” │ 2.75 ” │ - 7th │ 6.0 ” │ 3.75 ” │ 100 grms. ” ” - 8th │ 5.4 ” │ 2.50 ” │ - 9th │ 5.9 ” │ 2.50 ” │ - 10th │ 5.4 ” │ 3.88 ” │ 100 grms. ” ” - 11th │ 5.3 ” │ 3.0 ” │ - 12th │ 4.2 ” │ 2.5 ” │ - ——————————┴———————————┴——————————-┴————————————————————————— - -In the curve which follows, only the variations of digestive power are -represented. - -It is clear that the increase, both of digestive power and of juice -volume, is connected with the act of taking in food. - -It appeared of interest definitely to determine the volume and -properties of the secretion called forth by the act of eating in the -dog with the isolated stomach. We endeavoured, therefore, at the -beginning, to imitate the conditions of sham feeding as they occurred -in the case of the dog with divided œsophagus. In addition to the -fistular orifice leading into the isolated miniature stomach, another -was opened into the main portion of the organ. If we now fed the dog -in the ordinary way with small pieces of flesh, these were received -back again at the orifice of the latter fistula, covered with saliva. -Precisely as in sham feeding, after five minutes the juice began to -flow simultaneously, from both the large and small stomachs. The -secretion ran a corresponding course in the two cavities and ceased at -the same length of time in both after the administration of food was -stopped. Here is an instance taken from such an experiment performed by -Dr. Lobassoff. - -[Illustration: FIGURE 1.--Curve of digestive power constructed from the -foregoing table.] - -In five minutes the dog had eaten eighty pieces of flesh (weighing 172 -grams), all of which soon afterwards dropped out at the fistula. The -secretion began in both stomachs after the lapse of seven minutes from -the commencement of the feeding, and proceeded as follows: - - - ══════╤═══════════════════════╦══════════════════════════════════ - │ Miniature stomach. ║ Main stomach. - ├——————————-┬———————————╫—————————————┬———————————————————— - Hour. │ Quantity │ Digestive ║ Quantity of │ Digestive power. - │ of juice. │ power. ║ juice. │ - ——————┼——————————-┼——————————-╫—————————————┼———————————————————— - 1 │ 7.7 c.c. │ ║ 83.2 c.c. │ 5.35 mm. - │ │ ║ │} In consequence of - │ │ ║ │} a mixture with - 2 │ 4.5 ” │} ║ 58.1 ” │ } bile (10-15 c.c.) - │ │ }6.25 mm ║ │ } the digestive - 2½ │ 0.6 ” │} ║ 8.5 ” │} power was greatly - │ │ ║ │} reduced. - ——————┴——————————-┴——————————-╨—————————————┴———————————————————— - -The secretion from both cavities also came to an end at the same time. - -This experiment proves to us, first, that the main and miniature -stomachs work in perfectly parallel manner with each other. The -beginning, the end, and the intermediate variations of the secretion -correspond in both cases. Secondly, the digestive power of the -secretion coincides in both, and is the same which was observed in the -so-called sham feeding. It has here remained at the same height till -the cessation of the secretion, without falling to the lower value -which we observed from the beginning of the second hour onwards, after -normal flesh feeding. - -This was also confirmed later, when we performed an œsophagotomy on the -dog, and carried out sham feeding in typical form. Here follows one of -these experiments taken from Dr. Lobassoff’s article. - -The first drop of juice appeared from both cavities during the sixth -minute after commencing the feeding, which was kept up for half an -hour. The further course of the secretion was as follows: - - ══════╤══════════════════════════╦══════════════════════════ - │ Miniature stomach. ║ Main stomach. - ├————————————-┬————————————╫———————————————┬—————————— - Hour. │ Quantity │ Digestive ║ Quantity │ Digestive - │ of juice. │ power. ║ of juice. │ power. - ——————┼————————————─┼————————————╫——————————————─┼—————————— - 1st │ 7.6 c.c. │ 5.88 mm. ║ 68.25 c.c. │ 5.5 mm. - 2nd │ 4.7 ” │ 5.75 ” ║ 41.5 ” │ 5.5 ” - 3rd │ 1.1 ” │ 5.5 ” ║ 14.0 ” │ 5.38 ” - │———— │ ———— ║ ————— │ ———— - │13.5 (total) │ 5.75 (mean)║123.75 (total) │ 5.5 (mean) - ——————┴—————————————┴————————————╨———————————————┴——————————— - -The secretion came to an end in both stomachs at the same time. - -The above is represented in curves in Figs. 2 and 3, the scale on which -that for the main stomach is drawn being ten times less than that for -the small. As you see, the progress of secretion is identical in both. - -The existence of a fistula leading into the large stomach affords us -also the possibility of performing an experiment upon our dog which -is exactly the converse of the sham feeding experiment, and which -constitutes a real _experimentum crucis_. While in sham feeding, we -had only, so to speak, the beginning of digestion before us, we are -now able in our cross experiment to start at the continuation of this -beginning. For this purpose it is only necessary to bring the food -into the stomach through the fistula, without attracting the dog’s -attention. Since in this experiment it is above all necessary not to -excite the dog’s appetite, it is best to carry out the procedure on the -sleeping animal. I may add at once, however, that the same result can -be obtained on the waking animal, only the process must be performed -unnoticed, and the animal’s attention must be diverted from thoughts of -food. - -[Illustration: FIGURE 2.--Curve of secretion from the miniature -stomach.] - -[Illustration: - FIGURE 3.--The same from the main stomach reduced ten times.] - -The results of this experiment are striking, and do not in any way -resemble the secretion after normal feeding. Some kinds of food, for -instance bread and coagulated white of the hen’s egg, when directly -introduced into the stomach, do not yield a single drop of juice -during the first hour or more afterwards. This holds good both for -the small and large stomachs. When a glass rod is introduced into the -food contained in the organ it remains dry. Flesh, if introduced at -this stage, is able to excite a secretion, but the appearance of the -juice is considerably retarded. It begins from fifteen to forty-five -minutes after the feeding, instead of from six to ten, is under normal -circumstances extremely scanty during the first hour (3 c.c. to 5 c.c. -instead of 12 c.c. to 15 c.c.), and possesses a very low digestive -power. - -Here is an experiment by Dr. Lobassoff: - - 400 grms. of flesh were brought into the stomach. - - Hour. Quantity of juice. Digestive power. - 1st 3.7 c.c. 2.0 mm. - 2nd 10.6 ” 1.63 ” - 3rd 9.2 ” 1.5 ” - 4th 7.0 ” 1.88 ” - 5th 5.6 ” 2.25 ” - 6th 6.6 ” 2.63 ” - 7th 7.5 ” 1.88 ” - 8th 5.3 ” 2.0 ” - 9th 3.0 ” 5.0 ” - 10th 0.2 ” — ” - -The secretion began twenty-five minutes after introducing the food. I -now ask you to compare the following tables: - - - ┌────—┬——————————————————╥——————————————————╥——————————————————┬———————┐ - │ │Fed with 200 grms.║Flesh (150 grms.) ║ Sham feeding │ Total │ - │ │of flesh (Chigin).║brought into ║ (Lobassoff). │ quan- │ - │ │ ║stomach(Lobassoff)║ │ tity │ - │Hour.├————————┬—————————╫————————┬—————————╫————————┬————————-┤ in two│ - │ │Quantity│Digestive║Quantity│Digestive║Quantity│Digestive│experi-│ - │ │of juice│ power. ║of juice│ power. ║of juice│ power. │ ments.│ - │ │ c.c. │ mm. ║ c.c. │ mm. ║ c.c. │ mm. │ │ - ├—————┼————————┼————————-╫————————┼—————————╫————————┼————————-┼———————┤ - │ 1st │ 12.4 │ 5.43 ║ 5.0 │ 2.5 ║ 7.7 │ 6.4 │ 12.7 │ - │ 2nd │ 13.5 │ 3.63 ║ 7.8 │ 2.75 ║ 4.5 │ 5.3 │ 12.3 │ - │ 3rd │ 7.5 │ 3.5 ║ 6.4 │ 3.75 ║ 0.6 │ 5.75 │ 7.0 │ - │ 4th │ 4.2 │ 3.12 ║ 5.0 │ 3.75 ║ — │ — │ 5.0 │ - └—————┴————————┴—————————╨————————┴—————————╨———————-┴—————————┴———————┘ - -The progress of juice secretion in the above is also represented in the -following curves: - -[Illustration: - FIGURES 4-7.—A. Ordinary curve of gastric secretion (200 grms. - flesh). B. Curve from direct introduction of food (150 grms. flesh). - C. Sham feeding with same. D. Summation of B and C.] - -As you see, the curve which represents the results of the direct -introduction of flesh ascends much more slowly and does not attain -anything like the height of that caused by normal feeding with the same -food. But if the quantities obtained by direct introduction of the -flesh be added to those of sham feeding, the resulting curve is almost -identical with the normal. - -In like manner the digestive power of the secretion in the foregoing -experiments can be dealt with, and with the same result. It is a good -instance of how a secretion curve can be synthetically constructed from -its constituent factors. - -Finally, I am able to demonstrate to you the following instructive -experiment. In the presence of some of my listeners, whom I had invited -to attend an hour before the lecture, I carried out the following -procedures on two dogs, both of which had ordinary gastric fistulæ and -were, besides, œsophagotomised. Into the stomach of one, while its -attention was distracted by patting and speaking kindly to it in order -to avoid arousing any thoughts of feeding, a definite number of pieces -of flesh were introduced through the fistula. The morsels were threaded -on a string, the free end of which was fastened to the fistular cannula -by inserting a cork. The dog was then brought into a separate room and -left to itself. A like number of pieces was introduced into the stomach -of the other dog in the same way, but during the process a vigorous -sham feeding was kept up, the animal being afterwards left alone. Each -dog received 100 grams of flesh. Since then an hour and a half have -elapsed, and now we may draw the pieces of flesh out by means of the -thread and weigh them. The loss of weight, and consequently the amount -of flesh digested, is very different in the two cases. In that of the -dog without sham feeding the loss of weight amounts to merely 6 grams, -while the flesh withdrawn from the stomach of the other dog weighs only -70 grams, that is to say, was reduced by 30 grams. This, therefore, -represents the digestive value of the passage of food through the -mouth, the value of an eager desire for food, the value of an appetite. - -I give also a series of figures obtained by Dr. Lobassoff in analogous -experiments. Into the dog’s stomach 25 pieces of flesh (100 grams) -were brought. The flesh remained two hours in the cavity. Without sham -feeding 6.5 per cent, with eight minutes' sham feeding 31.6 per cent, -of the quantity was digested. - -Again: the flesh remained an hour and a half in the stomach; without -sham feeding 5.6 per cent, with five minutes' sham feeding 15 per cent, -was digested. - -Once more: the flesh remained five hours in the stomach; without sham -feeding 58 per cent, with sham feeding 85 per cent, was digested, the -balance of undigested food being 42 per cent in the one case and 15 per -cent in the other. - -I must, however, add that from the nature of this experiment it is not -well adapted for class demonstration, and may often fail. On the one -hand, it is not at all easy to conceal the introduction of the flesh -from the dog; on the other, the unusual and distracting surroundings -of the animal often causes a short period of sham feeding to have less -effect than would otherwise pertain. In order to avoid such failures -it is better before an audience to carry out this experiment only -on dogs accustomed to appear in the lecture theatre, and of whose -temperament the experimenter is well assured. - -I hope you have now been convinced of the great importance which is to -be attached to the passage of food through the mouth and œsophagus, or, -in other words--and this, according to our former experiences, means -the same thing--to the eager desire for food. Without this longing, -without the assistance of appetite, many forms of food-stuffs which -gain entry to the stomach remain wholly devoid of gastric juice. -Others, it is true, excite a secretion, but the juice poured out is -scanty and weak. - -It is only later, when we have still more fully recognised the -conditions upon which the secretory work of the gastric glands depends, -that we shall be able to grasp the meaning of these facts in a more -comprehensive manner. For instance, why does bread brought unnoticed -into the stomach of the dog cause no secretion for hours, while flesh -tolerably soon (after twenty to forty minutes) provokes this act? This -will be explained in the next lecture; now, however, we must consider -other questions. - -How long does the after-effect, the echo of the first impulse to the -secretory nerves of the stomach, continue to last? How long does -appetite juice continue to flow after the normal act of eating, which, -especially in the case of animals, is not of long duration? We have -already determined many times, not only on our dog with the isolated -stomach, but also on other animals, how long the after-effect of sham -feeding is continued. - -Here, for example, is an experiment from the article of Professor -Ssanozki which deals with the point. The dog had a gastric fistula and -also an opening leading into the œsophagus. After a sham feeding of -five minutes the secretion began, and was continued as follows: - - Time in minutes. Quantity. Digestive power. - 10 25.5 c.c. 8.1 mm. - 10 20.0 ” 8.0 ” - 10 13.5 ” 6.8 ” - 10 11.0 ” 7.5 ” - 10 8.5 ” 8.1 ” - 10 6.5 ” 9.0 ” - 20 13.5 ” 7.4 ” - 20 11.0 ” 7.2 ” - 20 7.0 ” 7.2 ” - 20 11.5 ” 6.8 ” - 20 11.0 ” 6.5 ” - 30 6.5 ” 7.6 ” - 20 5.5 ” 7.2 ” - -The effect, therefore, even after a short period of sham feeding, -stretches over a length of time. Naturally the same holds good for the -taking of food in the normal way. One must, however, bear in mind that -in sham feeding, with all the force and reality of a hunger sensation -not satisfied, the eager desire for food, the effective agency, becomes -more and more accentuated, and therefore the secretory influence is -prolonged and more powerful. In normal feeding, however, the quelling -of the longing, the feeling of satisfaction which, as is well known, -sets in long before the termination of the digestive period from the -mere filling and distension of the stomach, must diminish the desire -for food, and, consequently, bring the secretory effect to an end. - -It is, therefore, improbable that the whole secretory process in the -stomach, which, in the case of certain kinds and quantities of food, -lasts from ten to twelve hours, is dependent on the factors which we -have up to the present investigated. This is all the more obvious -since a sham feeding of five minutes, even under the most favourable -circumstances, does not call forth a secretion for longer than three to -four hours. We must, therefore, seek for other exciting agencies of the -innervation apparatus of the gastric glands. - -Why and wherefore is the secretion instituted by psychic influence -maintained? What would first occur to all your minds is naturally -the immediate influence which the food exerts upon the walls of the -stomach. And this is true, but it does not happen in the simple, direct -fashion current in the minds of many physiologists and physicians. When -I said that bread or boiled white of egg, introduced directly into the -stomach, may not for hours produce a trace of secretion, probably many -of my hearers may have asked themselves with natural astonishment, -“How, then, is the effect of the forced feeding of phthisical and -insane patients, and the artificial feeding of those with gastric -fistulæ (performed on account of stricture of the œsophagus) to -be explained?” I will introduce my answer by a very unexpected -pronouncement relative to the assertion that mechanical stimulation of -the stomach wall by food constitutes a reliable and effective means -of calling forth the secretory work of the glands. This assertion, -which is so categorically set forth in many text-books of physiology, -and which consequently has gained hold of the mind of the physician, -is nothing else than a sad misconception degenerated into a stubborn -prejudice. My own statement, repeated in many published articles, and -at the meetings of various medical societies, that this dictum is only -a picture of the imagination, has met, for the most part, either with -an unbelieving shake of the head or else with a direct avowal that “it -cannot be so.” I regret exceedingly that these steadfast unbelievers -are not here, so that we might together bring the matter before the -tribunal of fact, to the demonstration of which we will now proceed. To -this matter I attribute very great importance. It is on this ground, -according to my opinion, that the whole battle must be fought out -between the generally accepted view that every agency is capable of -exciting the gastric mucous membrane and the theory that it is only -excitable by specific and selected stimuli. If once the defenders of -the old opinion are driven from their position and obliged to admit -the inefficiency of mechanical stimulation, there would be nothing -further left for them than to build up new theories and search out -old facts concerning gland work which have hitherto been rigidly kept -in the shade. We may take it that it is mainly because people were so -seized with the belief in the direct and simple mechanical explanation -that Bidder and Schmidt’s experiment of the excitation of gastric -secretion by mental effect has been so little taken into consideration, -notwithstanding that it appeared so thoroughly reliable and convincing. - -I will now repeat the experiment of mechanical stimulation of the -gastric mucous membrane before you in the well-known, traditional, -and classic manner. Here is a dog with a gastric fistula on which -a cervical œsophagotomy has in addition been performed. I open the -fistula; as you see, nothing flows out of the stomach; it was washed -out clean with water an hour ago. We take the celebrated feather and -also a tolerably strong glass rod. Folds of blotting-paper saturated -with red and blue tincture of litmus are placed at hand. I now ask my -assistant to continuously move the feather and glass rod, alternately, -in all possible directions in the stomach, changing from one to the -other every five minutes. On removal from the stomach each is carefully -dried with red and blue blotting-paper. You have all seen, gentlemen, -that this procedure has now been kept up for half an hour. From the -fistular orifice not even a single drop has escaped, and, moreover, the -drops of moisture on all the pieces of red blotting-paper I have been -able to hand to you have assumed a distinct blue tinge, caused by the -moisture of the alkaline mucous membrane. The blue pieces, however, -have merely been made wet without altering their colour. Consequently, -with the most thorough mechanical stimulation of the whole cavity of -the stomach, we have not been able to find a single spot possessing a -noticeable acid reaction. Where, then, are the streams of pure gastric -juice of which we read in text-books! What objection can be raised -against the conclusiveness of this experiment? In my opinion only one: -that we are dealing with a dog out of health, whose gastric glands from -some possible cause are unable to react normally. This single objection -can be set aside before your eyes. After failing with the mechanical -stimulation, we proceed forthwith to the sham feeding of the same -animal. The dog takes the food offered it with keen appetite, and you -see that, exactly five minutes after beginning the feeding, the first -drops of juice appear from the stomach, followed by others faster and -faster. I catch a couple of drops on the blue litmus paper, and you see -that they produce bright red specks on the blue sheet. After thirty -minutes' sham feeding we have collected 150 c.c. of juice, which, -without filtering, looks as clear and transparent as water. - -We cannot, therefore, possibly doubt that, when the proper stimulus is -used, the gastric glands react to it in a perfectly normal fashion, -furnishing a healthy gastric juice. From this it irrefutably follows -that only one explanation is to be found for the negative result in -the first half of our experiment, viz., that the mucous membrane -of the stomach, so far as secretory activity goes, is perfectly -indifferent to mechanical excitation. And yet this mechanical stimulus -is demonstrated as an exciting agency in the physiological lecture -theatre. I venture to think that this lecture experiment from now -onwards will quit the field, and give place to the one I have just -shown you. This apparently simple experiment of mechanical stimulation -can, however, only be successfully performed when certain very obvious -rules are followed. These, however, physiologists have not observed, -probably on account of a preconceived belief in the effectiveness of -the mechanical stimulus. These rules are two. First, it is necessary -that the stomach should be clean, and that nothing shall gain entry -to it from without. Such conditions were not formerly fulfilled. It -is true the stomach was emptied by removing the stopper from the -fistular cannula, but it was not washed out till an acid reaction -was no longer given, and consequently preformed gastric juice was -left behind between the folds of the mucous membrane. At the same -time saliva from the cavity of the mouth could gain entry, which -quickly became acidified in the incompletely emptied and imperfectly -washed-out organ. It is, therefore, not surprising that the glass -tube, by setting up contractions of the stomach, was the means of -expressing small quantities of acid fluid from the fistula-tube. (The -relationship between mechanical stimulation and the motor functions -of the stomach is not to be confounded with what we are here speaking -of.) That matters are as I state, and that the facts correspond to -the explanation is proved by this; namely, that nobody till now -has obtained genuinely pure gastric juice of an acidity amounting -to 0.5 or 0.6 per cent. It is only necessary to call to mind that -Heidenhain, when determining the acidity of the juice first obtained -from the resected stomach, was placed in no little doubt as to whether -his results (0.5 to 0.6) were correct, and his assistant at the -time (Gscheidlen) was set to verify the correctness of his standard -solutions. The acidity of the “purest” juice known at that time was -scarcely 0.3 per cent. As a further proof that none of the older -observers ever really obtained a secretion from mechanical stimulation -pure and simple, we may adduce the fact that none of them made mention -of the constant and precise period of five minutes' latency. To -overlook this was not possible if a genuine excitation of the glands -had been obtained. - -Of no less importance is the second condition when we wish to perform -the experiment of mechanical stimulation in the correct way. It is -very necessary that the gastric glands be not already in activity at -the beginning of the experiment, and also that during the experiment -no impulse comes into play, which of itself, apart from mechanical -excitation, could excite the glands to secretion. Nor have we any -proof that observers formerly waited for hours before commencing -the experiment and convinced themselves that the gastric glands had -ceased working. On the contrary, we have not the slightest evidence to -indicate that the authors had attempted to guard against accidental -psychical stimulation of the glands--a matter which we have seen is of -considerable difficulty. And some dogs are so easily excited in this -way that it is almost impossible to bring their glands to rest, or at -least it is necessary to wait for hours. The experimenter must strain -his whole attention to preserve such an experiment free from objection. -It is only necessary that some food be near the dog, or that the hands -of the attendant who has prepared the food should smell of it, or that -some other similar circumstance should come into play, and the glass -tube, quite undeservedly, will be made answerable for the excitation of -the gastric glands. As you have just seen, both of our conditions have -been fulfilled on the dog before you, and the result of the experiment -stands in irreconcilable contradiction to those of the laboratory and -lecture experiment of former times. - -The importance of the experiment, which I have already dwelt upon, -justifies me in making still further demands upon your attention in -order to show you two modifications of it. Nobody has as yet said, with -regard to mechanical stimulation, that in order to obtain results the -mechanical agency must simultaneously come into contact with numerous -points of the inner surface of the stomach. But in order to meet this -possible objection I will now show you two new modifications. Again -a similar dog is used, that is to say, one on which both gastrotomy -and œsophagotomy have been performed. The stomach has been washed out -clean and is at present in a state of complete rest. Into the fistula -I bring a thick glass tube containing a number of small openings (2 -to 3 mm. diameter) at its rounded end. The other end of the tube is -connected with a glass ball containing tolerably coarse sand. Leading -into the ball is a second tube, with which an india-rubber pump can be -connected and a blast of sand blown through. By rhythmic compression -of the india-rubber ball I inject sand with considerable force into -the stomach, and this play is kept up for ten to fifteen minutes; -nevertheless, we see no trace of gastric juice. The sand falls out -again between the side of the cannula and the glass tube, and it -is either dry or scarcely moistened, but in no case is it able to -turn blue litmus red. And yet we are here dealing with a strong and -widely diffused stimulus. Look for a moment at the performance of the -bellows outside the stomach. From every opening of the tube--numbering -considerably more than ten--a strong stream of sand is ejected. If you -hold your hand against it, you feel quite distinctly that the grains -of sand strike with considerable force. And now, when our experiment -is ended, we may convince ourselves by sham feeding, in easy and -unquestionable fashion, that the innervation of the dog’s stomach is -perfectly normal. - -Yet another experiment on a similar dog. Into its empty and resting -stomach an india-rubber ball is introduced. This is distended with -air by means of a syringe till it is as large as a child’s head and -maintained in this condition for a time, afterwards being allowed -to collapse. The procedure is kept up for ten to fifteen minutes. -During this time not a single drop of juice has appeared from the -stomach. The surface of the ball taken out of the organ is everywhere -alkaline. And here also subsequent sham feeding shows that the dog is -in a suitable condition for the experiment. I must add that in making -this observation the dog must not be too hungry, that is to say, must -have been fed within ten to twelve hours before, otherwise a psychic -excitation of the secretion can readily be induced. - -If one dispassionately regards this question, and if any of our methods -for the study of gastric secretion are reliable, one must be convinced -step by step in the laboratory of the uselessness of mechanical -stimulation. In the case of dogs with an ordinary gastric fistula, and -failing some special reason, not a drop of gastric juice ever escapes -from the stomach other than during the digestive period. How could -this be the case if the mechanical stimulus were effective, since the -inner rim of the fistula-tube is continuously in contact with the -gastric mucous membrane? The same holds good for the dog with resected -stomach. During the experiment a glass or india-rubber tube is brought -sufficiently far into the _cul-de-sac_ to catch the juice, and yet not -a drop flows through the tube, nor does its inner surface ever become -acid, so long as true secretory conditions are absent. Moreover, the -tube has tolerably often to be taken out and set right. - -In the ordinary gastric fistula in dogs, when the operation has lasted -a long time--over a year--folds of mucous membrane are often formed -in the neighbourhood of its inner orifice which completely close the -tube. In these cases a long, thick, perforated metal tube has to be -passed in deeply, and yet the manipulation of itself never calls forth -a secretion. Further, it is a daily occurrence to find in the stomach -of the dog thick rolls of hair, and yet their presence in no way -hinders the arrest of the secretion, which occurs when digestion has -ceased. Such an occurrence would have been specially obvious in our dog -with the isolated stomach, since it was bedded with sawdust in order -to guard against maceration of the wound by juice trickling out. Very -often we found enormous quantities of sawdust in the stomach, as much -as half a pound weight; obviously the dog had licked the wound from -adherent sawdust, which it then swallowed, together with that sticking -to its nose. And yet these particles of sawdust of themselves, which -certainly acted as mechanical stimuli, never caused a secretion. It -appears to me that this long series of facts ought to suffice to carry -the supposition to its grave that by direct mechanical stimulation -one is able to set the neuro-secretory apparatus of the stomach into -activity. - -And yet the feather and the glass tube continue the even tenor of -their ways to this moment and function in some text-books, yea, even -in articles which specially treat of gastric secretion as exciters of -the gastric glands. There are, it is true, a few physiologists who -hold mechanical stimulation, in relation to gastric secretion, not to -be very effective, and give it a subordinate position in the series of -exciting agencies, but as yet I know of no other physiologist who has -wholly denied its influence, and who has not held it possible to obtain -at least some juice by it. - -To conclude this lecture, we will take into consideration a question -connected with the matter we have just discussed. Since the contact of -food with the gastric mucous membrane has no direct influence on the -secretion, is its entry into the stomach devoid of all connection with -the secretory process? - -It can hardly be doubted that, under normal conditions, the stomach is -the seat of certain definite sensations, that is to say, its surface -has a certain degree of tactile sensibility. This sensation is, as a -rule, very weak, and the majority of people become accustomed to pay -no heed to it in the normal course of digestion. They obtain their -sensations of general well-being, and especially of satisfaction -from the enjoyment of food, without taking cognisance of the factors -contributing to them. The feeling of general hunger, however, is -referred solely to the stomach. - -On the other hand, all of us have met with men who could describe -exactly, and with gusto, how they were able to follow a special -tit-bit, or a mouthful of a favourite wine, the whole way through the -œsophagus down to the stomach, especially when the latter happened -to be empty. Naturally the gourmand, who directs his attention -continuously to the act of eating, can in the end distinctly perceive -sensations, and even call them up to the consciousness, which in other -people are normally masked by other sensations and impressions. We may -therefore take it that the satisfaction derived from eating is caused -not only by stimulation of the mouth and throat, but also by impulses -awakened by the passage of the food along the deeper portions of the -œsophagus and by its entry into the stomach. In other words, food which -merely passes through the mouth and throat produces less enjoyment -and excites, therefore, a less feeling of appetite than the food -which passes the whole way into the stomach. The appetite, the eager -craving after food, is, indeed, a very complex sensation, and often -not merely the need of the organism for food material is necessary for -its excitement, but also a condition of thorough well-being, together -with a normal healthy feeling in all parts of the digestive tract. For -this reason it is easy to understand how patients who have diseased -sensations in these organs, and who have no feeling of appetite, -no desire for food, remember the sensations, whether consciously or -unconsciously, even when they are no longer present. Cases are known -to neuro-pathologists where people with gastric anæsthesia suffered -from this loss of appetite. Such patients are no longer conscious of -having stomachs, and dislike the idea of eating because the food, as -they express it, appears to fall into a strange empty sack. In this -way one can also conceive how the appetite becomes lost in cases of -long-continued obstruction of the alimentary tube. The patients forget -their stomachs, and in such instances direct introduction of food into -the organ, after an operation, may suddenly bring back the appetite. - -As a further illustration, I may be permitted to give an instance from -my own personal experience. After an illness with which a transient but -high fever was associated, although otherwise fully recovered, I had -lost all desire for food. There was something curious in this complete -indifference towards eating. Perfectly well, I only differed from -others in that I could with ease abstain from all food. Fearing that I -should collapse, I resolved on the second or third day to endeavour to -create an appetite by swallowing a mouthful of wine. I felt it quite -distinctly pass along the œsophagus into the stomach, and literally at -that moment perceived the onset of a strong appetite. This observation -teaches that the tactile sensation of the stomach at the moment of -entry of food is capable of awakening or increasing the appetite. It is -known that withholding food from the organism, or in other words the -creation of a necessity for food, does not lead immediately, nor in -all cases, to the production of an appetite, to a passionate craving -for food. How often does it happen that the ordinary hour for a meal -has struck, and yet, owing to some keenly interesting occupation, not -the least desire for food is felt? It is known to everybody, indeed it -has become a proverb, that real appetite first sets in with eating. -If this be true, the initial impulse towards awakening an appetite -may originate in the stomach and not in the buccal cavity. When we -spoke above of the desire for food being the excitant of the secretory -nerves of the stomach, we naturally meant the passionate and conscious -longing for food, that which is called “appetite,” and not the latent -need of the organism for nourishment, the lack of nutrition, which -has not yet been transformed into a concrete passionate desire. A -good example which enables us to differentiate between these two -factors is furnished by our dogs with sham feeding. The necessity for -food exists in such cases even before the experiment; the juice, -however, only begins to flow as soon as this need has taken the form -of a passionate longing. It is therefore quite possible that in the -case of some dogs, and at a certain stage of hunger, the touching of -the gastric mucous membrane with any object at hand, its mechanical -excitation, its distension by the food mass, may give the impulse which -excites the appetite, and when the appetite is awakened the juice -flows. This is possibly a third reason why, in the old experiment, -the mechanical stimulus came to be considered effective. Viewed from -this point it may, to a certain degree, lead to a reconciliation -between my assertion concerning the inefficiency of the mechanical -stimulus and the generally prevailing belief. I further also admit that -mechanical excitation will at times call into play the work of the -gastric glands, not however directly by means of a simple physiological -reflex, but indirectly, after it has first awakened and enlivened the -idea of food in the dog’s consciousness, and thereby called forth the -passionate desire. I hope that the foregoing will in no way lead to a -confusion of ideas in your minds, but will assist you to an exact and -concrete analysis of the previous simple explanation of the facts. This -representation, which bears more or less of a hypothetical character, -could, of course, be submitted to experimental proof. For such it is -only necessary to compare the influence which sham feeding exercises -in an œsophagotomised dog with that in one having a simple gastric -fistula. - - - - - LECTURE VIII - - PHYSIOLOGICAL ACTION AND THE TEACHING OF INSTINCT: EXPERIENCES OF THE - PHYSICIAN - - It would be desirable, in the interests of medicine, that the methods - described in these lectures should be employed in experimental - investigations into the pathology and therapeutics of the digestive - canal on the lines laid down--The fact that the beginning of the - secretory work in the stomach depends upon a psychic effect harmonises - with the experiences of every-day life, namely, that food should - be eaten with attention and relish--To restore the appetite has - from all ages been the endeavour of the physician--The indifference - of the present-day physician towards appetite--Probable causes of - this--Curative remedies based upon a restoration of appetite--The - therapeutic effects of bitters depend upon the excitation of - appetite--The usages of the mid-day meal are in agreement with - physiological requirements--Physiological reasons for certain - instinctive customs and empirical regulations--Importance of an - acid reaction of the food--Dietetics of fat and its therapeutic - application--The peculiar position of milk among food-stuffs is - based on physiological reasons--Explanation of the curative effects - of sodium bicarbonate and sodium chloride--The causes of individual - differences in the work of the digestive glands--Participation of - the inhibitory nerves of secretion in the production of pathological - effects. - - -GENTLEMEN,--To-day we shall endeavour to bring the previously -communicated results of our laboratory investigations into -reconciliation with the customs observed in the ingestion of food, -and with the regulations prescribed by the physician in disorders of -the digestive apparatus. To bring our knowledge to full fruition, and -so secure for it the most useful application, the same methods should -be applied from the same standpoint to the experimental investigation -of the pathology and therapeutics of the alimentary canal. Nor should -we be likely to encounter insuperable difficulties. Thanks to the -advances of bacteriology, many of the pathological processes can now -be experimentally produced in the laboratory. Moreover, we would, -in a sense, have to deal with external ailments, since our present -methods enable us to obtain access to any desired part of the inner -surface of the digestive canal. In such pathological animals the -functional diseases of the apparatus could be studied in a precise -and detailed manner; that is to say, the alterations of secretory -activity, the properties of the fluids, and the conditions under which -they appear could be examined. On such animals therapeutic remedies -could also be tested, the whole process of healing and the final result -experimentally observed, while the conditions of secretory activity -during every phase of the healing process could be investigated. It can -hardly be doubted that scientific, that is to say ideal, medicine, -can only take its proper position as a science when, in addition to an -Experimental Physiology and Pathology, there has also been built up an -Experimental Therapeutics. A proof that this is possible is furnished -by the recent vigorous strides made by the science of bacteriology. - -I have already described one of such pathological therapeutic -experiments; namely, on the dog whose vagi nerves were divided in the -neck. Other similar cases I can also call to mind. Our dog with the -two stomachs suffered at one time from a slight and transitory gastric -catarrh. It was then very interesting to observe that the pathological -process (which we were usually able to wholly guard against) spread -from the large to the small stomach. It manifested itself here in -an almost continuous slimy secretion of very slight acidity, but of -strong digestive power. At the beginning of the ailment, indeed before -it became fully established, the psychic stimulation was remarkably -effective (that is to say, still furnished juice in appropriate -quantity), while local excitants almost completely failed. One may -conceive that the deeper layers of the mucous membrane with the gastric -glands were still healthy, and thus easily thrown into activity by -central impulses, whilst the surface of the membrane with the end -apparatus of the centripetal nerves was already distinctly damaged. -I mention these, which I may call impressions rather than precise -observations, because I wish to point out what a fruitful field awaits -the investigator who wishes to study, with the aid of our present -methods, the pathological conditions of the digestive organs and their -treatment. Such an investigation is all the more desirable because -clinical study of the same subject (notwithstanding the zeal devoted to -it during the last ten years and the results derived therefrom) has to -contend with serious difficulties. We must not forget that the sound or -stomach-tube, the chief clinical instrument, is more uncomfortable than -the ordinary form of gastric fistula which was previously practised on -animals, and yet the physiology of the stomach, even with the aid of -the latter, made no material progress for many long years. Nor is this -difficult to understand. The investigator obtained through the fistula -a mixture of substances from which it was difficult, or even at times -impossible, to decide anything. - -Hence the exact scientific study of therapeutic questions in this -region still belongs to the future. But this does not exclude the -probability that the newer acquirements of physiology may fruitfully -influence the work of the physician. But physiology naturally can make -no pretence to guide the field of medicine, since the knowledge at its -disposal is incomplete and is much more restricted than that of the -broad world of clinical reality. As a recompense for this, however, -physiological knowledge is often able to explain the causation of an -illness and the meaning of empirical curative methods. To employ a -remedy the mode of action of which is not clear is quite a different -thing from knowing precisely what we are doing. In the latter case -the treatment of the diseased organ will be more effective because it -will be better adapted to the special needs of the case. It is thus -that medicine, being daily enriched by new physiological facts, will -at length grow into what it ideally must become; namely, the art of -repairing the damaged machinery of the human body, based upon _exact_ -knowledge, or, in other words, applied physiology. - -We may now return to our subject. If it be at all admitted that human -instinct is the outcome of an every-day experience, which has led to -the unconscious adoption of the most favourable conditions for life, -it is particularly so with regard to the phenomena of digestion. The -expression that physiology merely confirms the precepts of instinct -is justified here more than anywhere else. It appears to me also -that, in relation to the foregoing facts, instinct has often made -out a brilliant case when brought before the tribunal of physiology. -Perhaps the old and empirical requirement, that food should be eaten -with interest and enjoyment, is the most imperatively emphasised and -strengthened of all. In every land the act of eating is connected -with certain customs designed to distract from the business of daily -life. A suitable time of day is chosen, a company of relatives, -acquaintances, or comrades assemble. Certain preparations are carried -out (in England a change of raiment is usually effected, and often a -blessing is asked upon the meal by the oldest of the family). In the -case of the well-to-do a special room for meals is set apart, musical -and other guests are invited to while away the time at meals--in a -word, everything is directed to take away the thoughts from the cares -of daily life, and to concentrate them on the repast. From this point -of view it is also plain why heated discussions and serious readings -are held to be unsuitable during meal-times. Probably this also -explains the use of alcoholic beverages at meals, for alcohol, even -in the lighter phases of its action, induces a mild narcosis, which -contributes towards distraction from the pressing burden of the daily -work. Naturally this highly developed hygiene of eating is only found -in the intelligent and well-to-do classes, first, because here the -mental activity is more strained and the various questions of life more -burning; and secondly, because here also the food is served in greater -quantity than is required for the wants of the organism. In the case of -the poorer classes, where mental activity is less highly developed, the -greater amount of muscular activity and the constant lack of more than -sufficient nourishment insure a strong and lively desire for food in a -normal manner, without recourse to any special regulations or customs. -The same conditions explain why the preparation of food is so choice -in the case of the upper classes and so simple in that of the lower. -Further, all the accessories of the meal, which are foretastes of the -actual repast, are obviously designed to awaken the curiosity and -interest, and to augment the desire for food. How often do we see that -a person who begins his customary meal with indifference afterwards -enjoys it with obvious pleasure when his taste has been awakened by -something piquant or, as we say, appetising. It was here only necessary -to give an impulse to the organs of taste, that is, to excite them, in -order that their activity might be later maintained by less powerful -excitants, for a person who feels hungry such extra inducements are, -of course, not necessary. The quelling of hunger in his case affords of -itself sufficient enjoyment. It is not, therefore, without reason that -it is often said that “Hunger is the best sauce.” This dictum, however, -is only right up to a certain point, for some degree of appetising -taste is desired by everybody, even by animals. Thus, a dog which has -not fasted for more than some hours will not eat everything with equal -pleasure which dogs usually eat, but will seek out the food which it -relishes best. Hence the presence of a certain kind of spice is a -general requirement, although naturally individual tastes differ. - -This short discussion as to how different people behave with regard -to the act of eating is of itself testimony that care should ever be -taken to keep alive the attention and interest for food and to promote -enjoyment of the repast--that is to say, that care should be taken of -the appetite. Every one knows that a normal, useful food is a food -eaten with appetite, with perceptible enjoyment. Every other form of -eating, eating to order or from conviction, soon becomes worse than -useless, and the instinct strives against it. One of the most frequent -requests addressed to the physician is to restore the appetite. Medical -men of all times and of every land have held it to be a pressing -duty, after overcoming the fundamental illnesses of their patients, to -pay special attention to the restoration of the appetite. I believe -that in this they are not only animated by an endeavour to free their -patients from troublesome symptoms, but also by the conviction that -the return of appetite of itself will favour the restitution of normal -digestive conditions. It may be said that to the same extent to which -the patient wishes back his appetite the physician has effectively -employed measures to restore it. Hence we have not a few remedies which -are specially named “gastric tonics,” and whose action is to promote -appetite. Unfortunately medical science has latterly deviated from -this, the correct treatment of the appetite, and that which corresponds -to the real conditions. If one reads current text-books on disorders of -digestion, it is remarkable how little attention is paid to appetite -as a symptom or to its special therapy. Only in a few of them is its -importance indicated, and then merely in short, parenthetic phrases. -On the other hand, one may meet statements in which the physician is -recommended to adopt no special means for counteracting so unimportant -a subjective symptom as a bad appetite! After what I have said and -demonstrated to you in these lectures, one can only designate such -views as gross misconceptions. If anywhere, it is precisely here -that symptomatic treatment is essential. When the physician finds it -necessary, in disorders of digestion, to promote secretory activity by -different remedies, this object can most certainly and completely be -achieved by endeavouring to restore the appetite. We have already seen -that no other excitant of gastric secretion, so far as quantity and -quality of the juice are concerned, can compare with the passionate -craving for food. - -To a certain degree we can understand--and this contributes to an -explanation of matters--how medical science of our time has come -to regard so lightly the loss of appetite as a special object for -treatment. Now, however, the experimental method has penetrated more -and more into medical science, with the result that many pathological -factors and therapeutic agents are judged of according to whether they -hold good in the laboratory or not--that is to say, they are valued -only in so far as they can be verified by laboratory experiments. -Naturally we do not doubt that a movement in this direction indicates -a great advance, but even here, as with every undertaking of mankind, -things do not proceed without mistakes and exaggerations. We must not -consider an event to be a mere picture of the imagination because -it is not realisable under given experimental conditions. We often -do not know all the essential conditions for the production of the -phenomenon in question, nor are we yet able to grasp the connection -between all the separate functions of life as fully as may be desired. -Thus in the clinical treatment and pathology of digestion assistance -was sought for in the laboratory, but nothing was there met with which -had a relation to appetite, and consequently this factor was overlooked -in medical practice. As stated above, the psychic gastric juice -obtained only cursory mention in physiology, and this not even by all -authors; and when it was noticed it was related more as a curiosity. -Great importance was, on the other hand, assigned to the mechanical -stimulus, the efficiency of which, now that our knowledge is more -complete, has been shown to be purely imaginary. Each of the contending -factors has at length been assigned its proper place, and if clinical -medicine maintains her worthy desire of following out the experimental -investigation of her problems, she must in actual practice accord to -appetite its old claim for consideration and treatment. - -But notwithstanding the indifference of physicians to appetite in -itself, many therapeutic measures are based on the promotion of it. -And in this the truth of empiricism makes itself irresistibly felt. -When the patient is enjoined to eat sparingly, or when he is restrained -from eating at all till the physician expressly permits, or again, when -he is (for instance, during convalescence) removed from his ordinary -surroundings and sent to an establishment where the whole life, and -particularly the eating, is regulated according to physiological -needs--in all these cases the physician seeks to awaken appetite, and -relies upon it as a factor in the cure. In the first case, where the -food is prescribed in small portions, in addition to preventing the -overfilling of a weak stomach, the oft-recurrence of appetite juice, -which is so rich in quantity and so strong in digestive power, is of -great importance. I ask you here to call to mind one of our experiments -in which food was given in small portions to a dog, and thus led to -a secretion of much stronger juice than if the whole ration had been -eaten at once. This was an exact experimental reproduction of the -customary treatment of a weak stomach. And such a regulation of diet -is all the more necessary, since, in the commonest disorders of the -stomach, only the surface layers of the mucous membrane are affected. -It may, consequently, happen that the sensory surface of the stomach, -which should take up the stimulus of the chemical excitant, is not -able to fulfil its duty, and the period of chemical secretion, which -ordinarily lasts for a long time, is for the most part disturbed, or -even wholly absent. A strong psychic excitation, a keen feeling of -appetite, may evoke the secretory impulse in the central nervous system -and send it unhindered to the glands which lie in the deeper as yet -unaffected layers of the mucous membrane. - -An instance of this, taken from the pathological material of the -laboratory, I have already related at the beginning of this lecture. It -is obvious in these cases that the indication is to promote digestion -by exciting a flow of appetite juice, and not to rely upon that excited -by chemical stimuli. From this point of view the meaning of removing -a patient, the subject of chronic weakness of the stomach, from his -customary surroundings is also plain. Take, for instance, a mentally -overstrained individual, or a responsible official; how often does -it happen that he cannot for a moment distract his thoughts from his -daily work. He eats without noticing it, or eats and carries on his -work at the same time. This often happens, particularly in the case of -people who live in the midst of the incessant turmoil of great cities. -The systematic inattention to the act of eating prepares the way for -digestive disturbances in the near future, with all their consequences. -There is no appetite juice, no “igniting juice,” or, at most, very -little. The secretory activity comes slowly into play; the food remains -much longer in the digestive canal than is necessary, or passes, for -want of sufficient digestive juices, into a state of decomposition -which irritates the mucous membrane of the alimentary canal and brings -it into a condition of disease. No medicinal treatment can help -such a patient while he remains surrounded by his old conditions. -The fundamental cause of his illness still continues in progress. -There is only one course to pursue; namely, to take him completely -away, to free him from his occupation, to interrupt the interminable -train of thought, and to substitute for a time, as his only object -in life, the care of his health, and a regard for what he eats. This -is attained by sending the patient to travel, or by placing him in a -hydropathic establishment. It is the duty of the physician to regulate -not only the life of individual patients according to such rules, -but also to have a care that in wider circles of the community a due -conception of the importance of eating should be disseminated. This -is particularly so with the Russian physician. It is precisely in the -so-called intelligent classes of Russians that a proper conception -of life generally is often found wanting, and where an absolutely -unphysiological indifference towards eating often exists. More -methodical nations, like the English, have made a species of cult of -the art of eating. It is, of course, degrading to indulge excessively -and exclusively in culinary enjoyments, but, on the other hand, a lofty -contempt for eating is also reprehensible. As so often is the case, the -best course here also lies between the two extremes. - -With the establishment of mental effect upon the secretion of juice the -influence of condiments enters upon a new phase. The conclusion had -already been empirically arrived at that it was not alone sufficient -for the food to be composed exclusively of nutrient substances, but -that it should also be tasty. Now, however, we know why this is so. -For this reason the physician, who has often to express an opinion -upon the suitability of the dietaries of different persons, or even -of whole communities, should constantly bear in mind the question of -psychic secretion; that is to say, he should inquire after and learn -how the food has been eaten, whether with or without enjoyment. But how -often do the people who have charge of the commissariat pay attention -solely to the nutritive value of the food, or place a higher value on -everything else than taste? We must, further, in the interest of the -public weal, direct attention especially to the feeding of children. -If this or that inclination of the taste ultimately determines the -relation of grown-up individuals towards food, a matter with which -the commencing phase of digestion is closely linked, it would seem -undesirable to habituate children solely to a nicety and uniformity of -gustatory sensations. Such might effect their capabilities of adapting -themselves to other conditions in after life. - -The question of the therapeutic influence of the so-called bitters, -it appears to me, bears the closest connection with that of appetite. -After a long period of high repute these substances have been almost -expelled from the list of pharmaceutic remedies. When tested in -the laboratory, they were unable to justify their old and valued -reputation; when directly introduced into the stomach, many of them -were unable to produce a flow of gastric juice. Consequently, in the -eyes of the clinician, they became greatly discredited, so that many -were quite ready to discard their use altogether. Obviously, the simple -conclusion was drawn that a weak digestion could only be assisted by -a remedy which directly excites secretory activity. In this, however, -it was forgotten that the conditions of the experiment possibly had -not corresponded with the actual state of affairs. The whole question -of the therapeutic importance of the bitters, however, acquires a -different significance when we link it with another question, such, for -instance, as how do bitters affect the appetite? It is the universal -opinion of the earlier and later physicians that bitters increase -the appetite, and if this be so everything is said. They are, in -consequence, real secretory stimulants, since the appetite, as has many -times been repeated in these lectures, is the strongest of all stimuli -to the digestive glands. It is, however, not by any means strange -that this had not previously been observed in the laboratory. The -substances were either introduced directly into the stomachs of normal -dogs or else injected into the circulation. But their action is chiefly -bound up with their effect upon the gustatory nerves, and it was not, -therefore, without some reason that this large group of remedies, -consisting of substances of the most varied chemical composition, were -grouped together mainly on account of a certain bitter taste common -to them all. A person who suffers from digestive disturbance has, -moreover, a blunted taste, a certain degree of gustatory indifference. -The ordinary foods, which are agreeable to other people, and also to -himself when in health, now appear tasteless. They not only arouse no -desire for eating, but may even cause a feeling of dislike; there -is no sense of taste, or at best a perverse one. It is necessary, -therefore, that the gustatory apparatus should receive a strong -stimulus in order to restore a normal sensation. As experience teaches, -this object is most quickly attained by exciting sharp, unpleasant, -gustatory impressions, which by contrast awaken the idea of pleasant -ones. In either case there is no longer indifference, and this is the -foundation upon which an appetite for this or that kind of food may -be awakened, and here a general physiological law is illustrated. The -light appears brighter after darkness, a sound louder after silence, -the enjoyment of blithesome health more intense after illness, and so -on. This explanation of the appetising effects of bitters proceeding -from the mouth does not exclude the possibility of some such similar -influence coming also from the stomach. As has been already stated in -the fifth lecture, there is some reason for believing that certain -impulses from the cavity of the stomach are likewise necessary for -the excitation of appetite. It is possible that bitters not only act -directly on the gustatory nerves in the mouth, but that they also act -on the mucous membrane of the stomach in such a way that sensations -are generated which contribute to the passionate craving for food. As -a matter of fact, it has been confirmed by many clinicians that after -the administration of bitters some such special sensations do arise -in the stomach. The effect of these remedies consists, therefore, not -merely in the generation of a simple reflex, but in the production of -a certain psychic effect, which indirectly excites a physiological -secretory activity. The same probably applies to other substances, such -as condiments. In any case, whether our explanation corresponds to the -actuality or not, the question of the therapeutic effect of bitters -is settled in the affirmative the moment we acknowledge that these -substances awaken appetite. The problem, therefore, of an experimental -investigation of bitters consists in establishing the fact that they -have an effect upon the appetite. The question is a difficult one, -and has not hitherto been attempted in the laboratory. It is not -sufficient to hand over clinical observations to the laboratory as -experimental proofs. One must have, in addition, the assurance that the -investigation has been correctly carried out; that is to say, that it -dealt exactly with the point under consideration. It is interesting to -observe that the connection between appetite and gastric juice is by -many physicians, and in many text-books of medicine, exactly reversed. -Thus it is represented that some medicinal remedy calls forth a -secretion of gastric juice, and this, by its presence in the stomach, -awakens an appetite. Here we have to deal with a false explanation of -a true fact, and that because it was not recognised that a psychic -effect could by any possibility be a powerful excitant of secretory -nerves. The customs of the chief meal of the day also correspond with -our physiological results. After this or that _hors d’œuvre_, perhaps -also with a liqueur of brandy (especially customary in Russia), both of -which are designed to awaken the appetite, the repast proper begins, -and, in the majority of cases, with something hot, consisting mostly of -meat broth (_bouillon_, different soups, and so on). After this comes -the really nourishing food--meat of different kinds served in various -ways, or, in the case of poorer people, stews made with vegetables, -and therefore rich in carbohydrate material. This sequence of foods, -from the standpoint of physiology, is quite rational. Meat broth, as -we have already seen, is an important chemical excitant of gastric -secretion. An attempt is therefore made in two ways to secure a free -secretion of gastric juice to act on the chief food; first, in the -excitement of the appetite juice by the _hors d’œuvre_, and secondly, -in the promotion of the flow by the action of the meat broth. It is in -this way that human instinct has made provisions for the digestion of -the chief meal. A good meat broth can only be afforded by well-to-do -people, and consequently with the poorer classes a less expensive, -and, indeed, also a less effective, chemical excitant is used for -awakening the early secretion. For example, _kwas_[31] serves in this -way with the Russian population, while in Germany, where the price -of meat is high, different kinds of soups are used, consisting of -water mixed with flour, bread, etc. It is further to be borne in mind -that the quantity of the digestive juices in general stands in close -connection with the content of water in the organism. This has been -shown by the experiments of Dr. Walther for the pancreatic juice, and -by my own for the gastric juice. If this sequence of foods, therefore, -holds good for healthy people, it must be even more strictly adhered -to in pathological conditions. Thus, when a person has no appetite, -or only a weak one, he has no psychic juice or only very little; -consequently, the meal must in every case be begun with a strong -chemical excitant--for example, with a solution of the extractives of -flesh. Otherwise solid foods, particularly if they do not consist of -meat, would remain long in the stomach without any digestion whatever. -It is, therefore, in every way desirable to prescribe meat juice, -strong broth, or meat extract to people who have no appetite. The same -applies also to forced feeding, for instance, of the insane. It is true -that the method of introduction in this case necessarily secures the -presence of a chemical excitant, since the food can only be introduced -in a fluid form. In any case the addition of meat extract would be very -useful. If one arranged the ordinary fluid foods in descending order, -according to the influence of the chemical excitants, the following -would be the series: first, the preparations of the flesh, such as meat -juice and the like; secondly, milk; thirdly, water. - -The usual termination of the repast is also, from the physiological -standpoint, easy to be understood. The chief meal is generally ended -with something sweet, and everybody knows that sweets are pleasant. -The meaning of this is easy to guess. The repast, begun with pleasure, -consequent on the pressing need for food, must also, notwithstanding -the stilling of hunger, be terminated with an agreeable sensation. At -the same time the digestive canal must not be burdened with work at -this stage; it is only the gustatory nerves which should be agreeably -excited. After thus dealing in general with the usual arrangement of -our meals, we may now speak of some special points. - -Above all comes the acid reaction of the food. It is apparent that -acidity enjoys a special preference in the human taste. We use quite -a number of acid substances. Thus, for example, one of the commonest -seasoning substances is vinegar, which figures in a number of sauces -and such like. Further, many kinds of wine have a somewhat acid -taste. In Russia, _kwas_, especially in the acid form, is consumed in -great quantities. Moreover, acid fruits and green vegetables are used -as food, and they are either of themselves acid, or made so in the -preparation. In medicine this instinct is likewise often made use of, -and acid solutions, especially of hydrochloric and phosphoric acids, -are prescribed in digestive disturbances. Finally, Nature itself -constantly endeavours to prepare lactic acid in the stomach in addition -to the hydrochloric acid. The former arises from the food introduced, -and is consequently always present. These facts are all physiologically -comprehensible when we know that an acid reaction is not only necessary -for an efficient action of the peptic ferment, but is at the same time -the strongest excitant of the pancreatic gland. It is even conceivable -that in certain cases the whole digestion may depend upon the -stimulating properties of acids, since the pancreatic juice exerts a -ferment action upon all the constituents of the food. In this way acids -may either assist digestion in the stomach where too little gastric -juice is present, or bring about vicarious digestion by the pancreas -where it is wholly absent. It is easy, therefore, to understand why the -Russian peasant enjoys his _kwas_ with bread. The enormous quantity -of starch which he consumes, either as bread or porridge, demands a -greater activity upon the part of the pancreatic gland, and this is -directly brought about by the acid. Further, in certain affections of -the stomach, associated with loss of appetite, we make use of acids, -both from instinct as well as medical direction, the explanation being -that they excite an increased activity of the pancreatic gland, and -thus supplement the weak action of the stomach. It appears to me that a -knowledge of the special relations of acids to the pancreas ought to be -very useful in medicine, since it brings the gland--a digestive organ -at once so powerful and so difficult of access--under the control of -the physician. We could, for instance, intentionally discard digestion -in the stomach, and thus transfer it to the bowel, by prescribing -substances which do not excite the gastric glands. On the other hand, -by lessening the acidity of the gastric juice we could reduce the -activity of the pancreas, and these are matters which might be made use -of in various special diseases, or even in some general disturbances of -the digestive apparatus. - -No less instructive is a comparison of the results of our experiments -upon fat, with the demands of instinct and also with the precepts of -dietetics and therapeutics. Everybody knows that fatty foods are heavy, -that is, difficult of digestion, and in the case of weak stomachs -they are usually avoided. We are now in a position to understand this -physiologically. The existence of fat in large quantities in the chyme -restrains in its own interest the further secretion of gastric juice, -and thus impedes the digestion of proteid substances; consequently, a -combination of fat and proteid-holding foods is particularly difficult -to digest, and can only be borne by those who have good stomachs -and keen appetites. The combination of bread and butter is less -difficult, as might _a priori_ be inferred from its wide employment. -Bread requires for itself, especially when calculated per unit, but -little gastric juice and but little acid, while the fat which excites -the pancreatic gland insures a rich production of ferment both for -itself and also for the starch and proteid of bread. Fat alone does -not count by any means as a heavy food, as may be seen from the fact -that large quantities of lard are consumed in certain districts of -Russia with impunity. This also is comprehensible, since the inhibitory -influence of the fat in this case does not prevent the digestion of -any other food-stuff, and is conducive to the assimilation of the -fat itself. There is no struggle in this case between the several -food constituents, and therefore no one of them suffers. In harmony -also with daily experience the physician, in cases of weakness of the -stomach, totally excludes fatty food and recommends meat of a fat-free -kind; for example, game, etc. In pathological cases, however, where an -excessive activity of the gastric glands is manifested, fatty food, -or fat as emulsion, is prescribed. And here medicine has empirically -brought to its aid the restraining action of fat, which we have so -strikingly seen in our experiments. - -Amongst all the articles of human food, milk takes a special position, -and this is unanimously recognised, both in daily experience and in the -practice of medicine. By everybody milk is considered a light food, -and is given in cases of weak digestion as well as in a whole series -of severe illnesses; for example, in heart and kidney affections. The -extreme importance of this substance, a food prepared by Nature itself, -we can now well understand. There are three properties of milk which -secure it an exceptional position. As we already know, in comparison -with nitrogenous equivalents of other foods, the weakest gastric juice -and the smallest quantity of pancreatic fluid are poured out on milk; -consequently, the secretory activity requisite for its assimilation is -much less than with any other food-stuff. In addition, milk possesses -a further important property. Thus, when it is introduced unobserved -into the stomach of an animal it causes a secretion both in the stomach -and also one from the pancreas; consequently, it appears to be an -independent chemical excitant of the digestive canal; and in this -action it is remarkable that we perceive no essential difference in -the effect when the milk is brought unnoticed into the stomach from -that which occurs when it is given to the animal to lap. Although -flesh is a better chemical excitant, it is by no means a matter of -indifference how it gets into the stomach. It must, therefore, be -accepted that milk excites not only a really effective, but at the same -time a very economic, secretion, and also that the appetite is unable -to stimulate this secretion into a more active or abundant flow. The -secret of the relation of milk to the secretion of the digestive juices -can, unfortunately, at present be submitted to no further analysis or -investigation. We are at liberty, however, to suppose that the fat on -the one hand is of importance for the inhibition of the gastric glands, -and the alkalinity on the other for the restraint of the pancreas. Thus -the gastric glands and the pancreas, notwithstanding the presence of -excitants, are maintained by milk at a certain but not too high degree -of activity, a matter which is in every way desirable in consideration -of the easy digestibility of its constituents. Finally, the third -characteristic which is observed to belong to milk, and which is -probably only an expression of the first, consists in the following. -When one administers to an animal equivalent quantities of nitrogen, in -the one case as milk, in the other as bread, and afterwards estimates -the hourly output of nitrogen in the urine, it results that the -increase during the first seven to ten hours after the milk (compared -with the excretion beforehand) amounts only to from 12 per cent to 15 -per cent of the nitrogen taken in, while after bread it amounts to 50 -per cent. If the hourly rate of absorption and the extent to which -milk and bread are respectively used up be taken into consideration, -it has to be admitted that these augmentations of urinary nitrogen -which appear soon after feeding must be expressions of the functional -activity of the digestive canal itself, and that this activity in the -case of bread is three or four times greater than in the case of milk -(_Experiments of Prof. Rjasanzew_); consequently, in the case of milk -a much larger fraction of its nitrogen is free to be used up by the -organism at large (irrespective of the organs of digestion) than in -that of any other kind of food. In other words, the price which the -organism pays for the nitrogen of milk, in the form of work on the part -of its digestive apparatus, is much less than that for other foods. How -admirably, therefore, the food prepared by Nature distinguishes itself -when compared with all others! - -The facts just related bring forward a new aspect from which the -relative nutritive values of different foods may be judged. The older -criteria must frankly make room for the new or else be displaced by -them. Experiments upon the utilisation of food-stuffs, in which what -remains undigested is determined as well as what is absorbed into -the body fluids, cannot alone be trusted to solve the question in a -satisfactory manner. Suppose, for instance, that in the digestion of -a given food the alimentary canal has been given a certain work to -perform; if it be in health the work will be accomplished in the -best possible manner--that is to say, with complete abstraction of -everything nutrient. You will thus learn how much nutrient material was -contained in the food, but the question of its digestibility remains -as obscure as before. In your experiment you do not know how great an -effort it has cost the alimentary canal to extract all the nourishment -from the food. Nor can artificial digestion experiments settle the -question of digestibility, for experiments in which food is normally -partaken of are quite different from those in the test-tube, where -we have to deal with only one juice, and not with the interaction of -different juices and different food constituents. That one must here, -as a matter of fact, make a distinction is clear from the observation -of Dr. Walther in our laboratory. Fibrin, which is regarded by all as -the most easily digested proteid, proved, when compared with a nitrogen -equivalent of milk, to be a much stronger excitant of the pancreas, -although milk contains, in addition to nitrogenous substances, a good -deal of other non-nitrogenous material. The digestibility and nutritive -value of foods must obviously be decided by an estimation of the real -work which they entail upon the digestive apparatus, both in regard to -the quantity and quality of the juices poured out on a given amount -of nutrient material. The energy used up in gland metabolism must be -deducted from that of food taken in. The remainder will then indicate -the value of the food to the organism; that is to say, will give the -amount available for use by all the other organs exclusive of the -digestive apparatus. From this point of view those materials must be -taken as less nourishing and less digestible which are in large part -used up to make good the expenditure entailed by their digestion on -the part of the alimentary canal; that is to say, those food-stuffs -are less useful whose nutritive value little more than covers the cost -of their digestion; consequently, it is of great practical importance -to compare from this aspect the same foods differently prepared--for -example, boiled and roast meat, hard and soft boiled eggs, boiled and -unboiled milk, etc. - -A discussion of some further medical questions may here be taken up. -The first concerns the therapeutic use of the neutral and alkaline -salts of sodium. In clinical, pharmacological, and physiological -text-books it is stated now, as ever, that these salts promote a flow -of gastric juice. We may look in vain, however, for any experimental -foundation to support this doctrine. The experiments brought forward -cannot be regarded as conclusive. When Blondlot sprinkled sodium -bicarbonate upon flesh, or Braun and Grützner introduced sodium -chloride solutions directly into the blood, they began with methods -either false in themselves or far removed from normal conditions. In -this case, however, the gaps in the experiment were happily made good -by the clinician, for the experiment appeared to be confirmatory of -clinical experience. That sodium salts (the chloride and bicarbonate) -are useful in disorders of the digestive apparatus there can be no -doubt. How do they act, however? It appears to me that here, as in -some other cases, medical science has fallen into error. When we -know that an effect takes place it does not by any means imply that -we know the mechanism by which it occurs; and although medicine is -broad enough and comprehensive enough to make free use of empiricism -in practice, yet it often thinks in narrow grooves when it turns to -the explanation of facts. It frequently tries to explain complicated -healing processes in the simplest way, on supposed physiological -data. And this is true in the present case, which affords an example -of prevalent medical reasoning; the alkalies work favourably in -digestive disturbances--therefore they are succagogues. Naturally -the stomach, under the influence of alkalies, sometimes begins to -secrete a greater quantity of juice. This means, however, that it -has recovered from a disordered state and has returned to normal -conditions. Consequently, the effect is due to the fact of recovery, -and not to a direct influence of the alkalies. This latter, however, -must be specially proved. The assistance afforded by the alkalies to -the organism might be capable of another explanation; for example, -that which is ordinarily given. In this case, however, I venture to -offer a reason for the effects of sodium chloride, and of the alkaline -salts of sodium, which is exactly the opposite of that generally -accepted. We were unable to convince ourselves of any succagogue -influence on the part of these salts. Indeed, both on the stomach -and pancreas they proved in our hands to have an inhibitory effect. -In addition to the experiments which I previously brought forward -concerning the relation of alkalies to gastric and pancreatic juice, -I may relate the following observation. A dog which fortunately had -survived the performance, one after the other, of a gastric fistula, -a pancreatic fistula, and an œsophagotomy, received daily during the -course of several weeks an addition of soda to its food. The animal -enjoyed good health and had an excellent appetite. When the first sham -feeding experiment was carried out, the relatively small effect of -this otherwise very active juice-exciting procedure at once struck -us. At the same time we observed that the pieces of flesh which fell -from the upper end of the œsophagus, contrary to the ordinary rule, -were hardly at all insalivated. In this dog, therefore, a greatly -lowered activity of several digestive glands--viz., of the gastric, -pancreatic, and salivary glands--simultaneously existed. With regard -to the salivary glands the circumstance was naturally submitted to -closer investigation. I believe that the inhibitory influence of the -alkalies on the digestive glands, which was here proved experimentally, -may furnish a basis for the following representation of their mode -of action in producing healing effects. Catarrhal affections of -the stomach are characterised by an incessant or very protracted -secretion of slimy, weakly acid gastric juice. Further, in many cases -the affection begins with a hypersecretion, that is an abnormal -excitability, of the secretory apparatus which makes itself evident in -a superfluous and useless flow. The same must be conceived to happen -in disorders of the pancreatic gland; at least such a condition sets -in after operations performed for physiological purposes. It is, -further, justifiable to suppose that, when an affection is once set -up by this or that cause, it may later maintain itself independently; -for continuous activity has undoubtedly a harmful influence on the -glands. The due nourishment, and the restoration of organs after -activity, proceeds best during rest. In the normal course of events, -after a period of active work follows a pause, during which the -latent work of restoration is accomplished. When, therefore, a remedy -effectively restrains the excessive work of a diseased organ, it may -in this way contribute to the removal of the pathological condition, -and thus to a restoration of the normal state. In this consists, in my -opinion, the healing effects of the alkalies. One might draw a parallel -between the action of these substances in digestive disturbances -and that of digitalis in compensatory disturbances of the heart. An -uncompensated heart beats rapidly, and thereby only aggravates its -condition. Its time of rest, that is of recovery, of restitution of -the organ, is shortened. A vicious cycle is set up. The weak action -of the heart lowers blood pressure; the lowering of this leads (from -known physiological causes) to an increase in the number of beats; -the quickening leads to weakening of the organ. Without doubt the -digitalis aids by breaking through this vicious cycle, in that it -greatly slows the pulse, and thereby gives new power to the heart. With -our explanation of the action of the alkalies harmonises the further -circumstance that, with the use of the salts in question, a strict diet -is generally prescribed, which means that a certain amount of rest is -secured for the digestive glands. It is interesting that in clinical -investigations with the stomach-tube, after a period when the alkalies -were looked upon as succagogues, a new phase has also set in, mention -being now more frequently made of a restraining effect. - -The cause of the erroneous belief that alkalies promote a flow of juice -obviously lies in this, that people omitted to compare the effects -of the saline solutions with those of like quantities of water (_Dr. -Chigin_). - -The second point which we may consider is the following. The chief -difficulty of the physician who wishes to regulate the diet of patients -when they suffer from digestive disturbances consists in the fact -that idiosyncrasy plays a very important _rôle_. In one and the same -illness, different patients react to the same diet in wholly different -ways. That which is agreeable to one, and is well borne and useful, -may be rank poison to another. Consequently, the golden rule in -dietetics is to give no directions with regard to food till one has -made inquiries concerning the inclinations and habits of the patient. -What does all this indicate? Till now physiology had no experimental -answer to the question. But our facts, it appears to me, contribute -to a clearing up of the situation. Every food determines a certain -amount of digestive work, and when a given dietary is long continued, -definite and fixed types of glands are set up which can only slowly -and with difficulty be altered. In consequence, digestive disturbances -are often instituted if a change be suddenly made from one dietetic -_régime_ to another, especially from a sparse to a rich diet; such, for -instance, as happens after the long Russian fasts. These disturbances -are expressions of the temporary insufficiency of the digestive glands -to meet the new demands made upon them. - -Finally, it may be of some use to relate the following here. There -are often cases of sudden and unaccountable digestive disturbances. -From the standpoint of modern physiology they might be explained by -an activity of the secreto-inhibitory nervous system, which from some -cause or other has been excessively and abnormally stimulated. In any -case this system is now a factor of which the physician has to take due -account. - - - - - SWALLOWING AND MOVEMENTS OF THE STOMACH AND INTESTINES - - BY W. B. CANNON, M.D. - -_Of the Physiological Laboratory of the Harvard Medical School Boston, - Mass., U. S. A._ - - - [NOTE.--In the beginning of 1896 Dr. Professor Henry Pickering - Bowditch, one of our Board of Scientific Assessors in the Nutrition - Case suggested the use of the Röntgen ray as a means of learning more - than was then known about the mechanism of swallowing. There was - much difference of opinion among research physiologists about this - important function, and the question was far from settled. Magendie - published a theory of deglutition, in Paris, in 1836, which was - practically accepted until 1876, when Dr. Professor Angelo Mosso, of - the University of Turin, Turin, Italy, established the theory of sole - peristaltic assistance in swallowing. Again in 1880 Dr. Professor - Kronecker, of Berne, Switzerland, in connection with Dr. Falk, and - later in connection with Dr. Meltzer, of New York, produced evidence - to prove a more complicated process in deglutition than that of - peristalsis alone. But even Kronecker and Meltzer found, as they went - on, evidence to modify their earlier beliefs, and hence the subject - was not cleared up to a point of general agreement. - - The suggestion made by Dr. Bowditch was taken up in the Harvard - Physiological Laboratory and formed the beginning of a series of - studies of the mechanical factors in digestion. The reports of these - studies, presented by Dr. W. B. Cannon and collaborators, in the - _American Journal of Physiology_, in the volumes of 1898 and 1903, - are so understandable, even to the layman ignorant of physiological - nomenclature, that we are prompted to give them, almost entire, - leaving out only the technical description of the methods employed, - which are only interesting to research students who have access to the - _Journal_. - - - It will be noted that three of the professors of physiology - mentioned in connection with this preliminary study of the nutrition - problem--Bowditch, Mosso, and Kronecker--are members of our presently - organised Board.—HORACE FLETCHER.] - - - - - THE MOVEMENTS OF THE FOOD IN THE ŒSOPHAGUS - - BY W. B. CANNON AND A. MOSER - - _From the Laboratory of Physiology in the Harvard Medical School_ - - Extracts from _American Journal of Physiology_, 1898 - - -The movements of deglutition, in common with many other physiological -processes, were explained by the older physiologists on anatomical -grounds. Thus, Magendie divided the act into three parts, corresponding -to the anatomical regions of the mouth, pharynx, and œsophagus. The -muscles of each of these divisions were considered the active agents -in propelling the food onward. The function of moving the mass to the -pharynx was variously ascribed to the tongue itself, to the mylohyoid -muscles, and to gravity. For the second part, the movement through the -pharynx, there was more unanimity of opinion, since the constrictors, -especially the middle and lower, were evidently concerned. - -Direct observations on the movement of swallowed masses in the -œsophagus were first made by Mosso. The œsophagus of a dog was laid -bare, and a transverse incision made through it, or a piece of it -excised. A small wooden ball was placed in the canal below the excised -part, and the animal was then stimulated to swallow. One or two seconds -after the contraction of the pharyngeal muscles a peristaltic wave -began to traverse the œsophagus. This wave did not stop at the point of -excision, but in due time reappeared below, and carried the ball to the -stomach. Thus the act was shown to be controlled by the central nervous -system. Peristalsis was so plainly the motive power that the action was -never doubted. Yet this belief was soon to be questioned. - -In 1880 Falk and Kronecker studied the movements in the mouth and -pharynx, and advanced the theory that deglutition was accomplished by -the rapid contraction of the muscles of the mouth. During the act of -swallowing the air-tight buccal cavity shows a manometric pressure of -twenty centimetres of water. The same pressure was demonstrated to be -present also in the œsophagus, but not in the stomach. This pressure -was considered sufficient to force food through the œsophagus before -the peristaltic wave traversed it. Another argument for rapid descent -was found in the fact that cold water can be felt in the epigastric -region almost immediately after being swallowed. Further, when strong -acids pass through the gullet, they corrode but small parts of it, and -not the entire mucous membrane, as would be the case were the acid -carried to the stomach by peristalsis. - -Over a year and a half ago it was suggested by Prof. H. P. Bowditch -that if some substance opaque to the Röntgen rays were swallowed, -it could be seen in its passage to the stomach, and the nature of -its movement thus determined. Anæsthesia could be dispensed with,--a -desirable condition, since observers had found that it interfered -greatly with the deglutition reflex. It would be unnecessary to open -either the abdominal or the pleural cavity. The reflex stimulus of -food, moreover, would be better than electrical stimulation of the -superior laryngeal nerve. In short, the animal would swallow normal -food under practically normal conditions. At Dr. Bowditch’s suggestion -and with his valuable assistance--which we gratefully acknowledge--we -made the following series of experiments. - -To render the swallowed mass opaque, subnitrate of bismuth was used. -The salt is tasteless, practically inert, and can be fed in large -quantities without harm. In order that observations could be made by -more than one person, all experiments were conducted in a dark room. On -the side of the animal opposite the Crookes tube was placed an open -fluorescent screen, on which the different tissues of the animal were -outlined with varying degrees of light and shade. Among these shadows -the swallowed mass appeared as a darker object, and thus its motion -could be studied. - -For the first experiments the goose was selected. The head and neck -were held stationary by a tall pasteboard collar, which allowed free -movement of the head without constriction of the neck. The fluorescent -screen was placed against this collar at a uniform distance of thirty -centimetres from the tube. When a bolus of corn-meal mush mixed with -bismuth was placed in the pharynx, it descended slowly and regularly, -and occupied about twelve seconds in passing over a distance of fifteen -centimetres. The screen was marked at intervals of two centimetres with -cross lines, by means of which the relative rate in different parts of -the œsophagus could be studied. A vibrator marking tenths of a second -was interrupted whenever the bolus crossed a line. An average of over -one hundred such observations showed that the rate became slightly -slower as the bolus proceeded. - -In order to test liquids, molasses was mixed with bismuth to such a -consistency as to drop easily from a glass rod. When this was fed -with a pipette, it passed slowly and regularly down the œsophagus, -clearly by peristalsis. The rate was about the same as for solid food. -In both these experiments the addition of water would sometimes cause -irregularities in the descent. Microscopic sections from four different -parts of the œsophagus of the goose showed no histological difference. - -In the experiments on the cat, the animal was placed on its back and -left side on a holder. The extremities were secured by straps. The -head was held between two upright rods, connected above by a thong; -this allowed free movement of the head, without resistance to the -passage of food. Shreds of meat dipped in bismuth were ordinarily -masticated and swallowed without difficulty. For soft solids, bread and -milk were used, so fluid as to be easily drawn up into a pipette. The -insolubility of the bismuth salt rendered the study of liquids more -difficult. Strong solutions of potassic iodide and other salts, and -suspension of bismuth, in acacia and molasses were tried; but a simple -mixture of milk and bismuth, shaken in a test tube and immediately -drawn up into a pipette, was found most practicable. - -Inasmuch as the movement of these different foods varied in different -parts of the œsophagus, it will be convenient to divide the latter into -three sections. The first or cervical portion extends from the pharynx -to the thorax; the second or thoracic, from here to the lower half of -the heart; and the third comprises the rest of the canal. The relative -length of these three parts is about in the ratio of 9:8:6. - -The beginning of deglutition was noted by one observer by a finger on -the larynx; the same observer called out when the bolus arrived at -the thorax, heart, and stomach respectively, while the other observer -noted the time. The movement of solids will first be considered. The -descent the entire way was by peristalsis, but the rapidity varied. The -duration of the movement in the cervical portion was two and a half -seconds, and in the thoracic region a little less than two seconds. -At the lower end of the heart there was sometimes a slight pause. In -the lower section, from the heart to the stomach, the movement was -decidedly different; the rate was always very slow. The distance was -less than one-third of the entire canal, yet the time consumed in this -part ranged from six to seven seconds, or three-fifths of the entire -time of descent. The character of the movement here was also peculiar. -Whereas in the upper sections the passage was uniform and regular, with -a slight acceleration in the thoracic region, here it was apparently -irregular, for the bolus descended about one centimetre with each -inspiratory movement of the diaphragm, and remained stationary or -descended very slightly during expiration. Thus a series of hitches -seemed to carry the bolus to the cardia. A probable explanation of this -peculiar movement is that the stomach and lower œsophagus were pulled -down with each descent of the diaphragm. This would make the movement -appear irregular, although it was really a slow peristalsis. It may be -well to remark here that this movement was invariably observed in the -cat with every kind of food. - -Semi-solids, namely, a mush of bread and milk, descended in the same -way as solids; but the rate was slightly faster in the upper œsophagus, -for the bolus took about a second less to reach the cardiac level. From -here the rate was the same as with solids. - -For liquids, one and a half to two seconds sufficed for the descent to -the midheart region. Here there often occurred a long pause, from a few -seconds to a minute or more. Then the œsophagus apparently contracted -above the liquid, which slowly passed on to the stomach, as already -described. Sometimes it seemed as if a swallowing movement, evidenced -by a rise of the larynx, started the peristaltic wave. Again, several -swallows would succeed one another before the liquid passed on. A few -times the bismuth and milk seemed strung out along the œsophagus; -some more liquid descending would gather this up, and the whole mass, -assuming an ovoid form, would move into the stomach. - -Thus in the cat the total time for deglutition varies from nine to -twelve seconds. The lowest section presents no change ascribable to a -difference in consistency, while in the upper sections the rate does -slightly increase with the more liquid character of the food. - -In experiments on the dog, bismuth enclosed in capsules or wrapped in -shreds of meat was fed as the solid. The general phenomena were as -follows: With the rise of the larynx there was a quick, propulsive -movement of the bolus, which descended rapidly for a few centimetres, -sometimes as far as the clavicle. From this point the rapidity -was diminished, yet no pause was observed; the bolus simply moved -more slowly. This rate was then continued to the stomach without a -slackening of speed in the diaphragmatic region, as was observed in the -cat. Semi-solids moved in the same way as solids. The total time of -descent from larynx to stomach was from four to five seconds. - -Liquids gave even a more decided squirt in the beginning of the -movement. To render the œsophagus as lax and free as possible, the -head of the dog was released from the upright rods and held by the -hands after the food was placed in the mouth. Sometimes the liquid -descended rather rapidly as far as the heart, at other times no further -than the clavicle; then without a pause it passed on slowly and -regularly, reaching the stomach in about the same time as solids and -semi-solids. - -Thus in the dog and cat but little variation was seen in the swallowing -of liquids and solids. The liquids pass somewhat faster in the upper -œsophagus. But in some animals the difference of rate with foods of -varying consistency is much more marked. In the horse, for instance, -mere observation shows a decided variation in the rate of movement -in the œsophagus. Liquids shoot along the gullet, while solids move -clearly by peristalsis. To determine the rate of solids, one hand was -placed on the larynx of a horse to note the beginning of swallowing, -and the other hand near the shoulders, where the bolus could be easily -felt in its passage. The time consumed by the bolus in passing over a -certain distance was measured by a stop watch. The rate obtained for -solids, such as hay or grain, was from thirty-five to forty centimetres -a second. - -For semi-solids, a mixture of bran and water was made, thin enough to -run easily between the fingers. Each bolus was watched by a separate -observer with a separate watch. The average rate obtained was the same -as for solids. - -Liquids in the horse pass with a rapidity too great to be affected -by peristalsis. Another force must be sought. Among the various -muscles supposed to be effectual in moving food into the pharynx, the -mylohyoids were shown by Meltzer to be essential. The styloglossi were -cut by him without much interference with deglutition, but section of -the mylohyoid nerves rendered the act impossible. The activity of these -muscles in the horse during swallowing is easily perceived by the hand. -Their energetic contraction is a sufficient explanation of the rapid -passage of water through the œsophagus. The motion here is more than -five times as rapid as that of solids and semi-solids. - -Meltzer’s experiment to measure the rate of liquids in man by -passing a stomach tube containing litmus paper was repeated by us -with some modifications. Congo red paper was used, since it is more -sensitive than litmus; it also furnishes a means of differentiating -between mineral and organic acids, as the discolouration produced -on Congo red by mineral acids is removed by ether. It was thus -possible to distinguish between the discolouration produced by -gastric regurgitation and that produced by the swallowed liquid. For -the swallowed liquid, one-half per cent lactic acid was found most -satisfactory, as the colour produced by it on Congo red test paper is -almost instantly discharged in ether. By this method the paper was -found discoloured within half a second after the rise of the larynx, -certainly too short a period for a peristaltic wave to carry the liquid -to the neighbourhood of the cardia. - -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. - -In the cat the movement is always peristaltic, and slightly faster than -in fowls. A bolus takes from nine to twelve seconds in reaching the -stomach. Liquids move somewhat more rapidly than semi-solids in the -upper œsophagus. In the lower or diaphragmatic part the rate is very -much slower than above, and is the same for liquids as for solids. - -In the dog the total time for the descent of a bolus is from four -to five seconds. The food is always propelled rapidly in the upper -œsophagus, and moves more slowly below. This rapid movement is -frequently continued further with liquid food. No distinct pause was -observed when the movement of the bolus changed from the rapid to the -slower rate. - -In man and the horse liquids are propelled deep into the œsophagus at a -rate of several feet a second by the rapid contraction of the mylohyoid -muscles. Solids and semi-solids are slowly carried through the entire -œsophagus by peristalsis alone. - - - - - THE MOVEMENTS OF THE STOMACH STUDIED BY MEANS OF THE RÖNTGEN RAYS - - BY W. B. CANNON, M.D. - - _From the Laboratory of Physiology in the Harvard Medical School_ - - Extracts from _American Journal of Physiology_, 1898 - - -Since the stomach gives no obvious external sign of its workings, -investigators of gastric movements have hitherto been obliged to -confine their studies to pathological subjects or to animals subjected -to serious operative interference. Observations made under these -necessarily abnormal conditions have yielded a literature which is -full of conflicting statements and uncertain results. The only sure -conclusion to be drawn from this material is that when the stomach -receives food obscure peristaltic contractions are set going, which -in some way churn the food to a liquid chyme and force it into the -intestines. How imperfectly this describes the real workings of the -stomach will appear from the following account of the actions of the -organ studied by a new method. The mixing of a small quantity of -subnitrate of bismuth with the food allows not only the contractions -of the gastric wall, but also the movements of the gastric contents -to be seen with the Röntgen rays in the uninjured animal during normal -digestion. An unsuspected nicety of mechanical action and a surprising -sensitiveness to nervous conditions have thereby been disclosed. - - - INTRODUCTORY LITERATURE - -The early writings on the subject of gastric movements are -characterised by general inferences from physical laws and from the -anatomical structure of the stomach. According to Galen the stomach -had four functions: to draw the food from the mouth (_facultas -attractrix_), to retain the food (_facultas retentrix_) during the -process of chemical digestion (_facultas alteratrix_), and, finally, -to pass the changed material onward (_facultas expultrix_). In later -writings the _facultas attractrix_ failed to appear as one of the -functions of the stomach. Fallopius, in the sixteenth century, changed -the notion of the _facultas retentrix_ by suggesting that the pylorus -alone performed this office, and that the muscles of the gastric wall -could help only by remaining quiet. Thus the _facultas alteratrix_ and -the _facultas expultrix_ are left as true gastric functions. It is with -the latter activity and its effects that this paper is concerned. - -The ideas of the early writers concerning the pylorus and cardia are -of interest. The cardia, they were agreed, is closed during normal -digestion in order to keep the food from re-entering the œsophagus. The -pylorus they looked upon as the ruler of the actions of the stomach. -Such names as pylorus (keeper of the gate), janitor justus, and rector, -which the first investigators gave to the sphincter, indicate their -theories of its functions. The passage of chyme into the duodenum, the -keeping of undigested food in the stomach, the act of vomiting, were -all dependent, they believed, on the “will” of the pylorus. - -No substantial advance was made beyond these hypotheses until the -beginning of the eighteenth century, when Wepfer and Schwartz applied -the experimental method to the study of the gastric movements and laid -the foundation of a more accurate knowledge. Wepfer vivisected wolves, -dogs, and cats, and observed constrictions following stimulation of -the stomach. He remarked a general contraction of the pyloric part in -vomiting and noted peristaltic and antiperistaltic movements passing -over the organ. About the middle of the stomach he frequently saw a -deep constriction. The investigations of Schwartz are more valuable in -that his search was for the normal action of the muscular coats. The -movements, as he observed them, were generally only slight. They began -either at the pylorus and passed to the left, half-way to the cardia, -or started at the fundus and went to the pylorus. The contractions -and relaxations, following one another, formed larger or smaller -depressions and elevations, _i. e._, more or less definite waves. - -Near the middle of the last century Haller, after confirming the -results obtained by Schwartz and Wepfer, summarised his knowledge of -the motor functions of the stomach as follows. In general, contraction -alternates with relaxation, so that the stomach is, now here, now -there, made narrower by longitudinal or transverse depressions; then -in these same places relaxation and bulging occur. So long as both -apertures are closed the food is driven hither and thither by the -shifting movements. It first takes a definite direction when the cardia -or the pylorus opens. If the cardia opens, there is an antiperistalsis -followed by regurgitation and vomiting. If, on the contrary, the -pylorus relaxes, a contraction, starting at the œsophagus, pushes the -contents of the stomach into the duodenum. The pylorus allows the -passage of fluids, but if it be stimulated by over distention or by -hard pieces of food, it closes tightly. - -Such was the knowledge of gastric movements in Haller’s time. A -comparison of his descriptions with those in any standard work on -physiology published ten or fifteen years ago will show that, despite -very many researches, little advance had been made. Examinations -of animals and men with gastric fistulas, studies of the stomach -through the atrophied abdominal wall, and vivisection have yielded -numerous results; but these have not been harmonious, and have led to -much controversy. Prominent in this mass of material as a valuable -contribution are Beaumont’s careful observations through the gastric -fistula of Alexis St. Martin. Beaumont’s work has recently been -confirmed by Hofmeister and Schütz, who, with Rossbach, Hirsch, -Openchowski, and others, have presented during the last twelve years -much new and interesting information. Since, however, it will conduce -to clearness to set forth the results of these investigations in -connection with my own work, their consideration will be deferred until -later. - -It will then appear that these later investigations, like the earlier -researches, disagree as to the details of the stomach movements. -Such differences in results are the proper outcome of the abnormal -conditions under which the studies have been conducted. Obviously, in -order to see the natural movements of the stomach, the organ should be -observed in its natural state, and not after it has been disturbed by -removal from the abdomen, or by the adhesions and losses of substance -incident to gastric fistulas. - -As a means of watching the gastric motor activities under normal -circumstances, Dr. H. P. Bowditch, in the autumn of 1896, suggested the -use of the Röntgen rays. The present paper is the result of the work -thus far completed. The kind assistance and stimulating counsel of Dr. -Bowditch throughout the investigation are gratefully acknowledged. - - - THE ANATOMY OF THE STOMACH AND ITS RELATIONS TO THE SHADOW - -It must be constantly borne in mind that the shadows described in this -research are cast by the gastric contents, not by the stomach itself. -Therefore the movements of the organ are not seen directly, but are -indicated by their effect on the contained food. Variations in the -length and breadth of the stomach can be inferred from changes in the -outline of the shadow, but variations in the front-to-back diameter of -the organ must be judged from changes in the intensity of the shadow. - -The form of the active stomach soon after food has been taken is shown -in outline in Figure 1. Since the several parts of the stomach are -to be mentioned frequently, it will be well to recall them here in -their relations to the outline. The larger, cardiac part of the organ -lies to the left of a line through _w x_. Into it the œsophagus opens -through the cardiac sphincter, or cardia, at _c_. The pyloric part, -which includes all of the stomach situated at the right of a line _w -x_, is closed by the pylorus at _p_. This part has two divisions: the -antrum at the right of the line _y z_, and the preantral part of the -pyloric portion, or middle region of the stomach, between the lines _w -x_ and _y z_. The lesser curvature corresponds approximately to the -anterior border of the shadow _c w p_; the greater curvature to the -more extensive sweep, _c p_, along the posterior border. - -[Illustration: FIGURE 1.] - -The wall of the cat’s stomach consists of three coats, but as this -paper deals only with the functions of the muscular coat, that alone -will be described. The gastric muscular fibres are disposed in three -sets: an outer longitudinal layer, a middle circular layer, and a set -of inner oblique fibres. The longitudinal fibres continue those of the -œsophagus, and, radiating over the cardiac end, become more marked -along the curvatures than on the front and back surfaces. Over the -antrum they lie in a thick, uniform layer. The circular fibres form a -complete investment, and are arranged in rings at right angles to the -curved axis of the stomach. Towards the pyloric end they become denser -and stronger, and at the pylorus form a thick bundle, the pyloric -sphincter. Separating the antrum from the rest of the stomach, at _y -z_, is a special thickening of the circular fibres, called by the -early writers the “transverse band,” and described by Hofmeister and -Schütz as the “sphincter antri pylorici.” The oblique fibres start -from the left of the cardiac orifice and pass as two strong bands -along the anterior part of the dorsal and ventral surfaces, giving off -fine fasciculi to the circular musculature; towards the antrum they -gradually disappear. - -The musculature of the stomach consists of smooth muscle fibres, -the chief physiological characteristics of which are slowness of -contraction, rhythmic alternation of contraction and relaxation, and -a very great tonicity, or power of prolonged contraction. The action -of these muscles in the process of gastric digestion is now to be -considered. - - - THE NORMAL MOVEMENTS OF THE STOMACH - -Since the time of Haller the chief contributors to the knowledge of the -mechanics of the stomach have been Beaumont, Hofmeister and Schütz, and -Rossbach. - -Beaumont’s famous investigations on Alexis St. Martin are recorded in -almost all general works on physiology. Through a gastric fistula he -introduced a thermometer-tube and observed how it was affected by the -motions of the stomach. His conclusions are as follows: “The circular -or transverse muscles contract progressively from left to right. When -the impulse arrives at the _transverse band_, this is excited to a more -forcible contraction, and closing upon the alimentary matter and fluids -contained in the pyloric end, prevents their regurgitation. The muscles -of the pyloric end, now contracting upon the contents detained there, -separate and expel some portion of the chyme.... After the contractile -impulse is carried to the pyloric extremity, the circular band and all -the transverse muscles become relaxed, and a contraction commences in a -reversed direction, from right to left, and carries the contents again -to the splenic extremity to undergo similar revolutions.” - -In close accord with Beaumont’s description of the activities of the -human stomach are the records of the investigations on the stomach -of dogs by Hofmeister and Schütz. They removed the stomach from the -body and placed it in a moist chamber, kept at body-heat and covered -with glass. Under such conditions the organ remained active for from -sixty to ninety minutes. A typical movement is described by these -observers as composed of two phases. In the first phase a constriction -of the circular fibres, deeper on the greater curvature, starts a -few centimetres from the cardia and passes towards the pylorus. As -the constriction proceeds it increases in strength until a maximum -is reached about two centimetres in front of the antrum. This -annular contraction, called by Hofmeister and Schütz the “preantral -constriction,” closes the first phase. Immediately thereafter the -strong sphincter antri pylorici, or transverse band, contracts. Now, -while the preantral constriction is relaxing, the sphincter antri -pylorici tightens still more, and the antrum is shut off from the rest -of the stomach. As soon as this has occurred a general contraction of -the muscles of the antrum follows. Relaxation begins at the sphincter -antri pylorici and progresses slowly towards the pylorus; it is -sometimes accompanied by an antiperistaltic movement. - -Although Rossbach also used dogs, his results vary considerably from -those of Hofmeister and Schütz. This discrepancy is possibly accounted -for by a difference in method, for Rossbach left the stomach in the -body. The dogs were treated with morphia and curare, and the abdomen -was then widely opened, so that the movements could be clearly seen. -When the stomach was full Rossbach saw deep constrictions begin near -the middle and pass in waves to the pylorus. At first these movements -were weak; later, however, they became more vigorous. The fundus -remained in tonic contraction about its contents and took no part in -the peristalsis. - -Before attempting to explain the difference in the records of these -observers I shall give an account of what may be seen in a cat by use -of bismuth subnitrate and the Röntgen rays. - -1. _Movements of the pyloric part._--Within five minutes after a cat -has finished a meal of bread, there is visible near the duodenal end -of the antrum a slight annular contraction which moves peristaltically -to the pylorus; this is followed by several waves recurring at regular -intervals. Two or three minutes after the first movement is seen very -slight constrictions appear near the middle of the stomach, and -pressing deeper into the greater curvature, course slowly towards the -pyloric end. As new regions enter into constriction, the fibres just -previously contracted become relaxed, so that there is a true moving -wave, with a trough between two crests. When a wave swings round the -bend in the pyloric part the indentation made by it deepens; and as -digestion goes on the antrum elongates and the constrictions running -over it grow stronger, but until the stomach is nearly empty they do -not entirely divide the cavity. After the antrum has lengthened, a -wave takes about thirty-six seconds to move from the middle of the -stomach to the pylorus. At all periods of digestion the waves recur at -intervals of almost exactly ten seconds. So regular is this rhythm that -many times I have been able to determine within two or three seconds -when a minute had elapsed simply by counting six similar phases of the -undulations as they passed a given point. It results from this rhythm -that when one wave is just beginning several others are already running -in order before it. Between the rings of constriction the stomach is -bulged out, as shown in the various outlines in Figures 2, 3, 4, and 5. -The number of waves during a single period of digestion is larger than -might possibly at first be supposed. In a cat that finished eating -fifteen grams of bread at 10.52 A.M., the waves were running regularly -at 11.00 o’clock. The stomach was not free from food until 6.12 P.M. -During that time the cat was fastened to the holder at intervals of -half an hour, and the waves were always observed following one another -in slow and monotonous succession. At the rate of three hundred and -sixty an hour, approximately two thousand six hundred waves passed over -the antrum during that single digestive period. - -From the above review it will be manifest that my observations of the -movements of the pyloric part agree closely with those of Rossbach, -but differ considerably from the harmonious results of the work of -Beaumont, and Hofmeister and Schütz. Beaumont’s methods, however, may -be justly criticised on the ground that the thermometer-tube which he -held in the stomach was wholly unlike food and very liable to bring -about unwonted contractions in so sensitive an organ as the stomach. -Further, the movements observed by Hofmeister and Schütz, as Ewald has -pointed out, may easily have resulted from the abnormal stimulus due -to lack of blood--a potent cause of peristalsis. And it will be shown -later that the accounts given by these investigators describe very well -the actions of the stomach when stimulated by an unusual irritant. -In this connection it may be added that since the publication of the -preliminary notice of my work, Roux and Balthazard, using the Röntgen -rays, have published the results of observations on the stomachs of the -dog and man similar to those thus far described in this paper. - -The fact that my observations and those of Roux and Balthazard -were conducted under normal conditions, and that the conditions of -Rossbach’s experiments were more nearly normal than those of the other -observers mentioned, warrants the conclusion that the pyloric part has -a more important function than that of merely expelling the contents -of the stomach into the intestines. After summarising the description -given by Hofmeister and Schütz, Ewald, for _a priori_ reasons, -declares: “I cannot accept this view. The plain fact that the pyloric -portion secretes a strongly digesting fluid containing pepsin and -hydrochloric acid proves it to be an important part for the peptonising -function of the stomach.” The account of the remarkable manner in which -the pyloric portion performs this function must be deferred until the -movements of other parts of the stomach have been considered. - -2. _Movements of the pyloric sphincter._--Rossbach mars his otherwise -careful work by declaring that the pylorus is tightly closed during -the whole digestive period of from four to eight hours, and that then -the sphincter relaxes and the peristaltic waves empty the stomach. -That this is not the normal action of the sphincter has been shown -by several observers. Hirsch watched dogs with duodenal fistulas and -saw food come from the stomach at intervals of one-fourth of a minute -to several minutes. Roux and Balthazard maintain that in dogs food -enters the duodenum at the completion of each wave of constriction. -Observations on the cat, however, do not support their view, but agree -rather with the statement of Hirsch. - -In cats fed with bread mixed with subnitrate of bismuth, ten or -fifteen minutes elapse after the first constriction in the antrum -before any food can be seen in the duodenum. When food does appear -it is spurted through the pylorus and shoots along the intestine for -two or three centimetres. Not every constriction-wave forces food -from the antrum. On one occasion, about an hour after the movements -began, three consecutive waves were seen, each of which squirted food -into the duodenum. The pylorus remained closed against the next eight -waves, opened for the ninth, but closed once more against the tenth and -eleventh. For each of the four succeeding waves the sphincter relaxed, -but blocked the food brought by three constrictions that followed; and -in this irregular way the food continued passing from the stomach. Near -the end of gastric digestion, when the constrictions are very deep, it -may be that the pylorus opens for every wave. - -When a hard bit of food reaches the pylorus, the sphincter closes -tightly and remains closed longer than when the food is soft. This -action of the sphincter was shown by giving with the regular food of -the cat a dry, hard pellet of equal parts of starch paste and bismuth -subnitrate about the size of a pea. The food itself contained merely -enough bismuth to throw a dim shadow, near the centre of which the -pellet could be clearly seen as a dark object. The continual passing of -the contraction-waves finally brought the little ball to the pylorus. -When it arrived there, five grams of bismuth subnitrate were introduced -into the stomach through a tube in the œsophagus. This was done in -order that the food passing into the intestines after the ball came to -the pylorus might be distinguished from that which had gone on before. -By kneading the stomach the bismuth was distributed, as shown by the -uniformly black shadow. The pellet could still be seen near the end of -the antrum when the constrictions passed over it. Now, although the -waves continued to run regularly, the very black food did not gather in -the intestines in sufficient amount to be recognised until forty-two -minutes after it had been introduced. And when, finally, the food did -show itself in the intestines, its shadow contrasted strongly with that -of the food which had already passed on. The slowness of the expulsion -is not to be regarded as wholly due to the hard mass. No doubt the -kneading of the stomach mixed the contents of different parts of the -organ and brought to the pylorus food not yet sufficiently digested -to be passed by that selective sphincter. But this does not explain -the whole delay. Food similar to that given here, except that it -contained no hard particles, has usually been seen as small masses in -the intestines within fifteen minutes after being swallowed. A part of -the delay was evidently, therefore, caused by the hard pellet. Further -evidence on this point was secured when, on one occasion, the sphincter -was seen to open only seven times in twenty minutes following the -arrival of a hard particle of food at the pylorus. The conclusion may -therefore be drawn that hard morsels keep the pylorus closed and hinder -the passage of the food into the duodenum. - -3. _Activity of the cardiac portion._--The part played by the fundus -apparently has not hitherto been properly appreciated. It has been -regarded as the place for peptic digestion, or as a passive reservoir -for food; but it is in fact a most interestingly active reservoir. - -[Illustration: FIGURE 2.] - -[Illustration: FIGURE 3.] - -[Illustration: FIGURE 4.] - -[Illustration: - FIGURE 5.--Figures 2, 3, 4, and 5 present outlines of the shadow - of the contents of the stomach cast on a fluorescent screen by the - Röntgen rays. The drawings were made by tracing the outline of the - shadow on tissue paper laid upon the fluorescent surface, and are - about one-half the actual size. They show the change in the appearance - of the stomach at intervals for half an hour, from the time of eating - until the stomach is nearly empty. -] - -The action of the cardiac portion will be best understood by comparing -the appearances the stomach presents at various stages in a digestive -period. In order to show these stages I carefully made a set of three -tracings of the outlines of the stomach as soon as possible after a -cat had finished eating, and another set of three every half hour -thereafter, until the contents had disappeared (Figs. 2, 3, 4, and -5). These tracings were made by placing white tissue paper over the -fluorescent screen, and drawing with a thick lead pencil, easily seen, -as much of the boundary of the stomach as I could at the end of each -expiration. Between the times for making the drawings the cat was -allowed to rest quietly on a mat, but care was taken to lay her in the -same position on the holder for every drawing. The drawings of each set -were afterwards fastened over one another, so that the lines coincided -as closely as possible. Another piece of tissue paper was then put over -these, and all four sheets were laid on an illuminated pane of glass. -It was thus easy to get a composite tracing which, considering the -movement imparted to the stomach by respiration, and the dimness of -the shadows in the later stages of digestion, probably represents more -exactly than any single drawing the outline of the stomach for each -successive period. - -A comparison of these drawings shows that as digestion proceeds the -antrum appears gradually to elongate and acquire a greater capacity, -and that the constrictions make deeper indentations in it. But when the -fundus has lost most of its contents, the longitudinal and circular -fibres of the antrum contract to make it again shorter and smaller. -Its change of form, however, compared with the rest of the stomach, is -slight. - -The first region to decrease markedly in size is the preantral part -of the pyloric portion. The peristaltic undulations, caused by the -circular fibres, start at the beginning of this portion, and gradually, -by their rhythmic recurrence, press some of the contents into the -antrum. As the process continues, the smooth muscle fibres with their -remarkable tonicity contract closely about the food that remains, so -that the middle region comes to have the shape of a tube (Figs. 3 and -4--1.30 P.M. to 2.30 P.M.), with the rounded fundus at one end and the -active antrum at the other. Along the tube very shallow constrictions -may be seen following one another to the pylorus. - -At this juncture the longitudinal fibres which cover the fundus like -radiating fingers, and the circular and oblique fibres reaching in -all directions about this spherical region, begin to contract. Thus -the contents of the fundus are squeezed into the tubular portion. -This process, accompanied by a slight shortening of the tube, goes on -until the shadow cast by the fundus is almost wholly obliterated (Fig. -5--5.30 P.M.). - -The waves of constriction moving along the tubular portion press the -food onward as fast as they receive it from the contracting fundus, and -when the fundus is at last emptied they sweep the contents of the tube -into the antrum (Fig. 5--5.00 P.M. to 6.00 P.M.). Here the operation is -continued by the deeper constrictions till, finally (in this instance -at 6.12 P.M.), with the exception of a slight trace of food in the -fundus, nothing is to be seen in the stomach at all. - -The food in the fundus may possibly be slightly affected by the -to-and-fro movements of the diaphragm in respiration. With normal -breathing the upper border of the cardiac portion swings through about -one centimetre; with dyspnœa, or deep breathing, through one and a half -or two centimetres. Since the lower border does not move so much, the -contents are gently pressed, and then released from pressure, at each -respiration. The pyloric portion is moved very little by the diaphragm, -the oscillation being less than a half centimetre. - -Moritz has pointed out the value of an organ like the stomach for -holding the bulk of the food and serving it out a little at a time, so -that the intestines may not become congested during their digestive and -absorptive processes. All of the advantages supposed to be thus secured -to the intestines may be claimed also for the stomach itself. For -the preceding description indicates, and experiments to be described -later prove, that the stomach is composed of two physiologically -distinct portions: the busy antrum, over which during digestion -constriction-waves are running in continuous rhythm; and the cardiac -part, which is an active reservoir, pressing out its contents a little -at a time as the antral mechanism is ready to receive them. - - - THE MOVEMENTS OF THE STOMACH IN VOMITING - -The appearance of the stomach during vomiting has been studied -particularly by Openchowski. He says that when an emetic is given -there follows a quivering of the stomach-wall, which, beginning near -the pylorus, shows itself later in the antral and middle regions of -the stomach. The quivering afterwards passes into a contraction, most -strongly marked in the antral part, since the peristaltic waves running -down to the antrum from above are continually growing deeper. At the -same time the fundus expands spherically. The increased contraction in -the pyloric part drives the contents towards the more dilated portion, -and thence they are forced into the œsophagus by abdominal pressure. - -The same phenomena occur when a cat is given apomorphine -hypodermatically. First the upper circular muscles relax and become so -flaccid that the slightest movement of the abdomen changes the form -of the fundus. Then there are apparently irregular twitchings of the -fundus wall. Soon a deep constriction starts about three centimetres -below the cardia and, growing in strength, moves towards the pylorus. -When it reaches the transverse band the constriction tightens and holds -fast, while a wave of contraction sweeps over the antrum. Another -similar constriction follows. In the interval the transverse band -relaxes slightly, but tightens again when the second wave reaches -it. Perhaps a dozen such waves pass; then a firm contraction at the -beginning of the antrum completely divides the gastric cavity into -two parts. This same division of the stomach into two parts at the -transverse band is to be seen when mustard is given. Now, although -the waves are still running over the antrum, the whole preantral part -of the stomach is fully relaxed. A flattening of the diaphragm and a -quick jerk of the abdominal muscles, accompanied by the opening of the -cardia, now force the contents of the fundus into the œsophagus. As -the spasmodic contractions of the abdominal muscles are repeated, the -gastric wall again tightens around the contained food. Antiperistalsis -I have seen only once; then, while the cat was retching, a constriction -started at the pylorus and ran back, over the antrum, completely -obliterating the antral cavity. - -It will be recalled that the principal difference between the -movements of the stomach and their effects as described by Beaumont, -and Hofmeister and Schütz on the one hand, and Rossbach, Roux and -Balthazard, and myself on the other hand, is that the former observed -constrictions completely dividing the stomach at the transverse band, -and the antrum then squeezing its contents into the intestines; whereas -the latter have seen the constrictions moving forward as narrowing -rings, but not separating the gastric cavity into two parts. - -With the exception of peristalsis in the antrum, the gastric -movements at the beginning of emesis are almost exactly the same as -those Beaumont, and Hofmeister and Schütz, declare to be the normal -contractions of the stomach. Their observations were made, however, -when the organ was subjected to unnatural stimulation. In the excised -stomach, observed by Hofmeister and Schütz, not only were all nervous -connections severed, but likewise all flow of blood to the organ was -entirely stopped, and the cutting off of the blood supply is regarded -as one of the most powerful predisposing causes of peristaltic action. -The thermometer-tube used by Beaumont was an irritant to the stomach, -as he himself admits. “If the bulb of the thermometer,” he writes, “be -suffered to be drawn down to the pyloric extremity, and retained there -for a short time, or if the experiments be repeated too frequently, it -causes severe distress and a sensation like cramp, or spasm, which -ceases on withdrawing the tube, but leaves a sense of soreness and -tenderness at the pit of the stomach.” Moritz also noticed that a -rubber sound introduced into the human stomach proved to be a source -of irritation. It seems reasonable to suppose, therefore, that these -observers did not see the normal movements, but the actions resulting -from abnormal irritation. - - - THE EFFECT OF THE MOVEMENTS OF THE STOMACH ON THE FOOD - -In my first observations on the active stomach a bulging of the -stomach-wall was to be seen in front of the passing waves. But as -food did not immediately appear in the intestine, and as, after the -pylorus relaxed, the gastric contents did not diminish rapidly enough -to allow the supposition that all of the food squeezed forward by the -waves was immediately forced through the pylorus, it was assumed that -a part, at least, of the food under pressure was forced back towards -the cardia through the constriction-ring. This inference was stated in -the preliminary notice of my work. Roux and Balthazard also observed -the passage of the undulations over the pyloric part, but state merely -that the function of the constrictions is the propulsion of food into -the intestine, without mentioning what must be regarded as a very -important function; namely, the mixing effect of the waves. - -Most writers have agreed that the result of the active and passive -movements of the stomach is to force the contents hither and thither, -thus mixing them and the gastric juice together. Two observers, -Beaumont and Brinton, have attempted to explain the manner of the -mixing. Beaumont, after noting how the thermometer-tube, used by him to -indicate the gastric motions, was affected, describes the circulation -of the food as follows: “The bolus as it enters the cardia turns to the -left, passes the aperture, descends into the splenic extremity, and -follows the great curvature towards the pyloric end. It then returns, -in the course of the small curvature, makes its appearance again at -the aperture, in its descent into the great curvature, to perform -similar revolutions.” Brinton bases his theory of the circulation of -the food on an analogy between the movement of a constriction over the -stomach and the passage of a septum with a central perforation along -the interior of a cylinder full of liquid. The result in both cases, -he declares, must be a peripheral current of advance, and a central -current of return. Thus in the stomach there would be peripheral -currents from the cardia along the walls of the stomach to the -pylorus, where they would unite and run as an axial current back to the -cardia. - -Certain _a priori_ objections may be urged against each of these -conclusions. In the first place Beaumont’s observations were made on -a subject having a gastric fistula, and the adhesions between the -stomach and the abdominal wall would prevent the fundus from acting -quite normally in relation to its contents. Beaumont’s conclusions, -furthermore, are based on the movements of a thermometer-tube -introduced through the fistula, and on the recognition of particles of -food which he had seen before as they passed the fistulous opening: the -first method, as has been shown, made the conditions in the stomach -more abnormal than they were previously; the second gave uncertain -knowledge of the course of the food when out of the observer’s sight. -Brinton’s hypothesis states the probable movements of fluid contents -acted on by a passing constriction. But it may be objected that the -conditions assumed by him do not exist in all parts of the stomach. -For not only is there no peristalsis visible in the fundus, but with -the usual food the fundus contents are not liquid. Moreover, the -constrictions at the beginning of the pyloric portion are very slight -and move slowly. The food in front of them is, accordingly, not under -much greater pressure than the food behind them. The axial current -which might result, therefore, could not be strong enough to go far -into the cardiac portion. - -It is easily possible to test experimentally the validity of these -two theories by watching the action of pieces of food which throw a -black shadow in a dimly outlined stomach. For this purpose little -paste pellets of bismuth subnitrate, with starch enough to keep the -form, were given with the customary meal. These pellets, it was found, -did not break up in the stomach during the gastric digestion of soft -bread. Several times I have been fortunate in getting two of the little -balls in the axis of the stomach and about a centimetre apart. As the -constriction-wave approached them, both moved forward, but not so -rapidly as the wave. Now when the constriction overtook the first ball, -the ball moved backward through the constricted ring, in the direction -of least resistance. The wave then overtook the second ball, and it -also passed backward to join its fellow. At the approach of the next -wave they were both pushed forward once more, only to be again forced -backward, one at a time, through the narrow orifice. As the waves -recurred in their persistent rhythm, the balls were seen to be making -progress--an oscillating progress--towards the pylorus; for they went -forward each time a little farther than they retreated. This to-and-fro -movement of the pellets was much more marked in the antrum, where the -waves were deep, than in the middle region. On different occasions from -nine to twelve minutes have elapsed while the balls were passing from -where the waves first affected them to the pylorus; which means that -on the way they were moved back and forth by more than a half hundred -constrictions. - -If the pylorus does not relax, it is evident that a wave approaching it -pushes the food into a blind, elastic pouch, the only exit from which -is through the advancing constricted ring. The constrictions are deeper -near the end of the antrum, and the rings are small; consequently, -the food is squirted back through them with considerable violence. As -has been noted, the pylorus opens less frequently for a while after a -solid piece of food comes to it. In such a case the slow driving waves -squeeze the hard morsel and the soft food about it up to the sphincter, -only to have the whole mass shoot back, sometimes half-way along the -antrum. Over and over again the process is repeated till the sphincter -at last opens and allows the more fluid parts to pass. Hofmeister and -Schütz, and Moritz have disclaimed any selective action of the pylorus, -and declare that solids are driven from the pylorus to the fundus by -antiperistalsis. The action of the pylorus which I have seen, however, -is more like that described by the earlier investigators; for during -digestion there was no antiperistalsis, and the sphincter, separating -the fluids from the solids, caused the solids to remain and undergo a -tireless rubbing. Frequently, when several of these balls have been -given at the same time, they have all been seen in the antrum after the -stomach was otherwise empty. Here they remain to be softened in time -by the juices, or to be forced through the pylorus later, for solids -do pass into the intestine. Thus when the teeth neglect their work the -stomach attempts to perform their function; the relative inefficiency -of the gastric method of grinding and its interference with the normal -gastric activities point an obvious hygienic moral. - -During the process of digestion the food in the cardiac portion gives -no sign of currents. Balls which lie in the fundus immediately after -the food is ingested keep their relative positions until the cardiac -portion begins to contract, and then move very slowly towards the -antrum. Moreover, the food in the fundus of a cat has the same mushy -appearance when examined after gastric peristalsis had been active -for an hour and a half that it had when ingested. The contents of -the antrum, on the other hand, look quite different and have the -consistency of thick soup. The inactivity of the food in the fundus -can also be proved by feeding first five grams of bread and bismuth, -then five grams without bismuth, and finally five grams again with -bismuth in it. The stomach contents are thus arranged in two dark -layers along the curvatures, with a light layer between. Tracings made -on tissue paper show that ten minutes after peristalsis commenced the -stratification had entirely disappeared in the pyloric part, but that -an hour and twenty minutes thereafter the layers were still clearly -visible in the cardiac region. - -The value of the circulation of the food, as described by Beaumont -and Brinton, lay in the supposition that the contents of the stomach -were thus brought near to the secreting gastric wall, and that the -gastric juice could thus more readily exert its action. Although my -observations do not support their theories of mixing currents running -throughout the stomach, they still show that the pyloric portion is -an admirable device for bringing all of the food under the influence -of the glandular secretions of that region. For, when a constriction -occurs, the secreting surface enclosed by the ring is brought close -around the food lying within the ring in the axis of the stomach. -As this constriction passes on, fresh areas of glandular tissue are -continuously pressed in around the narrow orifice. And also, as -the constriction passes on, a thin stream of gastric contents is -continuously forced back through the orifice, and thus past the mouths -of the glands. The result of this ingenious mechanism is that every -part of the secreting surface of the pyloric portion is brought near to -every bit of food, before the latter leaves the stomach, a half hundred -times or more, as evidence by the moving ball. - - - SALIVARY DIGESTION IN THE STOMACH - -The absence of movement in the fundus would seem to give the food -during its stay there little opportunity to become mixed with the -gastric juices, and thus to undergo peptic digestion. The truth of -this supposition can easily be proved experimentally by feeding a -slightly alkaline meal, and later testing the chemical reaction of the -contents of various parts of the stomach. A cat which had been without -food for fifteen hours was given eighteen grams of mushy bread made -slightly alkaline with sodium carbonate. One hour and a half after -the cat had finished eating she was killed, and the stomach laid bare -by opening the abdomen. A very small hole was then made through the -wall in the fundus region, and another similar hole was made into -the antrum. By means of a glass pipette food was extracted first -from the periphery of the fundus; this food was slightly acid. The -cleaned pipette was then introduced two and a half centimetres into -the fundus contents, and the food thus extracted gave the original -alkaline reaction. Specimens of the liquid contents of the antral and -middle regions, taken from various depths, were all strongly acid. -A dog killed an hour and three-quarters after eating showed similar -differences between the reactions of the food in the fundus and the -food in the pyloric portion. So, as a matter of fact, the food does not -become acid at a uniform rate in all parts of the stomach, as would -be the case if Beaumont’s and Brinton’s theories of mixing currents -were true. Moreover, if the facts accorded with their notions, the -saliva, which ceases to act in the presence of more than 0.003 per -cent free hydrochloric acid, and is destroyed when the percentage -of acid proteids is large, would manifestly have its service as a -ferment limited to the relatively short time during which the stomach -contents, in the process of thorough mixing, were reaching that degree -of acidity. There is, however, no movement of food in the fundus, and -the alkaline food received from the œsophagus remains alkaline in this -region for a considerable period. The nutriment, therefore, if well -chewed and thus mixed with saliva, can undergo salivary digestion in -the fundus for a considerable period without interference by the acid -gastric juice.[32] - -From all these observations the conclusion must be that the fundus -acts as a reservoir for the food, in which the digestion of sugars and -starches may take place; and that the pyloric portion with its simple -but marvellous peristaltic mechanism, by a single process, triturates -the food, brings it near to the active glands, stirs it thoroughly with -their secretions, and expels the products into the intestines. - - - THE INHIBITION OF STOMACH MOVEMENTS DURING EMOTION - -Early in the research a marked unlikeness was noticed in the action -of the stomachs of male and female cats. The peristalsis seen with -only a few exceptions in female cats failed to appear in most of the -males, although both had received exactly the same treatment. Along -with this difference was a very striking difference in behaviour when -bound to the holder; the females would lie quiet, mewing occasionally, -but purring as soon as they were gently stroked. The males, on the -contrary, would fly into a violent rage, struggle to be loose from -their fastenings, bite at everything near their heads, cry loudly, and -resist all attempts to quiet them. On account of this difference only -female cats were used for some time, and the significance at first -attributed to the action of the males was almost forgotten when the -following incident recalled it and suggested that the excitement caused -the suspension of the stomach movements. On October 23, 1897, a male -cat was fed at 12.00, but was not placed on the holder till ninety -minutes later. The waves were passing at the rate of six a minute. The -cat fell into a rage and the waves suddenly stopped. - -A few days later an observation on a female with kittens explained -the absence of gastric movements in the males. While the peristaltic -undulations were coursing regularly over the cat’s stomach, she -suddenly changed from her peaceful sleepiness, began to breathe -quickly, and struggled to get loose. As soon as the change took place, -the movements in the stomach entirely disappeared; the pyloric portion -relaxed and presented a smooth, rounded outline. I continued observing, -and stroked the cat reassuringly. In a moment she became quiet and -began to purr. As soon as this happened the movements commenced again -in the stomach; first a few constrictions were visible near the end of -the antrum, then a few near the sharp bend in the lesser curvature, -and finally the waves were running normally from their habitual -starting-place. By holding the cat’s mouth closed between the thumb and -last three fingers, and covering her nostrils with the index finger, -she could be kept from breathing. At the first sign of discomfort -the fingers were removed. This experiment was repeated a great many -times on different cats, and invariably the evidence of distress was -accompanied by a total suspension of the motor activities of the -stomach and a relaxation of the antral fibres. - -No amount of kneading or compression of the abdomen with the fingers, -short of making the cat angry, would cause the waves to stop; so -that the cat’s movements, in themselves, were not the source of the -inhibition. And since expressions of strong feeling on the part of the -animal always accompanied cessation of the constriction-waves, the -inhibition was probably due to nervous influence. It has long been -common knowledge that violent emotions interfere with the digestive -process, but that the gastric motor activities should manifest such -extreme sensitiveness to nervous conditions is surprising. - - - SUMMARY - -1. By mixing a harmless powder, subnitrate of bismuth, with the food, -the movements of the stomach can be seen by means of the Röntgen rays. - -2. The stomach consists of two physiologically distinct parts: the -pyloric part and the fundus. Over the pyloric part, while food is -present, constriction-waves are seen continually coursing towards the -pylorus; the fundus is an active reservoir for the food and squeezes -out its contents gradually into the pyloric part. - -3. The stomach is emptied by the formation, between the fundus and the -antrum, of a tube along which constrictions pass. The contents of the -fundus are pressed into the tube and the tube and antrum slowly cleared -of food by the waves of constriction. - -4. The food in the pyloric portion is first pushed forward by the -running wave, and then by pressure of the stomach-wall is returned -through the ring of constriction; thus the food is thoroughly mixed -with gastric juice, and is forced by an oscillating progress to the -pylorus. - -5. The food in the fundus is not moved by peristalsis, and consequently -it is not mixed with the gastric juice; salivary digestion can -therefore be carried on in this region for a considerable period -without being stopped by the acid gastric juice. - -6. The pylorus does not open at the approach of every wave, but only at -irregular intervals. The arrival of a hard morsel causes the sphincter -to open less frequently than normally, thus materially interfering with -the passage of the already liquefied food. - -7. Solid food remains in the antrum to be rubbed by the constrictions -until triturated, or to be softened by the gastric juice, or later it -may be forced into the intestine in the solid state. - -8. The constriction-waves have, therefore, three functions: the mixing, -trituration, and expulsion of the food. - -9. At the beginning of vomiting, the gastric cavity is separated into -two parts by a constriction at the entrance to the antrum; the cardiac -portion is relaxed, and the spasmodic contractions of the abdominal -muscles force the food through the opened cardia into the œsophagus. - -10. The stomach movements are inhibited whenever the cat shows signs of -anxiety, rage, or distress. - - - - - THE MOVEMENTS OF THE INTESTINES STUDIED BY MEANS OF THE RÖNTGEN - RAYS[33] - - BY W. B. CANNON - - - _From the Laboratory of Physiology in the Harvard Medical School_ - - Extracts from _American Journal of Physiology_, 1902 - - - INTRODUCTION - -The investigation of intestinal movements has been beset by the same -difficulties that characterised the investigation of the gastric -mechanism. Pathological subjects or animals subjected to the disturbing -action of drugs and anæsthetics and of serious operations have been the -only sources of our knowledge. A considerable difference of opinion as -to the nature of the normal movements in the intestines has resulted -from observations made under these necessary abnormal conditions. The -slowly advancing peristaltic wave and the _Pendelbewegung_, or swaying -movement, described by Ludwig, have been regarded as true physiological -processes. Concerning antiperistalsis and the swiftly running -vermicular contraction, observers are not so nearly in agreement. -The activity of the large intestine has been described as simply -peristalsis of a slower rate than that seen in the small intestine. - -The best known of the intestinal movements is the normal peristaltic -wave. This wave is slow, having a rate of about two centimetres per -minute, is regular, and by most observers is said to move always in one -direction. The progress of the contraction, as suggested by Nothnagel’s -experiments, and as clearly stated by Mall and by Bayliss and Starling, -is dependent upon a local reflex. According to Mall, when an object -stimulates the mucosa there occurs above the point of stimulation a -constriction which forces the object downward; and as it moves downward -new regions immediately above the mass are by this reflex brought into -constriction, and thus the wave and its stimulus advance together. “At -the same time,” Mall states, “a sucking force, due to active dilatation -below the body, may have a tendency to drag it down.” In what manner -an active dilatation of the intestinal wall may occur so as to produce -a “sucking force” he does not make wholly clear. Bayliss and Starling, -in describing normal peristalsis in the intestine, state that the -contractions above the bolus increase until there is a strong tonic -constriction. This passes the bolus onward, and as it advances the ring -of constriction follows it. While the bolus is passing down, the gut -above it is traversed by waves running as far as the constricted ring. -These observers state the law of intestinal peristalsis thus: “Local -stimulation of the gut produces excitation above and inhibition below -the excited spot.” - -The pendulum movements are characterised by a gentle swaying motion -of the coils, and are accompanied by rhythmical contractions of the -intestinal wall. They continue with undiminished force after paralysis -of the local nervous mechanism by nicotine or cocaine; they have been -called, therefore, myogenic or myodromic contractions. Observers have -described them variously as shortenings and narrowings of the gut, -rhythmically repeated at nearly the same intestinal circumference; as -alternating to-and-fro movements of the long axis without changes in -the lumen; as local or extensive periodic contractions and relaxations -mainly of the circular musculature; and as waves involving both -muscular coats of the intestine, and travelling normally from above -downward at a rapid rate (2 to 5 cm. per second). They have been -seen in the dog, and in the rabbit and cat. In the cat Bayliss and -Starling noticed that when the lumen of the gut was distended by a -rubber balloon, there appeared rhythmical contractions, which nearly -always were most marked at about the middle of the balloon; _i. e._, -the region of greatest tension. This form of constriction, which, -as my observation shows, is an indication of the manner in which -the rhythmical contraction acts in the cat’s intestine, Bayliss and -Starling seem to have regarded with slight attention, since it did not -accord with the law of peristalsis. - -The swift vermicular wave may pass the whole length of the intestine -in about a minute. It is often seen just after death, as well as in -pathological states such as intestinal anæmia or hyperæmia, and when -the bowel contains gases and organic acids from decomposing food. -Starling is inclined to regard this type of intestinal activity as an -exaggeration of the rhythmic type; Mall, on the other hand, places -it in a class by itself, and declares that its service is to rid the -intestine rapidly of irritating substances. Nothnagel, who designates -this form of movement with the term _Rollbewegung_, thinks it is -transitional between a physiological and a pathological activity. - -The existence of antiperistalsis has been so much questioned that -it will be considered in a special section of this paper, where my -observations may be conveniently introduced. - -The common understanding of the manner in which food passes through the -intestinal canal is that the chyme ejected from the stomach is pressed -downward by a peristalsis, which passes slowly over a part or all of -the small intestine. The peristaltic waves of the colon are supposed -to constitute an independent group, similar to those of the small -intestine, but weaker and slower. Movements of the food other than the -uninterrupted advance have been mentioned by some observers. Starling -states that the effect of the pendulum movement is to mix the contents -of the intestine and bring them into intimate contact with the mucous -membrane. Grützner writes that he has been brought “by strange and -peculiar observations” to believe that the fluid contents of the small -intestine move irregularly forward, then forward and back, then perhaps -remain quiet for some time, only to pass backward for a long distance, -and finally to move forward steadily to the end. In this manner the -food is mixed and brought into contact with the absorbing walls. The -to-and-fro shiftings of the food Grützner ascribed to advancing and -retrograde contractions of the intestinal musculature, and he argued -that even circular constrictions must force the liquid contents away -in both directions. To support his contention, Grützner introduced -mercury into the intestine and observed it with the Röntgen rays. After -noting a backward and forward movement of the mercury he dismissed the -method, saying, “Many a flash must come from the Röntgen tube before -the _normal_ movement of the intestinal contents is made entirely clear -by this method.” - -The following account is a summary of many repeated observations on -different animals, and is a contribution to a clear understanding of -the normal movements of the intestines and their contents. - - - THE MOVEMENTS OF THE SMALL INTESTINE - -When the food has been distributed through the intestine so as to -present the appearance shown in Figure 1, a noticeable feature in most -or all of the loops is the total absence of movement. If the animal -remains quiet, however, only a few moments elapse before peculiar -motions appear in one or another of the loops, or perhaps in several, -and last for some time. These motions consist in a sudden division -of one of the long, narrow masses of food into many little segments -of nearly equal size; then these segments are again suddenly divided -and the neighbouring halves unite to make new segments, and so on, in -a manner to be more fully described. I have called this process the -rhythmic segmentation of the intestinal contents. Further observation -reveals peristalsis here and there, and under certain circumstances the -typical swaying movements may be seen. All these phenomena are now to -be considered in detail. - -[Illustration: - FIGURE 1.--Appearance of food in the intestines 5¾ hours after eating. - This and other radiographs reduced two-thirds.] - -[Illustration: - FIGURE 2.--Diagram representing the process of rhythmic segmentation. - Lines 1, 2, 3, 4 indicate the sequence of appearances in the loop. - The dotted lines mark the regions of division. The arrows show the - relation of the particles to the segments they subsequently form.] - -_Rhythmic segmentation of the intestinal contents._--This is by far the -most common and the most interesting mechanical process to be seen in -the small intestine. The nature of the process may best be understood -by referring to the diagram in Figure 2. A string-like mass of food -is seen lying quietly in one of the intestinal loops (line 1, Fig. -2). Suddenly an undefined activity appears in the mass, and a moment -later constrictions at regular intervals along its length cut it into -little ovoid pieces. The solid string is thus quickly transformed, -by a simultaneous sectioning, into a series of uniform segments. A -moment later each of these segments is divided into two particles, -and immediately after the division neighbouring particles (as _a_ -and _b_, line 2, Fig. 2) rush together, often with the rapidity of -flying shuttles, and merge to form new segments (as _c_, line 3, Fig. -2). The next moment these new segments are divided, and neighbouring -particles unite to make a third series, and so on. At the time of the -second segmentation (line 3, Fig. 2) the end particles are left small. -Observation shows that these small pieces are not redivided. The end -piece at A simply varies in size with each division; at one moment it -is left small, at the next moment it is full size from the addition -of a part of the nearest segment, and a moment later is the small bit -left after another division. The end piece at B (probably the rear -of the mass) shoots away when the end mass is divided, and is swept -back at each reunion to make the large end mass again, only to be -shot away and swept onward with each recurrence of the constrictions. -Thus the process of repeated segmentation continues, with the little -particles flitting towards each other and the larger segments shifting -to and fro, commonly for more than half an hour without cessation. -From the beginning to the end of a period of segmentation the food -is seen to have changed its position in the abdomen to only a slight -extent; whether this change is a passing of the food along the loop, -or a movement of the loop itself, it is impossible to tell from the -shadows on the screen. The change of position, however, is much less -conspicuous than the lively division and redivision which the mass -suffers so many times from the busy, shifting constrictions. - -From this typical form of rhythmic segmentation there are several -variations. Sometimes, and especially when the mass of food is thick, -the constrictions do not make complete divisions and are so far apart -that the intermediate portions are relatively large. Moreover, the -constrictions do not take place in the middle of each portion, but -near one end; thus each portion is constricted, not into halves, -but into thirds. If a little pointer is placed at the middle of a -segment, when the segments are completely divided into halves, in a few -seconds the pointer will be in the middle of the clear space between -two segments; but in a few seconds more the first phase will return -and the pointer will again be indicating a segment,--two operations -intervene between similar phases. When, however, the portions are -constricted into thirds, the indicator shows it, since three operations -intervene between similar phases. The manner of these changes is made -clearer by reference to the diagram in Figure 3. That each portion is -constricted into three pieces is proved also by watching the gradual -reduction of the portion at the left end of line 1 through lines 2 -and 3, and also in the gradual formation of a full-sized portion at -the right end of lines 2, 3, and 4. When food undergoing this process -is watched, it appears to be affected by a series of constrictions, -each of which starts at one end of the mass and marches through to the -other end, leaving its impress at short intervals along the length. The -progression of the dotted lines from right to left in _a_, _b_, _c_, -and _d_, etc., Fig. 3, gives a notion of these advancing constrictions. - -Another variation of the segmentation is shown in Figure 4. In this -type there are evidently divisions and subdivisions, _i.e._, one more -operation between the appearance and the reappearance of the same phase -than is present in the simple division of the small segments in a long -string of food (Fig. 2). This form of segmentation is fairly typical -for the constrictions seen in food advancing through the intestine. -Sometimes the divisions occur in the middle of a long string of food -and leave the ends wholly unaffected. - -[Illustration: - FIGURE 3.--Diagram showing the relations of the portions when they are - constricted into three pieces. The dotted lines indicate regions of - constriction; the arrows indicate the relationship of the pieces to - the portions they subsequently form.] - -A remarkable feature in the segmentation of the food is the rapidity -with which the changes take place. The simplest way of estimating the -rate of division is to count, not the number of times the partition of -the food recurs in the same place, but the number of different sets of -segments observed in a given period. Thus in Figure 4 the appearances -of lines 1, 2, 3, 4, etc., would be counted, and not merely lines 1, -4, etc. Repeated observations on different animals have shown that -the most common rate of division in long, thin chains of food varies -between twenty-eight and thirty times in a minute; _i. e._, there is -a change from one set of segments to another set every two seconds, -and a return of the same phase every four seconds. In some cases the -rate is as low as twenty-three times per minute. The larger masses seem -to be associated with a slower segmentation; the operations indicated -in Figure 3, for example, occurred from eighteen to twenty-one times -in a minute, so that the same phase reappeared only once in eight or -nine seconds. The segmentation frequently continues for more than half -an hour; in one instance it was seen to persist with only three short -periods of inactivity for two hours and twenty-two minutes. At the rate -of thirty segmentations per minute it is clear that a slender string -of food may commonly undergo division into small particles more than a -thousand times while scarcely changing its position in the intestine. - -I have seen once, in a cat only lightly etherised, the exterior of an -intestine which was dividing the food as above described. An hour and -a half after a meal of salmon the anæsthetic was given, the abdomen -opened, and the flaps raised so as to form walls. Warm salt solution -was then poured into the abdominal cavity, and the floating coils left -covered with the transparent omentum. The gastric peristaltic waves -were running regularly; on the intestine there were visible at various -places during the period of observation regions of constriction which -had the appearance shown in Figure 3, except that the rings were -relatively nearer together. New rings of constriction took place on the -same side of all the bulging parts at the margin of the constricted -portion (_cf._ dotted lines, Fig. 3). As new rings occurred the old -relaxed, but apparently with tardiness, for the contents gurgled as -if forced through the narrowed lumen. The constrictions recurred -irregularly and at much longer intervals than in the normal animal. The -contracted rings were pale and bloodless. - -The effect of the process of rhythmic segmentation proves it an -admirable mechanism. The food over and over again is brought into -closest contact with the intestinal walls by the swift kneading -movement of the muscles. Thereby not only is the undigested food -intimately mixed with the digestive juices, but the digested food is -thoroughly exposed to the organs of absorption. Mall has shown that -contraction of the intestinal wall has the effect of pumping the blood -from the submucous venous plexus into the radicles of the superior -mesenteric vein, and thus materially aids the intestinal circulation. -Moreover, lacteals loaded with fat will in a few moments become empty -unless the intestine is slit lengthwise, so that the muscles cannot -exert compression. The rhythmic constrictions, therefore, both -propel the blood in the portal circulation and act like a heart in -promoting the flow of lymph in the lacteals. This single movement with -its several results is an excellent example of bodily economy; the -repeated constrictions, as already shown, thoroughly churn the food and -digestive fluids together, and also plunge the absorbing mucosa into -the very midst of the food masses: but not only are the processes of -digestion and absorption favoured by these movements; they also, by -compression of the veins and lacteals of the intestinal wall, serve -to deport through blood and lymph channels the digested and absorbed -material. - -_Peristalsis._[34]--The phenomena of peristalsis and segmentation are -usually combined in some manner while the food passes through the small -intestine. Peristalsis is observed normally in two forms: as a slow -advancing of the food for a short distance in a coil, and as a rapid -movement sweeping the food without pause through several turns of the -gut. The latter form is frequently seen when the food is carried on -from the duodenum; and it may readily be produced in other parts of the -small intestine by giving an enema of soapsuds. - -When a mass of food has been subjected for some time to the segmenting -activity of the intestine, the separate segments, instead of being -again divided, may suddenly begin to move slowly along the loop in -which they lie. That this movement is not a swinging of the coil as -a whole, but a peristaltic advance of separate rings of its circular -musculature, is made probable by the fact that the succeeding segments -follow along the same path their predecessors have taken. The advance -of the little pieces may continue for seven or eight centimetres, -when finally the front piece stops or meets other food. Then all the -succeeding pieces are swept one by one into the accumulating mass, -which at last lies stretched along the intestine, a solid string -manifesting no sign of commotion. - -[Illustration: - FIGURE 4.--Diagram showing combined peristalsis and segmentation.] - -Another form of slow peristalsis is frequently observed when the food -is pushed forward, not in small divisions, but as a large lump. The -relatively long string of food is first crowded into an ovoid form as -the forward movement begins, and as it is collecting thus, it seems -at the last to be suddenly formed into a more rounded ball, as if the -mass were pulled or pushed together at the two ends. The next moment -it is indented in the middle by a circular constriction (as shown in -Fig. 4, line 2), which spreads it in both directions along the loop. -The trailing portion (_a_) is next cut in two, and the severed part -sometimes flies back over its course about a centimetre. Now the whole -mass is swept together again and slightly forward as shown in line 4, -Fig. 4, and the segmenting process is repeated. At stage 3, Fig. 4, -a constriction sometimes appears around the middle of the advanced -portion (_b_). Thus, with many halts and interruptions, the food slowly -advances. - -A slight variation of the movement just described is observed when the -amount of food is greater and extends farther along the intestine. -Under such circumstances, as the mass moves forward, constrictions -appear just in front of the rear end, which separate it from the main -body, and cause it to shoot backward sometimes through the distance of -a centimetre. The main body meanwhile is not disturbed. No sooner has -the rear section been shot away than it is swept forward again into -union with the rest of the food, and the whole mass then advances until -another interfering constriction repeats the process. - -_Rhythmic segmentation and the pendulum movement._--There is little -doubt that the segmentation of the food which I have seen is due -to an activity of the intestinal musculature similar to that which -causes the so-called pendulum movement. This activity, as already -noted, is rhythmic, and, although accounts differ, analytical methods -prove that it involves both the longitudinal and the circular layers -of muscle. Observations of the effect of the rhythmic contractions -upon the food show that the action of the circular fibres is most -prominent. It is probable, however, that the longitudinal fibres also -play an important part in the process of segmentation. Examination -of Figure 2 makes clear that in line 2 the regions of constriction -appear between the regions of constriction in line 3; before _c_ can -be formed, therefore, the constriction between _a_ and _b_ must relax. -Contraction of the longitudinal fibres between two segments would help -to enlarge the constricted lumen of the gut. It seems probable that, as -the constrictions on either side of _c_ occur, the longitudinal fibres -between them contract; almost simultaneously the constriction between -_a_ and _b_ relaxes, and the two particles are thus brought swiftly -together. A similar process naturally would take place for each of -the shifting segments. Thus the function of the longitudinal muscles -would be to contract between new rings of constriction and thereby aid -in relaxing the former ring between them. During my one observation -of the segmenting process, as seen on the surface of the intestine, -I could not be sure that the distance between neighbouring segments -was shortened as the constriction relaxed; that activity of the -longitudinal fibres is present, however, is indicated by observations -of Raiser on the intestines of the rabbit and the cat. Raiser observed -the outer surface of the coils, and describes the normal movement -as an alternate contraction and relaxation of single divisions of -the longitudinal fibres; he notes that these short divisions shift. -But whether they shift in alternation with the shifting circular -constrictions, as seems probable, is an interesting point not yet -determined. - -[Illustration: FIGURE 5.--Tracing showing segmentation of chyme in the -duodenum. This and other tracings reduced two-thirds.] - -Bayliss and Starling state that the swaying pendulum movements are -essentially due to peristaltic waves recurring in the same place and -running rapidly downward. This form of the movements I have seen only -once. At this time about 90 c.c. of soapy water had been injected. -This procedure has the effect of exaggerating in every particular the -movements of the small intestine. In this instance a broad constriction -appeared about the middle of a long string of food and persisted there -while it spread down the gut. As the contraction spread, the gut swayed -slowly to and fro before it. Then there was a relaxation, followed by -a recurrence of the constriction in the same place, a spreading of the -contraction, and a swinging of the loop just as before. This phenomenon -was repeated again and again, till finally the string was divided and -the forward piece pushed through a tortuous course to the colon. - -_The course of the food in the small intestine._--Chyme is not forced -from the stomach by every wave that passes over the antrum, but only -at intervals. When the pylorus relaxes, the food, moved towards the -pylorus under considerable pressure, is squirted along the duodenum -for two centimetres or more. Careful watching of this food shows that -usually it lies for some time in the curve of the duodenum until -additions have been made to it from the stomach, and a long, thin -string of food is formed. While it is resting in this place it is -exposed to the outpouring of the bile and pancreatic juices. All at -once the string becomes segmented (see Fig. 5) and the process of -rhythmic segmentation continues several minutes, thoroughly mixing -the intestinal digestive juices with the chyme. In this region the -alternate positions of the segments are sometimes far apart, and the -to-and-fro movements of the particles may be a relatively extensive -and very energetic swinging. Finally the little segments unite into -a single mass, or form in groups, and begin to move forward. The -peristalsis here, as already mentioned, is much more rapid than the -normal peristalsis elsewhere in the small intestine. The masses, once -started, go flying along, turning curves, whisking hither and thither -in the loops, moving swiftly and continuously forward. After passing on -in this rapid manner for some distance the food is collected in thicker -and longer strings, resembling the strings seen characteristically in -the other loops. Towards the end of digestion the small masses shot -out from the stomach, after a few segmentations, may move on in the -rapid course without being accumulated in a larger mass until the swift -movement ceases. - -During the first stages of digestion in the cat’s small intestine the -food usually lies chiefly on the right side of the abdomen; during the -last stages the loops on the left side contain the greater amount of -food. In these loops the food remains sometimes for an hour or more -with no sign of movement. All at once a mass begins to show irregular -depressions and elevations along its length, and then suddenly it is -divided, at first partially, later completely, into many little equal -parts, and these repeatedly undergo division and reunion, division -and reunion, over and over again, in the manner described above as -rhythmic segmentation. After a varying length of time the activity -wanes and the little segments are carried forward individually and -later brought together, or join and move on as a single body, or they -may reunite and lie quietly for some time without further change. Thus -by a combined process of kneading and peristaltic advance the food is -brought to the ileocæcal valve to enter the large intestine. Records -from ten different animals show that salmon does not appear in the -small intestine until an hour or an hour and a half after the food is -eaten. Inasmuch as five or six hours elapse after eating before this -food begins to be seen in the colon, it is evident that the chyme takes -four to five hours to pass the length of the small intestine. It is -interesting to note that the operations are considerably shortened if -the meal has consisted of bread and milk. - - - THE COMPETENCE OF THE ILEOCÆCAL VALVE - -The ileocæcal valve in the cat is situated three or four centimetres -from the blind end of the cæcum. Its position is usually marked in -shadows of the food in the colon by a slight indentation, towards which -masses about to enter the colon are ordinarily directed from a point -somewhat distant in the small intestine (see Fig. 6). - -Regarding the competence of the ileocæcal valve many observations -have been made. Grützner has reviewed the evidence bearing on the -question and concludes that the valve is not competent, least of all -for liquids. He declares that as soon as liquids or thin fluid masses -appear in the upper part of the colon they pass in many instances into -the small intestine the moment that the pressure on the colon side -rises slightly. If the colon contains a solid or a thick, mushy mass, -the passage towards the small intestine is scarcely possible, because -every increase of pressure in the large intestine must force the two -lips of the valve together and close it. - -The importance of the competence of the ileocæcal valve under normal -conditions cannot be appreciated until the function of the first part -of the colon is considered. In order that this part of the intestinal -mechanism may perform its service, the competence of the valve for the -food which enters the colon from the ileum should be perfect. As a -matter of fact, such is the case. Not only does the activity of the -colon prove this statement, but the failure of every attempt to drive -the food in the colon back through the valve into the ileum confirms -the proof. Again and again I have tried, by manipulation through the -abdominal wall, to press the normal contents of the colon downward with -sufficient force to cause them to return to the small intestine, but -without success. The valve held perfectly. - - - THE MOVEMENTS OF THE LARGE INTESTINE - -When the large intestine is full, palpation through the abdominal wall -demonstrates that the material in the lower descending colon and in -the sigmoid flexure is usually composed of hard, incompressible lumps, -while that in the ascending and transverse colon and the cæcum is -soft, permitting the walls of the gut to be easily pushed together. -The condition of the contents in these two regions seems to indicate -a rough division of the large intestine into two parts, and the -mechanical activities of these two parts verify the differentiation. In -the descending colon the material is very slowly advanced by rings of -tonic constrictions (see Fig. 7); in the ascending and transverse colon -and in the cæcum by far the most common movement is an antiperistalsis. - -_Antiperistalsis in the colon._--The colon of cats which have been -without food for a day usually contains enough gas to make the position -of the gut distinguishable with the fluorescent screen (see Fig. 1). -The first food to enter the colon from the small intestine is carried -by antiperistaltic waves into the cæcum (Fig. 1), and all new food as -it enters is also affected by these waves. Thus the contents of the -colon, instead of being driven immediately toward the rectum by slow -peristalsis, as is the general opinion, are first repeatedly pushed -toward the cæcum by an antiperistaltic action. - -These antiperistaltic waves follow one after another like the -peristaltic waves of the stomach (see Figs. 5, 6, and 10). They begin -either on the more advanced portion of the food in the colon (when only -a small amount is present), or at the nearest tonic constriction, which -is usually at the turn between the transverse and descending colon -(Figs. 7 and 8.) The waves rarely run continuously for a long time. -When the colon is full, it is usually quiet. The first sign of activity -is an irregular undulation of the walls, then very faint constrictions -passing along the gut towards the cæcum. These constrictions may -first appear only on the ascending colon. As they continue coursing -over the intestine they become deeper and deeper, until there is a -marked bulging between successive constrictions. When the waves have -thus become more prominent, they are seen to start near the end of -the transverse colon and pass without interruption to the end of the -cæcum. After these deepest waves have been running for a few minutes -the indentations grow gradually less marked, until at last they are so -faint as to be hardly discernible. The final waves are sometimes to be -observed only at the end of the transverse colon. - -Such a period of antiperistalsis lasts from two to eight minutes, -with an average duration of four or five minutes. The periods recur -at varying lengths of time; in one instance a period began at 1.38 -P.M. and was repeated at 2.06, 2.34, 2.55, 3.15, and at 3.36, when -the observation ceased; in another instance a period began at 2.43 -P.M., and was repeated at 2.57 and at intervals of from ten to fifteen -minutes thereafter while the animal was being watched. The waves have -nearly the same rate of recurrence as those in the stomach; about five -and a half waves pass a given point in a minute, _i. e._, eleven waves -in two minutes. This rate has proved fairly constant in different cats -and at different stages in the process of digestion; in one case, -however, the waves passed at the rate of nine in two minutes. - -The stimulating effect of rectal injections on the movements of the -small intestine has already been noted. Enemata have also pronounced -stimulating action on the antiperistalsis of the colon. Usually the -almost immediate result of a rectal injection of warm water is the -appearance of deep antiperistaltic waves, which often continue running -for a long period. In one case, after an injection of 50 c.c. of warm -water, the waves followed one another with monotonous regularity during -an observation lasting an hour and twenty minutes. The manner in which -this antiperistaltic mechanism affects nutrient enemata introduced into -the bowel will be discussed in the section devoted to the question of -antiperistalsis. - -These constrictions passing backward over the colon do not force -the normal contents back through the valve into the small intestine -again. I have seen hundreds of such constrictions, and only twice have -there been exceptions to this rule,--once under normal conditions, -when a small mass slipped back into the ileum, and at another time -when a large amount of water had been introduced into the colon. The -importance of the competence of the ileocæcal valve is now apparent; -indeed, antiperistalsis in the colon gives new meaning and value to -the location of a valve at the opening of the ileum. For, inasmuch -as the valve is normally competent, the constrictions repeatedly -coursing towards it force the food before them into a blind sac. The -effect on the food must be the same as the effect seen in the stomach -when the pylorus remains closed before the advancing waves. The food -is pressed forward by the approach of each constriction; but since -it cannot go onward in the blind sac, and is, moreover, subjected to -increasing pressure as the constriction comes nearer, it is forced -into the only way of escape, _i. e._, away from the cæcum through -the advancing constricted ring. About twenty-five waves affect every -particle of food in the colon in this manner during each normal period -of antiperistalsis. The result must be again a thorough mixing of the -contents and a bringing of these contents into close contact with the -absorbing wall--a process which has already been variously repeated -many times in the stomach and in the small intestine. - -Two other movements have been observed in the ascending colon, but -they are rare appearances. The first of these was a serial sectioning -of the contents noticed in an animal given castor oil with the food. -A constriction separated a small segment in the cæcum; another -constriction then cut off a segment just above the first, and with the -disappearance of the first constriction the two separated segments -united. A third segmentation took place above the second, and the -changes occurred again. Thus the whole mass was sectioned from one -end to the other; and no sooner was that finished than the process -began again and was repeated several times. A slight modification of -this movement was observed in a colon containing very little food. The -mass was pressed and partially segmented in the manner characteristic -of the small intestine, and was thus again and again spread along -the ascending colon, and each time swept back into a rounded form -by antiperistalsis. The second of the two movements mentioned above -consisted in a gentle kneading of the contents. This was caused by -broad constrictions appearing, relaxing, appearing, relaxing, over -and over again, in the same place. When several of these regions were -active at the same time, they gave the food in the colon the appearance -of a restless undulatory mass. Once a constriction occurred and -remained permanently in one place, while the bulging parts on either -side of it pulsated alternately, at the rate of about eighteen times -in a minute, with the regularity of the heart-beat. Although these -phenomena are somewhat striking, they are not usual, and are in no way -so important as the antiperistalsis. - -_The changes when food enters the colon._--The passage of food through -the ileocæcal valve seems to stimulate the colon to activity. As food -is nearing the ileocæcal valve the large intestine is usually quiet and -relaxed (Fig. 6, 4.00), though occasionally indefinite movements are -to be observed; and sometimes just before the food reaches the end of -the ileum the circular fibres of the colon in the region of the valve -contract strongly, so that a deep indentation is present there. The -indentation may persist several minutes; it disappears as the muscles -relax just previous to the entrance of the food. The food is moved -slowly along the ileum and is pushed through the valve into the colon. -The moment it has entered a strong contraction takes place all along -the cæcum and the beginning of the ascending colon, pressing some of -the food onward, and a moment later deep antiperistaltic waves (Fig. 6, -4.03) sweep down from the transverse colon and continue running until -the cæcum is again normally full, _i. e._, for two or three minutes. - -[Illustration: - FIGURE 6.--Tracings showing changes when food enters the colon and - also the first tonic constriction. 4.00, the colon relaxed as food - approaches in the ileum. 4.03, the colon contracted and traversed by - antiperistaltic waves after the food has entered.] - -_The appearance of tonic constrictions._--It has already been noted -that as the food accumulates in the ascending colon it is at first -confined to this region by antiperistaltic waves. With further -accessions, however, the contents naturally must be pressed more and -more into the transverse and descending colon. In the early stages of -this accumulation, while the food lies chiefly in the ascending colon, -the only activity of the muscular walls is the antiperistalsis. As the -contents extend along the intestine a deep constriction appears near -the advancing end and nearly separates a globular mass from the main -body of the food (Fig. 6). The contents of the large intestine progress -farther and farther from the cæcum; meanwhile new tonic constrictions -appear which separate the contents into a series of globular masses. -And as the number of these divisions increases they take a position -farther from the cæcum, so that they are present chiefly in the -descending colon (Fig. 7). Raiser has recorded a similar appearance -in the terminal portion of the rabbit’s colon, in which deep circular -constrictions separate the scybalous masses. He maintains that these -masses are pushed onward by the constrictions. Comparing tracings -made at rather long intervals (forty-five minutes), I found that the -rings disappear from the transverse colon, and then are present with -the waste material in the descending colon. Thus in the cat also -these rings, which seem with short observation to be remaining in one -position, are in reality moving slowly away from the cæcum, pushing -the hardening contents before them. The contents at this stage are no -longer fluid, and consequently they must offer considerable resistance -to a force pushing them through the colon. It is an advantage to have -this pultaceous substance propelled in divisions rather than in a -uniformly cylindrical mass, since the fibres along the length of the -mass are thereby rendered effective. Such are the functions of the -persistent rings; they form the waste matter into globular masses at -the end of the transverse colon and slowly push these masses onward. - -[Illustration: - FIGURE 7.--Radiograph showing the region of tonic constrictions - (descending colon) and the region of antiperistalsis (transverse and - ascending colon).] - -In the transverse colon, which is free from the slowly moving rings, -the antiperistaltic waves have full sway. In the region of the -tonic rings an infrequent or even a slowly periodic relaxation and -contraction are often to be observed. These changes seem to take place -in all the rings at about the same time. Once I saw antiperistaltic -waves running over the uppermost of four segments, but since the rings -on either side of the segment held tightly, the waves had merely the -effect of churning the material of the segment and did not move it -onward. Inasmuch as the material in these segments at first is soft, so -that the segments are easily compressible, while the fæcal masses which -are the final result are relatively hard and dry, it follows that even -within the confines of these persistent rings some absorption is taking -place. - - - DEFECATION - -The process of clearing the colon is a process of repeated reduction -of the amount of material present. Figure 8 (3.11) is a radiograph -showing the food in the colon at 3.11 P.M. About 3.25, with a slow, -sweeping movement, the gut swung around so that the ascending colon was -lying in the position of the last half of the transverse colon, and the -transverse colon had taken the position of the descending part (Fig. -8, 3.25). At the same time the tonic constrictions disappeared and -were replaced by a strong, broad contraction of the circular muscle, -tapering the contents off on either side in two cones. The region of -strongest contraction was apparently drawn downward with the rest of -the gut by a shortening of the descending colon. As the intestine -swung around, more material was forced into the rectum, and when the -swinging of the intestine stopped, the constriction which divided -the lumen passed slowly downward, and with the aid of the muscles -surrounding the abdominal cavity, pushed the separated mass out of -the canal.[35] After the terminal mass had thus been pushed out, the -colon with the remainder of its contents returned to nearly its former -position (Fig. 8, 3.46). About two hours afterward this remnant had -been spread throughout the length of the large intestine by means of -the slowly moving rings. Figure 7 is a radiograph of the same colon -pictured in Figure 8; the radiograph was taken at 11.50 A.M., and at -12.15 P.M. the material in the lower descending colon was forced out in -the manner above described. Within three hours the remaining portion -had been spread into the evacuated region, as shown in Figure 8, 3.11. -The manner in which the material is spread from the region of the -antiperistaltic waves into the region of the slowly advancing rings -presents a problem. During normal living new food constantly arriving -in the colon must force the old contents forward just as the later -parts of a meal force forward the earlier parts; there is no doubt, -however, that most of the contents of the cæcum and the ascending colon -may be passed onward even during starvation. The emptying of these -regions, according to my observations, is never complete; for after -considerable time has elapsed and the large intestine is cleared and -dilated with gas, some substance is still to be detected in the cæcum -and clinging to the walls of the ascending colon. The only activities -manifested here are the antiperistaltic waves and the strong tonic -contraction of the whole circular musculature shown in Figure 6. It is -clear that the latter activity would serve to press into the transverse -colon a considerable portion of the contents of the ascending colon, -and the remnant seen clinging to the walls would be the part not thus -pressed forward. - -[Illustration: - 3.11 3.25 3.46 - - FIGURE 8.--Two radiographs and a tracing showing the changes taking - place in defecation. 3.11, material in the colon. 3.25, colon carried - downward and terminal mass separated. 3.46, after defecation, when the - colon returns to former position. Defecation occurred at 3.27.] - -Twice I have seen appearances which might account for the emptying of -the first portion of the large intestine in a more thorough manner -than that above described. At one time, without apparent stimulation, -strong tonic contraction occurred along the entire length of the -ascending colon, which forced the contents almost wholly into the -transverse portion. This action seemed merely an exaggerated form of -that observable after food passes the ileocæcal valve (see Fig. 6). At -another time, after a mass of food had passed through the ileocæcal -valve, after the ascending colon had contracted generally and the -antiperistaltic waves had coursed over it in the usual manner, a deep -constriction appeared at the valve and ran upward without relaxation -nearly the length of the ascending colon, pushing the contents before -it. For an instant the wave paused; then the constriction relaxed and -the food returned towards the cæcum. These observations indicate that -either a general contraction of the wall of the large intestine or a -true peristalsis may be effective in pressing waste matter from the -region where antiperistalsis is the usual activity into the region -where the slowly advancing rings may carry it on to evacuation (see -Fig. 7). - - - THE QUESTION OF ANTIPERISTALSIS - -In 1894 Grützner published an observation and made an assumption about -which there has since been much controversy. He maintained that when -normal salt solution, holding in suspension hair, powdered charcoal, or -starch grains, is injected into the rectum, it is carried upward into -the small intestine and may even enter the stomach. These experiments -have been repeated by several observers. Some have confirmed Grützner’s -results; others have failed, after using most careful methods, to -find any evidence of the passage of the injected material back to the -stomach, and they have declared that the apparent success was due to -carelessly allowing the food of the animal to become contaminated with -the test materials, so that these were introduced into the stomach by -way of the mouth. That antiperistalsis does not occur in the small -intestine seems to be proved by Mall’s experiment of reversing a -portion, sewing it in place, and then finding that the food does not -pass the reversed region, but collects at the upper end. Sabbatani -and Fasola reversed stretches of small intestine of varying length, -and found that the reversed portions allowed fluids to pass, but that -the persistence of the physiological direction of movement caused an -accumulation of undigested food in the region of the upper suture. -However a portion of the intestine lay in relation to the rest, it -always manifested the normal peristalsis. Many other observers working -directly on the intestine confirm this testimony and state that the -progress of the constriction-rings is always downward, and that -antiperistalsis is not physiological. In 1898, however, Grützner took -his stand again in favour of a backward movement in the intestines, -and in a somewhat metaphysical manner argued that peristalsis and -antiperistalsis belong to each other just as relaxation of muscle is -related to contraction. He assumed that as the contents are advanced -by slow peristalsis, so are they returned by a similar movement in -the opposite direction, and he mentions several pathological cases -(fistula of intestine) to substantiate the assumption. - -By means of the X-rays it is possible to see just what takes place when -a fluid is injected into the rectum. For the purpose of determining -how nutrient enemata are received and acted upon in the intestines, -I have introduced thin, fluid masses in large and small amounts, and -thick, mushy masses in large and small amounts, in different animals. -The enemata consisted of 100 c.c. of milk, one egg, ten to fifteen -grams of bismuth subnitrate, and two grams of starch to hold the -bismuth powder in suspension. To make the thick enema all these were -stirred together and boiled to a soft mush; to make the thin enema -all the parts were boiled together except the egg, which was added -after the boiled portion was cooled. The small amount injected was 25 -c.c.; the large amount almost 90 c.c., about the capacity of the large -intestine when removed from the body. The animals were given first a -cleansing injection, and after this was effective the nutrient material -was introduced. In order to make sure of the observation, a control -radiograph was first taken to show no bismuth food present, and other -radiographs taken at varying intervals after the injection to record -the course the food was following. - -[Illustration: - 1.50 2.15 3.00 - - FIGURE 9.—- Radiographs showing that after a large nutrient enema - (about 90 c.c.) has been given the food is forced more and more from - the large into the small intestine. The enema was introduced at about - 1.40 P.M. At 3.00 segmentation was occurring in many loops.] - -These experiments show that when small amounts of nutrient fluid are -introduced they lie first in the descending colon. In every instance -antiperistaltic waves are set going by the injection, and the material -is thereby carried to the cæcum. When large amounts are injected they -stop for a moment in the region between the transverse and descending -colon, as if a constriction existed there. Then a considerable amount -of the fluid passes the point, and antiperistaltic waves carry it -to the cæcum. In any case the repeated passing of the waves seems -to have the effect of promoting absorption, for in the region where -these waves continue running, the shadows become gradually more dim, -and finally the bismuth appears to be only on the intestinal walls; -in other regions, _e. g._ in the descending colon, the shadows retain -their original intensity. Small injections have never in my experience -been forced even in part into the small intestine; but with the larger -amounts, whether fluid or mushy, the radiographs show many coils of the -small intestine containing the bismuth food. - -The passage of the injected material beyond the ileocæcal valve is -probably due entirely to antiperistalsis in the colon,--a factor -unknown to both Grützner and his opponents. The valve, which is -thoroughly competent for food coming normally from the small intestine -into the large, is curiously incompetent for a substance, even of the -consistency of thick cream, introduced in large amount by rectum. When -the valve first permits the food to enter the ileum, the fluid pours -through and appears suddenly as a winding mass occupying several loops -of the intestine (Fig. 9, 1.50, about ten minutes after the injection). -The mass is continuous from the valve to the other end; antiperistalsis -is therefore not visible in the small intestine under the circumstances -of this experiment. The antiperistaltic waves of the colon, however, -continue running; the transverse and ascending colon are thus almost -emptied, and the small intestine more and more filled with food (Fig. -9, 2.15 and 3.00). After a short time the typical segmenting movements -can be seen in the loops, busily separating the food into small masses, -and over and over again dividing and redividing them. - -I have never seen food material pass back from the colon so far as the -stomach; but once, about ten minutes after an injection of 100 c.c. of -warm water, the cat retched and vomited a clear fluid resembling mixed -water and mucus. In the fluid were two intestinal worms still alive. - -The importance of the mechanism by which nutrient enemata are passed -backward in the intestine is evident. In the colon the nutrient -material is worked over by the antiperistaltic waves, intimately -mixed with whatever digestive juices may be present, and exposed to -the organs of absorption in that region. If the enemata are large, -the digestive and absorptive processes are by no means confined to -the colon, but may take place along extensive surfaces of the small -intestine. I have repeatedly seen rhythmic segmentation active -throughout many loops of the small intestine, thus exposing the -injected food to the same mixing and absorbing processes as affect the -nutriment which has come through the stomach in a normal manner. - - - THE EFFECT OF EMOTIONS AND SLEEP - -Observations on the stomach of the cat showed that the peristalsis -is inhibited whenever the animal manifests signs of anxiety, rage, -or distress. Since the extrinsic innervation of a large part of -the intestinal tract is the same as that of the stomach, it is of -interest to note the effect of emotional states on the movements of -the intestines. Esselmont, in a study of the dog’s intestine, noted -constantly after signs of emotion a marked increase of activity lasting -for only a few moments. Fubini also observed that fear occasioned more -rapid peristalsis. There is no doubt that many emotional states are -a strong stimulus to peristalsis, but it is equally true that other -emotional states inhibit peristalsis. In the cat the same conditions -which stop the movements of the stomach stop also the movements of the -intestines. - -[Illustration: - FIGURE 10.--Tracings showing the effect of excitement on - antiperistalsis in the colon.] - -The female cats used in these observations ordinarily lie quietly on -the holder and make no demonstration. Sometimes, however, with only a -little premonitory restlessness, the cat suddenly flies into a rage, -lashing her tail from side to side, pulling and jerking with every -limb, and biting at everything near her head. During such excitement, -and for some moments after the animal becomes pacified again, the -movements, both of the large and small intestine, entirely cease. Such -violence of excitement is not necessary to cause the movements to stop; -a cat which was restless and continually whining while confined to the -holder showed no signs of intestinal movements during any period of -observation (one period lasted more than an hour), although the changes -in the distribution of the food observable from one period to the next -proved that movements were going on during the quiet intermissions. -In another cat, uneasy and fretful for fifty minutes, no activity was -seen; then she became quiet for several minutes, and peristalsis of the -small intestine appeared. - -When the segmentation process in the small intestine is stopped by -excitement the segments unite and the series of parts returns to the -form of a solid string. The change occurring in the large intestine -when the antiperistalsis is inhibited by excitement is shown in Figure -10. The tonic constrictions in the descending colon are apparently not -affected by emotional states, for they do not seem to relax in the -excitement which causes the movements to cease. - -By holding the mouth and nostrils closed, or by pressing between the -rami of the jaw, the breathing may be stopped. As soon as the cat shows -distress from lack of breath every form of intestinal movement stops. - -The statement is sometimes made in text-books of physiology that the -gastric and intestinal mechanisms cease to act during sleep. It is -worthy of note that nearly all the animals curled up and slept during -the time between observations; nevertheless, the progress of the food -through the intestines continued. The statement is also made that at -night, even without sleep, the intestines are almost entirely at rest; -that this is their normal time for repose. I have seen both large and -small intestines actively at work, however, from half past nine until -half past ten o’clock at night. - - - SUMMARY - -1. Bismuth subnitrate, 10 to 33 per cent, mixed with the food renders -the movement of the intestinal contents, and thereby the movements of -the intestinal walls, visible on the fluorescent screen. - -2. The activity most commonly seen in the small intestine is the -simultaneous division of the food in a coil into small segments, and -a rhythmic repetition of the segmentation each time applied to the -new segments formed from parts of those just divided. In the cat this -rhythmic segmentation may proceed at the rate of thirty divisions per -minute. The effects of the constrictions causing the segmentation are -the mixing of the food and the digestive juices, the bringing of the -digested food into contact with the absorbing mechanisms, and the -emptying of the venous and lymphatic radicles of their contents by -compression of the intestinal wall. - -3. Peristalsis is usually combined with segmentation. As the food is -advancing, interfering constrictions often separate the rear end of the -mass from the main body. The separation is momentary, however; the -rear end is swept into union with the main body again, and the whole -mass is pushed onward until another constriction repeats the changes. - -4. The ileocæcal valve is thoroughly competent for food entering the -colon from the ileum. - -5. The usual movement of the transverse and ascending colon and the -cæcum is an antiperistalsis. This recurs in periods about every fifteen -minutes, and each period lasts commonly about five minutes; the waves -recur during a period at the rate usually of eleven waves in two -minutes. This antiperistalsis gives new significance to the ileocæcal -valve; for the food, now in a closed sac, is thoroughly churned and -mixed by the constrictions running towards the cæcum, and again exposed -to absorbing walls without any interference with the processes in the -small intestine. - -6. As soon as new food enters the large intestine a strong general -contraction takes place along the cæcum and ascending colon, forcing -some of the food onward; a moment later antiperistaltic waves begin to -pass. - -7. With the accumulation of material in the transverse colon, deep -tonic constrictions appear one after another and carry the material -into the descending colon, leaving the transverse and ascending -portions free for the antiperistaltic waves. - -8. In emptying the large intestine the material in the lower descending -colon is first carried out by combined peristalsis and pressure of -abdominal muscles; the remainder of the material is then spread into -the evacuated region, and this region is again cleared; the second -remainder may be similarly affected. In normal life the new food -arriving in the colon must force forward the old contents of the -ascending and transverse colon. - -9. The observations have revealed no evidence of antiperistalsis in -the small intestine, but since the ileocæcal valve will allow nutrient -material under pressure to pass backward, the antiperistalsis of the -large intestine may force into the small intestine a considerable -portion of a large nutrient enema. Segmentation in the small intestine -affects such an enema precisely as it affects food which has passed -normally through the stomach. - -10. Signs of emotion, such as fear, distress, or rage, are accompanied -by a total cessation of the movements of both large and small -intestines. The movements continue in the cat both during sleep and at -night. - - - - - THE BATTLE CREEK LABORATORIES - -THE MAMMOTH SANITARIUM AND THE LARGE ADOPTED FAMILY OF DR. AND MRS. J. - H. KELLOGG - - - [A report of one experiment has been selected from _Modern Medicine_ - relative to the work of the laboratories connected with the Battle - Creek Sanitarium because it relates to the effect of cooking and - mastication upon food in illustration of the statement of Dr. Campbell - pertaining to these aids to digestion. Much more evidence could be had - from the Sanitarium reports, but sufficient has already been given - herewith from various authoritative sources to justify our claims of - the great importance of mouth-treatment in human nutrition. - - It may be said here, however, that the trial of thorough mouth-work as - an aid to digestion, which has been in progress at the Sanitarium for - more than a year, and which has finally been accepted and prescribed - as the first requirement of the treatment of patients, is of the - utmost significance. This is, by far, the largest sanitarium in the - world, having some hundreds of physicians, nurses, and other attachés, - and treating many thousands of patients annually. The “cure” is based - upon natural methods of recuperation, and while all of the staff, both - medical and surgical, are fully equipped diplomatists, and whereas the - organisation has a legally and professionally accepted medical school - of its own, so-called medicines are rarely used, and never except as - antidotes to specific poisons. Nature is assisted by scientific means - to do the curing, and now that an economic nutrition to relieve the - exhausted system of the patient from all possible strain through ample - mouth-treatment of food, as intended by the anatomical, dental, and - chemical plan on which man is constructed, has been tried and accepted - as a fundamental principle of the institution, it gives a practical - indorsement of the claims set forth in “Glutton or Epicure,” and in - this present book, and declares that they are of greatest importance - in securing health and efficiency. - - The Battle Creek Sanitarium is a philanthropic and humanitarian - institution operating under a perpetual charter which compels the use - of all the profits gained to foster the spread of the humanitarian - work. More than sixty branches of the parent institution have been - established in or near large cities in different parts of the world, - under the title of The American Medical Missionary Association, - and each of these branches conducts a life-saving business on Good - Samaritan principles. The organisation started its medical missionary - work some thirty-seven years ago, with almost no capital and only - one patient, in a small two-storey frame house, in the then small - village of Battle Creek, Michigan. The incorporators were religious - enthusiasts who believed that Christianity should be expressed in - works as much as in faith, in curing the sick and healing the wounded, - and thus preparing the unfortunate for the reception of moral and - spiritual inspiration. - - The best evidence that this scheme of procedure to attain the ultimate - end was a good one is shown by the success of the institution in - its growth from such small beginning to the immense proportions of - the present time, with one of its buildings nearly a thousand feet - in length and five storeys in height and numerous other buildings - radiating from the main one and scattered about it in a finely wooded - park. Fire came and destroyed the old building and all its contents, - but yet it was soon rebuilt, and the concern goes on growing and - growing, because the foundation principle of the institution is the - beautiful Golden Rule, and the method of treatment employed is taken - from the open book of Nature. - - While the organisation was primarily based upon a special religious - creedal enthusiasm, it has become so broadly altruistic as to suggest - a return to original Christianity as defined in the Sermon on the - Mount. In such Christian expression honest agnostics, born Buddhists, - and the tolerant of all the different Christian creeds may join and - say amen! - - One of the splendid results of an economic nutrition, attained by - following the natural requirements and impulses, is the curing of - many diseases, among them several forms of constipation. The writer - has a genuine admiration for the spirit that is the motive power - of the Battle Creek Sanitarium and firm belief in the Christianity - demonstrated in the work, especially in the private experiment of Dr. - and Mrs. Kellogg, with their family of adopted waifs. Twenty-four - children of unfortunate parents, waifs so unfortunate in their - attractability as to be hopelessly neglected, have been gathered - under this sheltering roof and are showing their mettle and gratitude - by splendid behaviour and brilliant accomplishment in a manner that - any proud parent might approve. To miss any opportunity to express - gratitude to Dr. and Mrs. Kellogg for giving us such a splendid - example of the true meaning of practical Christianity would be showing - symptoms of the worst form of constipation; viz., constipation of - appreciation and affection.—HORACE FLETCHER.] - - - - -EXPERIMENTAL INVESTIGATION OF THE INFLUENCE OF MASTICATION AND COOKING - OF FOOD, ETC., IN THE LABORATORIES OF THE BATTLE CREEK, MICHIGAN, - SANITARIUM, UNDER THE DIRECTION OF DR. J. H. KELLOGG - - From _Modern Medicine_ - - -The table clearly shows the effect of cooking and the effect of -mastication upon the salivary digestion of food. Column 1 shows the -results obtained after an ordinary test meal consisting of 1½ ounces -of water biscuit to 8 ounces of water; column 2, 1½ ounces of water -biscuit ground fine, mixed with water and swallowed without chewing; -column 3, test meal consisting of 1½ ounces of raw wheat flour and -8 ounces of water; column 4, test meal consisting of 1½ ounces of -unground pearled wheat with 8 ounces of water. - - ═════════════════════════════════╤════════╤════════╤══════╤══════ - │ Water │ Water │ │ - │biscuit,│biscuit,│ Raw │ Raw - │ well │ not │flour.│wheat. - │chewed. │chewed. │ │ - │ 1 │ 2 │ 3 │ 4 - —————————————————————————————————┼————————┼————————┼——————┼—————— - Total acidity (A) │ 0.142 │ 0.140 │0.204 │0.136 - Calculated acidity (A´) │ 0.156 │ 0.132 │0.186 │0.128 - Total chlorine (T) │ 0.296 │ 0.284 │0.332 │0.272 - Free HCl (H) │ 0.050 │ 0.028 │0.056 │0.052 - Combined chlorine (C) │ 0.106 │ 0.104 │0.130 │0.076 - Fixed chlorides (F) │ 0.114 │ 0.152 │0.146 │0.144 - Maltose (M) │ 1.088 │ 0.272 │0.000 │0.000 - Dextrine and soluble starch (D) │ 0.812 │ 0.548 │0.300 │0.448 - │ │ │ │ - COEFFICIENTS │ │ │ │ - │ │ │ │ - Digestion of albumin (_a_) │ 0.82 │ 0.97 │1.00 │1.00 - Digestion of starch (_b_) │ 0.71 │ 0.42 │0.00 │0.00 - Salivary activity (_c_) │ 1.17 │ 1.11 │1.14 │1.37 - Fermentation (_x_) │ 5.00 │ 11.00 │6.00 │6.00 - Chlorine liberation (_m_) │ 0.80 │ 0.70 │0.85 │0.71 - —————————————————————————————————┴————————┴————————┴——————┴—————— - -Several points of interest are to be noted in the above table, the -first and most conspicuous of which is the fact that the saliva did -not act at all upon the raw flour and raw wheat, as shown by the total -absence of maltose in the cases represented in columns 3 and 4. The -small amount of dextrine and soluble starch shown was, perhaps, already -present in the raw grain, but this point I have not investigated. -It is clear, however, that no sugar was produced when raw starch was -taken, whereas the amount of sugar produced after the ordinary test -meal was more than 1 gram in each 100 c.c. of stomach fluid; in other -words, the stomach fluid contained more than one per cent of sugar -without taking into account the amount which had been absorbed. - -The figures for maltose in column 2 represent a test meal in which -little or no saliva was mixed with the test meal, the food being -swallowed without chewing, indicating very slight action of the saliva, -the amount of maltose found in the stomach fluid being but a trifle -more than one-fourth the amount obtained after an ordinary test meal. -The amount of soluble starch and dextrine was less than half the normal -amount in the case of the raw flour, and but little more in the case of -the raw wheat. - -Another point of interest is the increased amount of lactic acid found -in the test meal taken without chewing, represented in column 2. The -coefficient of fermentation which represents the number of milligrams -of lactic acid (as expressed in terms of HCl) found in 100 c.c. of -stomach fluid was more than double that found after the same kind -of test breakfast properly masticated, represented in column 1. The -results of this experiment distinctly associate acid fermentation with -imperfect mastication and imperfect salivary digestion. - -Another fact noted in a comparative study of the results of the -analysis of over 5000 stomach fluids, which very strongly confirms -this idea, is that starch conversion is usually complete in cases of -apepsia, while lactic acid is conspicuous by its absence. In nearly all -cases of apepsia which I have encountered, numbering about forty cases -in all, the most delicate tests for lactic acid have failed to show its -presence except in the most minute quantities; in most cases it was -entirely absent. - -There are a number of other points of interest in the above table in -addition to those which relate particularly to starch digestion. One of -the most noteworthy of these is the fact that the digestion of albumen -was not unfavourably influenced by the neglect to masticate the food, -the coefficient of digestion, in fact, being raised from .82 to .97. -This coefficient is a qualitative and not a quantitative index. The -higher coefficient indicates a more perfect elaboration of proteids and -a close approach to an absolutely perfect proteid digestion. - -Another fact of perhaps even greater interest has relation to the -digestion of albumen when the wheat was eaten raw, in the form of -either flour or wheat. The coefficient of proteid digestion in both -cases, as shown in columns 3 and 4, was 1.00, indicating perfect -elaboration of the albuminoids. From this it appears that raw gluten, -or the proteids of wheat, is digested more perfectly when taken in a -raw state than when cooked, the very opposite of which we have seen -to be true of starch. The digestion of raw starch may take place in -the intestines, by the action of the pancreatic juice, but cannot take -place in the stomach, for the reason that the saliva has not the power -to penetrate the cellulose envelope of the starch granule, and hence -cannot digest raw starch. - -This fact coincides in a most interesting manner with the biological -fact that man is by nature a frugivorous animal. In the process of -ripening, the starch of fruits undergoes a hydration similar to that -which takes place in cooking and in pancreatic digestion, whereby -the insoluble starch is converted into soluble starch, dextrine, and -sugar. This explains, also, why well-ripened fruit may be eaten raw -with impunity, while unripe fruit and farinaceous food of all sorts -require cooking. In his diet, man, like his nearest relative, the -monkey, being naturally a frugivorous animal, may eat fruits in the -state in which Nature has provided them; but when he introduces other -natural products into his bill of fare, he must adopt artificial means -for securing the preparation for digestion which Nature makes in the -ripening process of fruits. - -The coefficient of chlorine liberation (_m_) is very nearly uniform, -indicating that the mastication of food and the cooking of food have -little influence upon this digestive function. - -The coefficient of salivary activity (_c_) was determined independently -for each test breakfast. Its practical uniformity indicates that there -was no essential change in the character or quality of the saliva to -account for the differences shown by the totals in relation to the -stomach digestion of starch. - - - - - DR. EDWARD HOOKER DEWEY AND THE “NO BREAKFAST PLAN” - - - The “No Breakfast Plan,” evolved from the long experimental experience - of Dr. Dewey, to secure much needed rest for the stomach and - intestines, is described in a book bearing that title which can be - had direct from the author by addressing him at his home, Meadville, - Penn., U. S. A. - - “No Breakfast” is, evidently, a misnomer, but means, in the present - application, an appetite _earned_ after arising from sleep. The - writer, for instance, often begins work so early in the morning that - by the time the ordinary breakfast is ready he has already done a fair - day’s work. - - The writer has no reported details of the work of Dr. Dewey to add - to this volume. In “Glutton or Epicure” full appreciation of this - Esculapian Luther is expressed and extracts of his writings are - reprinted. In fighting for more than forty years for the principle of - less abuse of the tired body of man, Dr. Dewey has rendered a service - that some time will be reckoned very great; and while there is no - scientific report of the good doctor’s work to call for introductory - comment, it would be equally unhealthy to miss an opportunity to - express gratitude for what he has done for us all. - - - - - PROFESSOR JAFFA AND THE FRUITARIANS - - - Professor Jaffa, too, of the University of California, has been doing - most valuable service in testing the usefulness of fruits and nuts as - human foods. He generously furnished the author with elaborate tables - of his results, covering several years of observation, showing low - nitrogen possibilities similar to those demonstrated by the writer and - his colleagues at Cambridge and Yale. These have since been published, - and relating to special kinds of foods, as they do, suggest a wide - range of choice among the fruits of earth; but the collected evidence - of this book shows that human nutrition is best served when the - appetite, being kept at normal, is allowed to make selection from the - whole range of nutritious products furnished by good Mother Nature. - - - - - DR. H. P. ARMSBY - - - In the Oct. 16th, 1903, number of _Science_, also, is an interesting - article by Dr. H. P. Armsby on the heat values and muscular energy - values of different food elements and their isodynamic replacement of - each other under various conditions.—HORACE FLETCHER.] - - - - - Explanation of The A. B. C. Life Series - - THE ESSENTIALS AND SEQUENCE IN LIFE - - -It would seem a considerable departure from the study of menticulture -as advised in the author’s book, “Menticulture,” to jump at once to an -investigation of the physiology and psychology of nutrition of the body -and then over to the department of infant and child care and education -as pursued in the _crêche_ and in the kindergarden; but as a matter of -fact, if study of the causation of human disabilities and misfortunes -is attempted at all, the quest leads naturally into all the departments -of human interest, and first into these primary departments. - -The object of this statement is to link up the different publications -of the writer into a chain of consistent suggestions intended to -make life a more simple and agreeable problem than many of us too -indifferent or otherwise inefficient and bad fellow-citizens make of it. - -It is not an altogether unselfish effort on the part of the author of -the A. B. C. Life Series to publish his findings. In the consideration -of his own mental and physical happiness it is impossible to leave out -environment, and all the units of humanity who inhabit the world are -part of his and of each other’s environment. - -It would be rank presumption for any person, even though gifted with -the means to circulate his suggestions as widely as possible, and -armed with the power to compel the reading of his publications, to -think that any suggestions of his could influence any considerable -number of his fellow-citizens of the world, or even of his own -immediate neighbourhood, to accept or follow his advice relative to the -management of their lives and of their communal and national affairs; -but while the general and complete good of humanity should be aimed -at in all publications, one’s immediate neighbours and friends come -first, and the wave of influence spreads according to the effectiveness -of the ideas suggested in doing good; that is, in altering the point -of view and conduct of people so as to make them a better sympathetic -environment. - -For instance, the children of your neighbours are likely to be the -playmates of your own children, and the children of degenerate parents -in the slum district of your city will possibly be the fellow-citizen -partners of your own family. Again, when it is known that right or -wrong nutrition of the body is the most important agent in forming -character, in establishing predisposition to temperance or intemperance -of living, including the desire for intoxicating stimulants, it is -revealed to one that right nutrition of the community as a whole is an -important factor in his own environment, as is self-care in the case of -his own nourishment. - -The moment a student of every-day philosophy starts the study of -problems from the A. B. C. beginning of things, and to shape his study -according to an A. B. C. sequence, each cause of inharmony is at once -traced back to its first expression in himself and then to causes -influenced by his environments. - -If we find that the largest influences for good or bad originate with -the right or wrong instruction of children during the home training or -kindergarden period of their development, and that a dollar expended -for education at that time is worth more for good than whole bancs of -courts and whole armies of police to correct the effect of bad training -and bad character later in life, it is quite logical to help promote -the spread of the kindergarden or the kindergarden idea to include -all of the children born into the world, and to furnish mothers and -kindergarden teachers with knowledge relative to the right nutrition -of their wards which they can themselves understand and can teach -effectively to children. - -If we also find that the influence of the kindergarden upon the parents -of the infants is more potent than any other which can be brought to -bear upon them, we see clearly that the way to secure the widest -reform in the most thorough manner is to concentrate attention upon the -kindergarden phase of education, advocate its extension to include even -the last one of the children, beginning with the most needy first, and -extending the care outward from the centre of worst neglect to finally -reach the whole. - -Experience in child saving so-called, and in child education on the -kindergarden principle, has taught the cheapest and the most profitable -way to insure an environment of good neighbours and profit-earning -citizens; and investigation into the problem of human alimentation -shows that a knowledge of the elements of an economic nutrition is the -first essential of a family or school training; and also that this is -most impressive when taught during the first ten years of life. - -One cannot completely succeed in the study of menticulture from its A. -B. C. beginning and in A. B. C. sequence without appreciation of the -interrelation of the physical and the mental, the personal and the -social, in attaining a complete mastery of the subject. - -The author of the A. B. C. Life Series has pursued his study of the -philosophy of life in experiences which have covered a great variety -of occupations in many different parts of the world and among peoples -of many different nations and races. His first book, “Menticulture,” -dealt with purging the mind and habits of sundry weaknesses and -deterrents which have possession of people in general in some degree. -He recognised the depressing effect of anger and worry and other -phases of _fearthought_. In the book “Happiness,” which followed next -in order, _fearthought_ was shown to be the unprofitable element of -forethought. The influence of environment on each individual was -revealed as an important factor of happiness, or the reverse, by means -of an accidental encounter with a neglected waif in the busy streets of -Chicago during a period of intense national excitement incident to the -war with Spain, and this led to the publication of “That Last Waif; -or, Social Quarantine.” During the time that this last book was being -written, attention to the importance of right nutrition was invited by -personal disabilities, and the experiments described in “Glutton or -Epicure; or, Economic Nutrition” were begun and have continued until -now. - -In the study of the latter, but most important factor in profitable -living, circumstances have greatly favoured the author, as related in -his latest book, “The A. B.-Z. of Our Own Nutrition.” - -The almost phenomenal circulation of “Menticulture” for a book of its -kind, and a somewhat smaller interest in the books on nutrition and -the appeal for better care of the waifs of society, showed that most -persons wished, like the author, to find a short cut to happiness by -means of indifference to environment, both internal and external, while -habitually sinning against the physiological dietetic requirements of -Nature. In smothering worry and guarding against anger the psychic -assistance of digestion was stimulated and some better results were -thereby obtained, but not the best attainable results. - -Living is easy and life may be made constantly happy by beginning -right; and the right beginning is none other than the careful feeding -of the body. This done there is an enormous reserve of energy, a -naturally optimistic train of thought, a charitable attitude towards -everybody, and a loving appreciation of everything that God has made. -Morbidity of temperament will disappear from an organism that is -economically and rightly nourished, and death will cease to have any -terrors for such; and as _fear_ of death is the worst depressant known, -many of the _worries_ of existence take their everlasting flight from -the atmosphere of the rightly nourished. - -The wide interest now prevalent in the subjects treated in The A. B. C. -Life Series is evidenced by the scientific, military, and lay activity -in connection with the experiments at the Sheffield Scientific School -of Yale University and elsewhere, as related in the “A. B.-Z. of Our -Own Nutrition” and in “The New Glutton or Epicure” of the series. - -The general application is more fully shown, however, by the -indorsement of the great Battle Creek Sanitarium, which practically -studies all phases of the subject, from health conservation and child -saving to general missionary work in social reform. - - HORACE FLETCHER. - - - - - Index - - - A - - A. B. C. Life Series, the, xxiv, 15, 47; - explanation of, 399-407 - - Abdominal glands, the, 189, 190 - - —— muscles, the, 326, 388 - - —— wall, the, 364 - - Abernethy biscuit, 131 - - Acid reaction, of food, 269 - - Acids, stimulating properties of, 270; - supplement weak action in the stomach, 270; - special relation to the pancreas of, 270 - - Addison, Joseph, upon the work of Luigi Cornaro, 28 - - Adenoids, largely dietetic in origin, 148-152, 156 - - Afferent nerves, special duty of the peripheral terminations of, 184-185 - - Agriculture, U. S. Department of, 37 - - Albumen, digestion of, 394 - - Albuminoids, the, 395 - - Albuminous foods, minimum amount of, 74, 78 - - Alcoholic beverages, explanation of the use of, 252 - - Algarroba bean, the, 124 - - Alimentary canal, the, 13, 14, 15, 40; - pabulum derived from, 40, 92, 117; - Professor Pawlow’s conclusions concerning, 186; - experimental investigation of the pathology and therapeutics of, - 248, 260, 273, 275, 276, 277 - - Alimentation, human, study of, 13; - theory of, 180 - - Alkalies, the, 278, 279, 280, 281, 282 - - Alkaline reduction, 33, 34, 35, 36, 44 - - —— saliva, 33; - its quantity increased by mastication, 96, 102, 146 - - Alkalinisation, 92 - - Altruism, placed upon a business basis, xxiv - - American Medical Missionary Association, the, 390 - - —— Medical Missionary Cause, the, xxiii - - —— Physiological Society, the, 68 - - Anderson, Dr. William G., 54, 87, 88 - - Anger, causes indigestion, 7 - - Animal economy, 40 - - —— food, necessitates less thorough mastication than vegetable, 67, - 99-100, 173; - influenced less than vegetable by cooking, 118 - - —— organism, the efficiency of, 58 - - Anthropoid apes, 115, 116 - - Antiperistalsis, 326, 333, 342, 345, 364; - in the colon, 365-370; - the question of, 377-383, 384, 385, 387, 388 - - Antiperistaltic waves, 365, 367, 373, 374, 376, 381, 383, 387, 388 - - Antrum, the, 307, 308, 311, 315, 322, 323, 326, 327, 333, 334, 336, - 340, 341, 360 - - Apepsia, 394 - - Appendicitis, relationship between diet and, 141 - - Appendix, the, cause of catarrh of, 141 - - Appetite, demands proteid when wanted, xxxii; - knows what to do and when to do it, xxxiii; - most important factor in digestion, 6; - a perfect indicator, 6; - a creature of the mind, 7; - the caprices of, 7; - easily comprehended, how to read, 8, 9, 12; - an indicator of what the body requires, 20; - will close the valve when enough is eaten, 20; - striking effect of insalivation upon, 50; - fully understood, prevents intemperance in eating or drinking, 95; - sooner satisfied with thorough mastication, 137; - the first and mightiest exciter of the secretory nerves of the - stomach, 210; - is juice, 213; - Dr. Pawlow’s experiment showing value of, 226; - its initial impulse may originate in the stomach, 244; - in the rich and in the poor, 252-253; - care should be taken of, 254; - physicians most often called on to restore, 254; - remarkable how little attention is paid to, 255; - bitters increase, 263, 265; - the strongest of all stimuli to the digestive glands, 263; - connection between gastric juice and, 265. - - —— earned, a preliminary necessity of easy digestion, 180 - - ——, false, 6, 9, 29, 75 - - ——, normal, 6 - - “Appetite juice,” the, 213, 228, 258, 259, 260 - - Apples, 169 - - Appreciation, attention necessary to create, 7; - necessary to stimulate flow of digestive juices, 7, 12 - - Armsby, Dr. H. P., on the heat values and muscular energy values of - different food elements, 397 - - Asiatics, the, consume smaller proportion of proteids, 82 - - Asparagus, 93 - - Astrup, E., 126 - - Athletes, reason for training, 22 - - Attention, necessary to create appreciation, 7; - how to command, 8, 9, 12 - - Atwater, Prof. W. O., 54; - on the daily proteid requirement, 76 - - —— Respiration Apparatus, the, 57 - - Australians, the, 118, 129, 163 - - - B - - Bache Fund, the, 69 - - Bacteria, the action in the intestines of, 39, 117 - - Bacterial digestion, 40 - - —— flora, the, examination of, 26 - - Bacteriology, advances of, 248, 249 - - Bailey, 128 - - Balthazard, experiments of, 314, 315, 327, 328 - - Baltimore, Md., 68 - - Barling, Gilbert, 141 - - Barrett, Robert, 47 - - Bayliss, experiments of, 343, 344, 345, 359 - - Batter pudding, 98 - - Battle Creek, Michigan, 390 - - —— Laboratories, the, 389-391; - experimental investigation of the influence of mastication and - cooking of food, etc., in, 391-396 - - —— Sanitarium, the, xvii, xxiii, xxvii; - described, 389-391 - - Bayert, 123 - - Beans, 95, 132 - - Beaumont, experiments of, 305, 309, 310, 313, 326, 327, 329, 330, 334, - 336 - - Beef, 100 - - Benedict, Prof. Francis G., 54 - - Berlin, 56, 65 - - Berne, Switzerland, 284 - - Betel, chewing, 103, 128 - - Beverages, mastication in the preparation of, 123 - - Bidder and Schmidt, experiments of, 202, 204, 231; - conditions for success, 204-206 - - Bile, the, 360 - - Bitters, therapeutic influence of, 262, 265; - increase the appetite, 263, 264, 265 - - Blondlot, experiments of, 181, 182, 277 - - Blood, the, toxins absorbed into, 40; - influence of the contraction of the masticatory muscles on local - circulation of, 107, 148, 149, 278, 355 - - —— elements, the, 41 - - Blumfield, Dr. Joseph, 26 - - Body, the, considered as an engine, 4, 23; - derives its necessary energy from food, 72; - burdened by excess of food, 73 - - Boer War, the, 11 - - Bolting food, 35, 36, 134, 135, 138, 140 - - Bolus, the, 329, 343, 344 - - Boston Society of Medical Sciences, the, 342 - - Bouillon, 266 - - Bowditch, Dr. Prof. Henry Pickering, xxiv, xxv, 67, 68, 70, 284, 285, - 287, 306 - - Bowel, the, liable to suffer, 140, 345 - - “Bracer,” a, why required, 20 - - Braun and Grützner, experiments of, 278 - - Bread, 78, 98, 99, 132, 137, 143, 171, 270, 271, 274, 275 - - Brinton, experiments of, 329, 330, 334, 336 - - British Guiana, 124 - - —— Medical Association, the, 27, 48, 91, 92 - - “British Medical Journal,” the, 141 - - Bronchitis, 144, 146 - - Broth, strong, 268 - - Brown bread, 43 - - Brussels, 68 - - Buccal digestion, 8 - - —— nerves, the, 194 - - Bushmen, the, 118, 123 - - Butter, 43, 100 - - - C - - Cabbage, why indigestible, 99 - - Cæcum, the, 140, 141, 363, 364, 365, 366, 368, 370, 371, 372, 375, - 376, 377, 381, 387 - - Cake, 132 - - California, University of, 90, 397 - - Calm, easy to cultivate, 7 - - Cambridge, England, xxxi, 26, 47, 49 - - —— tests, the, 47, 69 - - —— University, England, xxv, 26, 53, 68, 91 - - Campbell, Dr. Harry, 8, 12; - on the importance of mastication, 92-179, 389 - - Cancer, produced by inefficient mastication, 138 - - Cane-sugar, changed to grape-sugar, 21, 169 - - Cannon, Dr. W. B., 7, 12; - on “Swallowing and Movements of the Stomach and Intestines,” - 284-300; - on the “Movements of the Stomach Studied by means of - the Röntgen Rays,” 301-341; - on the “Movements of the Intestines Studied by Means of the - Röntgen Rays,” 342-388 - - Carbohydrate foods, 78, 79, 80, 85, 86, 89 - - Cardia, the, ideas of early writers concerning, 303, 304, 325, - 326, 328, 329 - - Cardiac sphincter, the, 307 - - Carelessness, the sin of, xvii - - Carnegie, Andrew, xxxv - - —— Institution, the, 53 - - Carnivora, the, do not masticate, 97, 161 - - Cassava root, 124 - - Cat, the, experiments upon, 289-293, 299, 303, 307, 311, 312, 315, - 320, 322, 325, 333, 335, 337-339, 341, 344, 353, 359, 361, 365, - 366, 372, 382, 383-386, 388 - - Catarrh of the appendix, caused by inefficient mastication, 141 - - Cauliflower, 99 - - “Cause and Prevention of Decay in Teeth, the,” Wallace’s, 161 - - Cavendish lecture, Sir Frederick Treves’s, 140 - - Cell, a, determination of the metabolism of, 40 - - Cellulose, 117, 170 - - Cereals, 78, 84, 146 - - Ceylon, 128 - - Cheese, 43, 95; - when indigestible, 100, 137 - - Chemical excitants, the, 268 - - —— secretion, 259 - - Chemistry, organic, 62 - - ——, physical, 62 - - Chewing, length of time necessary for, xxxii - - Chicken bone, 166 - - Chigin, Dr., experiments by, 214, 216, 282 - - - Children, early feeding of, 130-132, 143; - defective mastication in, 148; - feeding of, 262 - - Children’s Aid Society, the, xxv, 68 - - Chimpanzee, the, 115 - - China, 82 - - Chittenden, Prof. R. H., conducting the experiments at Yale, xvii, 5; - emphasises the want of exact knowledge of nutrition, 53, 67, 68; - the Yale test, 69-91. - - Chop bone, 166 - - Chyme, the, 346, 360, 362 - - Circulation, the, stimulated by mastication, 96, 103, 157 - - Cocoa-nut, 137 - - Coffee, 132 - - Cole, Sidney W., 47; - his paper upon the isolation of the tryptophane element of the - proteid molecule, 47 - - Colon, the, 363, 364; - antiperistalsis in, 365-370; - changes when food enters, 370, 371, 372; - process of clearing, 373-377, 381, 382, 384, 387, 388 - - Comminution, 98, 100, 101 - - _Commonwealth_, the S. S., 69 - - Condiments, influence of, 261, 265 - - Constipation, cannot exist, 43 - - Constriction, waves of, 323, 340, 341 - - Cooked flesh, requires mastication, 97, 174 - - Cooking, influences vegetable more than mineral food, 118; - effect of, 389, 391-396 - - Cornaro, Luigi, reformed manner of living of, ix; - his autobiography, x, xvi, xvii; - Dr. Van Someren’s paper upon his theory of living, 26-46; - his treatise on the “Sure and - - Certain Method of Attaining a Long and Healthful Life,” 28; - Addison’s comments upon his work, 28, 92 - - Craving for food, 256 - - Cream, experiments with, 38-39, 43 - - Cuba, xiv, 70 - - Curr, E. M., 125, 129 - - - D - - Dastre, Dr. Prof. A., 67, 68 - - Day, experiments of, 337 - - Defecation, 373-377 - - Deglutition, Magendie’s theory of, 284, 285; - movements of, 285; - divided into three parts, 285; - Falk’s and Kronecker’s theory of, 286; - the X-ray method in the study of, 287-295; - phenomena of œsophageal, 298-300 - - —— reflex, the, 287 - - Dental caries, causation of, 161 - - Dewey, Dr. Edward Hooker, and the “No Breakfast Plan,” 396, 397 - - De Witt, Assistant Surgeon, Lieut. Wallace, in command of soldiers - in the Yale investigation, xiii, 70 - - Dextrine, 170, 171, 392, 393, 395 - - Diaphragm, the, 324, 326 - - Diet, best manner and system of, xiii; - the optimum, xxxi; - minimum, 74; - the anthropoid stage, 116; - the pre-cooking human stage, 117; - the pre-agricultural cooking period, 118; - the early agricultural age, 119; - the late agricultural period, 120; - for children, 130-132; - relationship between appendicitis and, 141 - - Dietary Ten Commandments, 5 - - Dietetics, precepts of, 272 - - Digestion, appetite the most important factor in, 6; - the true chemical end-point of, 10-11; - effect of the mental state upon, 74, 145; - psychic influence in, 180; - the phenomena in, 251; - thorough mouth-work as an aid to, 389 - - Digestion-ash, the, what it should be like, 10-11, 14; - should not be unclean, 24; - in experiments, 38-39, 42, 43, 47, 51, 79, 83, 84, 85, 94 - - Digestive activity, stopped by anger and worry, 7 - - —— canal, the. _See_ Alimentary canal, the - - —— glands, the, analogy between the innervation mechanism of the - salivary glands and, 188-190; - appetite the strongest of all stimuli to, 263, 280, 282 - - —— juices, the, 7; - appreciation necessary to stimulate flow of, 7, 12, 96; - mastication brings the food into intimate contact with, 98; - quantity of, 267; - relation of milk to the secretion of, 274, 383, 386 - - Digitalis, 281 - - Diphtheria, 149 - - Disease, caused by indiscretions in eating, x, xxxi; - follows disobedience, 29 - - Disobedience, disease follows, 29 - - Distention, 144 - - Distress, effect of, 388 - - Dog, the experiments upon, 181, 194-211, 212-246, 249, 254, 258, - 263, 279, 280, 285, 292, 293, 297, 298, 299, 303, 310, 311, - 313, 314, 315, 336, 344 - - Dolomites, the, 26 - - Drinking, too much, xix, 95 - - Dry food, 97 - - Dunn, Miss Eva, 122 - - Duodenum, the, 303, 315, 356, 360 - - Dyspepsia, dangers of, xv; - might cease to exist, 35 - - - E - - Eat, how to, 19 - - Eating, too much, ix; - indiscretions of, x, xix, xxix, 29, 95, 135; - too fast, 20; - systematic inattention to, 259, 260; - English have made a cult of, 261 - - Economic nutrition. _See_ Nutrition, economic - - Efferent nerves, 184, 185 - - Efficiency, human, the measure of, xxx; - research into causes for, 54 - - Eggs, experiments with, 38, 43, 78, 95, 100, 137, 277 - - “Encyclopædia Britannica,” the, 27 - - Enemata, the, 367, 379, 380, 388 - - Energy, the minimum transformation of, 59 - - ——, potential, 59 - - Engine, an, the body considered as, 4, 23 - - English, the, have made a cult of the art of eating, 261 - - Emetic, an, 325 - - Emotion, inhibition of stomach movements during, 337; - effect of, 383-384, 388 - - Empiricism, medical practice largely based upon, 52 - - Esquimaux, the, 118, 123, 125, 126 - - Esselmont, experiments of, 383 - - Evolution, Nature’s plan of, xi - - Ewald, experiments of, 313, 314 - - Excess, habitual, confirmed by experiments, ix - - Excrements. _See_ Digestion-ash, the - - Excretia. _See_ Digestion-ash, the - - Exercise, necessity of, xxix - - - F - - Fæces, the, 374. _See also_ Digestion-ash - - Falk, Dr., 284; - theory of deglutition of, 286 - - Fallopius, on the functions of the stomach, 302 - - Farinaceous food, 395 - - Fasola, experiments of, 378 - - Fat, potatoes need not produce, 21, 78, 79, 80, 85, 86, 95, 98, 100; - experiments upon, 271, 272, 274 - - Faucial tonsils, the, influence of mastication upon, 148 - - Fear, effect of, 388 - - Fearthought, 404 - - Featherman, 123 - - Fibrin, 276 - - Flesh food, reduction of craving for, 50 - - Fletcher, Horace, Dr. Van Someren’s comments upon the case of, - 30-31; - his experiments confirmed by Marckwald, 46; - Sir Michael Foster’s comments, 48; - the Cambridge tests, 49-52; - the Middletown test, 54-55, 60; - the Yale test, 75-91 - - Flour, 132, 392, 393, 395 - - Food, mal-assimilation of, x; - length of time for chewing, xxxii; - Dr. Kellogg’s estimate of amount habitually used, xxxiv; - mouth-treatment of, 5; - how to masticate and swallow, 8, 9, 31, 32; - actual process of mastication described, 32-34; - important bearing upon the economy of the body of its treatment - in the mouth, 48-49; - its function to supply material from which the body derives - necessary energy, 72; - any excess an incubus, 72-73; - classified under three heads, 78; - in excess, produces a large amount of unnecessary work, 80; - its nutritive value determined by the thoroughness of its - digestion, 79; - softness of, 129; - mastication tends to reduce amount of, 136; - should be eaten with interest and enjoyment, 252; - passionate craving for, 256; - its nutritive value should be considered rather than taste, 261; - the acid reaction of, 269; - relative nutritive values of different, 275, 276; - experiments upon the utilisation of, 275; - effect of the movements of the stomach upon, 328; - circulation of, 329; - experimental investigation of the influence of mastication and - cooking of, 389-396 - - Foster, Sir Michael, xxiv, xxv, 26; - his note upon Dr. Van Someren’s paper, 48-52; - emphasises the want of exact knowledge of nutrition, 52, 53, 67, - 68, 91 - - Fowls, experiments upon, 299 - - Fruitarians, the, 90, 397 - - Fruit sugar, 169 - - Fruits, 43; - under-ripe and over-ripe, 141, 395, 396; - usefulness of, 397 - - Fubini, experiments of, 383 - - Fundus, the, 317, 322, 323, 324, 325, 330, 333, 334, 335, 336, 337, - 340 - - - G - - Galen, on the functions of the stomach, 302 - - Gastric catarrh, 249 - - —— digestion, 309, 316 - - —— glands, the, 182; - the vagus and the sympathetic nerves exciters of, 183, 198; - mechanical and chemical stimulation of the cavity of the mouth - has no effect on, 201; - psychic excitation of, 205; - sleep exercises no restraining influence upon, 206; - the simultaneous excitation of the different sense organs the - first and strongest impulse toward activity of, 210; - psychic secretion the normal commencement of secretory activity - on the part of, 214; - conditions upon which depends the secretory work of, 227; - mechanical stimulation of, 237, 245, 249, 271, 272, 274, 280 - - Gastric juice, the, appreciation necessary to stimulate flow of, 7; - destroys micro-organisms, 41; - its flow increased by mastication, 102, 146; - secretion of, 181, 206, 208, 211, 213, 262; - connection between the appetite and, 265, 266; - experiments for, 267; - too little, 270, 272, 273; - salts of sodium promote a flow of, 277, 279, 280, 329, 334, 335, - 337, 340, 341 - - —— mechanism, the, 385 - - —— movements, the, 301; - early writings on subject of, 302; - later experiments upon, 303, 327, 329, 338 - - —— mucous membrane, the, excitability of, 181, 231, 241, 249, 258, - 259, 264 - - —— muscular fibres, the, 307 - - “Gastric tonics,” 255 - - Gastritis, inefficient mastication may produce, 138 - - Gastro-intestinal catarrh, 144 - - Gastronomic enjoyment, increased by proper mastication and - insalivation, 22 - - Germany, food in, 267 - - Ginger, preserved, 141 - - Gladstone, William E., his theory of mastication, 92 - - Gland metabolism, 277 - - Glinski, Dr., 190, 194, 196, 197 - - Gluten, raw, 395 - - “Glutton or Epicure,” 26, 31, 92, 389, 396. - _See also_ “New Glutton or Epicure, The” - - Goose, the, experiments upon, 288 - - Goose-fat, 100 - - Gorilla, the, 115 - - Gran Chaco Indians, the, 123 - - Grape-sugar, chemically made from cane-sugar, 21, 169 - - Greens, 132 - - Grey, Sir George, 128 - - Griddle-cakes, need not be hurtful, 21 - - Griffin, Charles & Company, 180, 181 - - Grützner, experiments of, 278, 346, 363, 377, 378, 381 - - Gscheidlen, 235 - - Guinea-pigs, experiments upon, 39 - - Gum arabic, chewing, 103 - - Gustatory indifference, 263 - - —— nerves, the, 263, 269 - - Gut, the, 344, 345, 355, 360, 364, 365, 374 - - - H - - Hæmorrhoids, cannot exist, 43 - - Haller, experiments of, 304; - his summary of the motor functions of the stomach, 304-305, 309 - - Harvard Medical School, 68 - - —— Physiological Laboratory, the, 284 - - Haste, danger of, 134-135 - - Headache, produced by inefficient mastication, 138 - - Health, the optimum, xxxi - - Hearing, the sense of, 210 - - Heart, the, stimulated by mastication, 96, 103, 281 - - Heartburn, 144 - - Heat values, 397 - - Heger, Dr. Prof. Paul, 67, 68 - - Heidenhain, 181, 182, 183, 235 - - Herbivora, the, practice thorough mastication, 97 - - Higgins, Dr. Hubert, letter from, xxvii-xxxiii, 47 - - Hirsch, experiments of, 305, 315 - - Hofmeister, experiments of, 305, 308, 309, 310, 311, 313, 314, 326, - 327, 332 - - Hopkins, Dr. F. Gowland, 26; - his paper upon the isolation of the tryptophane element of the - proteid molecule, 47 - - _Hors d’œuvre_, 266 - - Horse, the, experiments upon, 293, 294, 300 - - Hospital Corps, the, at New Haven, xiii, 70 - - Hunger, 241; - “the best sauce,” 254 - - Hyperacidity, 145 - - Hyperæmia, 345 - - Hyperchlorhydria, 144, 147 - - - I - - “Igniting juice,” 260 - - Ignorance, dietic, sin of, xvii - - Ileocæcal valve, the, 355, 362; - the competence of, 362-364, 367, 370, 376, 381, 387, 388 - - Ileum, the, 363, 364, 367, 370, 382, 387 - - India, 82, 128 - - Indians of Honduras, the, 124 - - —— of Nicaragua, the, 124 - - —— of North California, the, 122, 126 - - Indigestion, x; - dangers of, xv; - caused by anger and worry, 7; - “bunching hits” to oppose, 13-16 - - Indol, the odourous, 47 - - Industries, the, mastication in, 124 - - Infant life, action of saliva in, 36 - - Innervation mechanism, an, constituent parts of, 184 - - Insalivation, defined, 8, 22; - increases gastronomic enjoyment, 22, 46, 48; - its striking effect upon appetite, 50, 60; - effects of, 74, 89, 92, 93, 96; - mastication promotes, 101 - - Insane, the, forced feeding of, 268 - - Instinct, human, the outcome of every-day experience, 251; - physiology merely confirms the precepts of, 251; - provisions for digestion made by, 267; - demands of, 272 - - Intemperance, 95 - - International Congress of Physiologists, the, 26, 48, 56, 68, 91 - - —— Laboratory of Research, the, proposal to found, 55-69; - suggestions as to staff and personnel, 62; - estimate of initial outlay, 63; - suggestions as to location, 63; - suggestions as to management, 66 - - Intestinal anæmia, 345 - - —— canal, the, 39, 346 - - —— contents, the, rhythmic segmentation of, 347-355, 386 - - —— digestive juices, the, 361 - - —— mechanism, the, 385 - - —— movements, difficulties of investigating, 342; - the best known of, 343 - - —— secretion, 61 - - —— wall, the, 344, 381, 386 - - Intestine, the large, activity of, 343; - movements of, 364-377, 379, 386, 387, 388 - - ——, the small, 343, 346; - the movements of, 347-362, 366; - course of food in, 360-362, 365, 367, 369, 378, 381, 383, 385, - 386, 387, 388 - - ——, the, action of the bacteria in, 39; - micro-organic action in, 40, 80, 92; - much more sensitive than the stomach, 139, 301, 317, 328, 337, - 341; - studied by means of the Röntgen rays, 342-388, 395 - - - J - - Jaffa, Professor, 90; - and the fruitarians, 397 - - Japan, 82 - - Jaws, the, mastication stimulates the nutrition of, 96, 103, 155; - influence of mastication upon, 109, 148; - changes during man’s evolution in, 115-121; - instances of vigorous use, 122 - - Johns Hopkins University, 68 - - “Journal of Physiology, The” (American), 284, 301, 342 - - —— (English), 47 - - - K - - Kais Root, 123 - - Kane, Dr., 125 - - Kara, 124 - - Katabolic action, 41 - - Katabolism, 95 - - Kellogg, Dr. J. H., xxvii; - letter from, xxxiii-xxxv; - his estimate of amount of food habitually used, xxxiv; - tribute to, 391; - his experimental investigation of the influence of mastication - and cooking of food, 391-396 - - —— Mrs. J. H., 389; - tribute to, 391 - - Kelp, 122 - - Kotljar, experiment by, 217 - - Kreuznach, 46 - - Kronecker, Dr. Prof. Hugo, 67, 68, 284, 285; - theory of deglutition of, 286 - - Kumagawa, experiments of, 81 - - _Kwas_, 267, 269, 270 - - - L - - Lactic acid, prepared in the stomach, 269, 393, 394 - - - “Lancet, The,” 8, 26, 31; - Dr. Campbell’s articles from, 92-179, 145 - - Lard, 272 - - Laws of Nature, health, strength, and moral tone dependent upon - proper fulfilment of, 73 - - Leonardi, Dr. Professor, 26 - - Life, right conduct of, xiii; - the essentials and sequence in, 399 - - Lippincott, J. B. & Company, 180, 181 - - Liqueurs, 266 - - Liquids, how to treat, 9, 34, 93, 94, 95 - - Lobassoff, Dr., experiments by, 217, 218, 220, 222, 226 - - Lobster, 137, 141 - - London, 65 - - Lower Californians, the, 123 - - Ludwig, experiments of, 342 - - Lumen, the, 374 - - Lymph, influence of the contraction of the masticatory muscles on - local circulation of, 107, 148, 149, 355 - - - M - - Macaroni, 132 - - —— cheese, 100 - - Mackerel, 141 - - Madrid, 69 - - Magendie, theory of deglutition of, 284 - - Maize, chewed, 124 - - Mal-assimilation, of nutriment, x, xxi; - “bunching bits” to oppose, 13-16; - dangers of, 24, 35 - - Malay, 128 - - Mall, experiments of, 343, 345, 354, 378 - - Mal-nutrition, causes of, xxi, 35 - - “Malt extracts,” 102 - - Maltose, starch turned into, 101, 170, 392, 393 - - Man, the First Assistant of Nature, xi; - his disparity due to ignorance, xii; - absurdity of his ignorance, 4, 23; - experiments upon, 300; - by nature a frugivorous animal, 395 - - Maple sugar, 84 - - Marckwald, Max, paper “On Digestion of Milk in the Stomach of - Full-grown Dogs,” 46 - - Masticate, how to, 19 - - Mastication, inefficient, causation of, 129; - must lead to many evils, 129; - evils resulting from, 135; - conduces to excessive eating, 135; - may cause suffocation, 137; - may produce gastritis, 138; - excess of starch may pass into stomach because of, 141; - prevents a sufficient amount of alkali to pass into the stomach, - 146; - causes evils with the jaws and their appendages and the adjacent - structures, 148; - responsible for adenoids, 148-152; - a potent cause of Rigg’s disease, 159; - secondary evils of, 164, 394 - - ——, proper, increases gastronomic enjoyment, 22, 46, 48, 60; - effects of, 74, 89; - Dr. Campbell’s observations upon, 96-173; - the effects of, 96; - primary object of, 96; - promotes flow of saliva, 96, 101; - stimulates the heart and circulation, 96, 103; - influences the nutrition of the jaws, 96, 103; - facilitates swallowing, 97; - brings the food into intimate contact with the digestive juices, - 98; - increases amount of alkaline saliva passing into the stomach, 96, - 102; - acts reflexly upon the stomach, 102; - the muscles of, 104; - its influence upon the jaw-bones, 109; - its influence upon the teeth, 110; - in the preparation of beverages, 123; - in the industries, 124; - the instinct of, 126; - the causation of inefficient, 129; - less opportunity than formerly for, 130-133; - defective apparatus for, 133; - affected by individual differences, 134; - tends to diminish amount of food consumed, 136; - most effective way to secure starch digestion, 145; - effect upon the nasal passages, naso-pharynx, and faucial tonsils, - 148; - fast becoming a lost art, 157; - means of insuring adequate, 164, 389; - experimental investigation of the influence of, 391 - - Masticatory instinct, the, 126-129 - - —— muscles, the, 104; - influence of their contraction on local circulation of blood and - lymph, 107, 148 - - Matri, 128 - - Meadville, Penn., 396 - - Measles, 149 - - Meat, 78 - - —— broth, 266; - an important chemical excitant of gastric secretion, 266, 267 - - —— extract, 268 - - —— juice, 268 - - Mechanical stimulus, great importance assigned to, 257 - - Medical practice, largely based upon empiricism, 52 - - —— science, not possessed of final information concerning questions - of nutrition, 52 - - Medicine, ideal only when it can take its proper position, 249; - physiology can make no pretence to guide the field of, 251; - to what it will at length grow, 251; - treats too lightly the loss of appetite, 256 - - Melanesia, 128 - - Melanesians, the, 120 - - - Meltzer, Dr., 284; - experiments of, 294, 296, 297, 298 - - Mendel, Dr. Lafayette B., 69 - - Mendel Pass, _bei_ Bozen, Süd Tirol, Austria, experiments at, 26 - - Mental energy, 41 - - —— state, 12; - its effect upon digestion and nutrition, 74 - - Menticulture, physical and mental equipments necessary to promote, - 7 - - “Menticulture,” xxi, xxiv - - Metabolism, 37; - determination of, 40; - calorimetric trial-balance measurement of, 54 - - Micro-organisms, 40; - destroyed by acid gastric juices, 41 - - Middletown, Conn., experiments at, 54 - - Milk, how to drink, 9; - experiments in drinking, 36, 38-39, 78, 84, 93, 94, 268; - takes a special position among foods, 272; - the three properties of, 273; - its relation to the secretion of the digestive juices, 274, 275, - 276, 277 - - —— pudding, 97, 143, 172 - - “Modern Medicine,” 389, 391 - - Modoc Indians, the, 123 - - Moist foods, 97 - - Moritz, experiments of, 324, 328, 332 - - Mosso, Dr. Prof. Angelo, 67, 68, 284, 285 - - Mouth, the, should do all it can, 93, 180; - examination of, 174-179; - rinsing, 179; - mechanical and chemical stimulation of the cavity of, 201, 285, - 286 - - —— breathing, evils of, 151-153 - - —— discrimination, 94 - - —— thoroughness, 8 - - —— treatment, of food, 5, 12, 92; - a preliminary necessity of easy digestion, 180, 389 - - - Mucosa, the, 343, 355 - - Mucous membrane, the, 346 - - Munich, 56, 76, 81 - - Muster, 128 - - Mutton, 100 - - - N - - Nansen, J. F., 123 - [36] - Napoleon, died from fast eating, 138 - - Nasal passages, the, effect of mastication upon, 148 - - Naso-pharyngitis, 144, 148, 149 - - Naso-pharynx, the, influence of mastication upon, 148 - - National Academy of Sciences, the, contribute to fund for research, - 69 - - Natural Automatic Processes, 3, 180 - - Nature, plan of evolution of, xi; - Man the First Assistant of, xi; - her reward for conformity with her requirements, xii; - her generous assumption of forty-seven forty-eighths of labour, 5, - 12; - given an opportunity by economic nutrition, 22; - her plans perfect if her laws are obeyed, 29; - never intended a special diet or bottle of medicine, 30; - endeavours to prepare lactic acid in the stomach, 269 - - Negritos, the, 118 - - Negroes, the African, 120 - - Nerve cells, the, specific qualities of, 187 - - —— fibres, 184 - - Nervous system, the, influence upon the glands of, 183 - - Neutralisation, 92 - - “New Glutton or Epicure,” the, xxviii, 47. - _See_ also “Glutton or Epicure” - - New Guinea, 124 - - New Haven (Conn.), scientific experiments at, xiii, 54, 71. - _See_ Yale investigation, the, and Yale test, the - - Nitrogen, 85, 86 - - Nitrogenous equilibrium, 86 - - —— measurements, tests of, 26 - - “No Breakfast Plan,” the, 396 - - Nothnagel, experiments of, 343, 345 - - Northwest London Hospital, the, 8, 92 - - Nutarians, 90 - - Nutrient enemata, 367, 379, 380, 382, 388 - - —— fluid, 381 - - Nutriment, selection of, 7 - - Nutrition, economic, experiments upon problem of, ix, x, 48-52; - active interest now taken in, x; - the financial saving the least of the profits in, xi; - the key to England’s welfare, xxv; - attitude of the scientific mind towards, xxvii; - little accurate knowledge concerning, xxx; - psychology of, 6-7; - appetite the most important factor in, 6; - mechanical and chemical physiology of, 8; - its entire principle simple and practical, 19; - does not advise avoiding starchy foods for stout people, 21; - assures that the same food will add or decrease weight, 21; - keeps one in perfect condition, 22; - its requirements not hardships but pleasures, 22; - not a joke or fad, 24; - an appeal to self-examination and self-instruction, 24, 25; - first scientific recognition of principles of, 26; - medical science not possessed of final information concerning - questions of, 52; - plan for institution of an international inquiry into the subject - of, 53-55; - proposed to found an international laboratory of research for the - study of, 55-68; - no question of greater importance, 72; - poverty and vice traced to perversion of, 73; - great need of thorough physiological study of, 74; - effect of the mental state upon, 74 - - Nutrition, animal, 56, 57, 58 - - Nutritive equilibrium, 37; - experiments in, 37-39 - - Nuts, 141, 173; - usefulness of, 397 - - Nuttall, Dr. George H. F., 26, 39, 47 - - - O - - Œsophagus, the, may protect the stomach, 139, 192, 285, 286, 289, - 291, 292, 297, 299, 300, 303, 304, 307, 316, 325, 326, 336, 341 - - Openchowski, experiments of, 305, 325 - - Orang, the, 115 - - Oranges, 169 - - O’Reilly, Surgeon-General, xvii, 69, 70 - - Ozawa, Professor, 55 - - - P - - Pabulum, the, derivation of, 40, 41 - - Pacific Islands, the, 124 - - Padua, Italy, 28 - - Palate, the, “the dietetic conscience,” 75 - - Pancreas, the, excited by the vagus and the sympathetic nerves, 183, - 270; - special relations of acids to, 270, 271, 273, 274, 279 - - Pancreatic digestion, 395 - - —— gland, the, 269, 270, 271, 280 - - —— juice, the, experiments for, 267, 270, 273, 279, 360, 395 - - Paris, 56, 65 - - Pastry, 132, 172 - - Patagonians, the, 128 - - Pathology, 249 - - Pavia, University of, 26 - - Pawlow, Dr. Prof. J. P., 6, 7, 12; - researches of, 61, 67, 68; - his demonstrations of psychic influence in digestion, 180-283 - - Peas, 132 - - _Pendelbewegung_, the, 342 - - Pendulum movement, the, 358-360 - - Penegal, xxxiii - - Peptic digestion, 318, 335 - - Peristalsis, 327, 330, 333, 337, 340, 343, 344, 346, 348, 355-357, - 361, 365, 377, 378, 383, 384, 386, 388 - - Peristaltic wave, the, 343, 353, 365 - - Pflüger’s Archives, 182 - - Pharynx, the, 285, 286, 290, 298 - - Philippines, the, 69 - - Physicians, most of them called on to restore appetite, 254; - their indifference to appetite, 257; - in Russia, 260; - should bear in mind the question of psychic secretion, 261 - - Physiology, applied, 251 - - Pine-apple, 141 - - Pitcherie, chewing, 129 - - Polynesia, 128 - - Poorer classes, the, appetite stronger among, 253; - food of, 266, 267 - - “Popular Science Monthly, The,” xxxiii, 53; - Professor Chittenden’s article in, 69-91 - - Pork, 100, 141 - - Porridge, 97, 143, 172, 270 - - Potato, made digestible by saliva, 20; - if masticated, need not produce fat, 21; - experiments with, 38, 102; - yields abundant sugar by long-continued mastication, 142, 146 - - Potatoes, boiled, 143, 172 - - Poverty, traced to perversion of nutrition, 73 - - Proteid, demanded by the appetite, xxxii; - the putrid decomposition of, 47; - minimum amount of, 74, 78, 79; - Asiatics consume smaller proportion of, 82, 83, 85, 98, 100, 272, - 394 - - ——, the high, xxxii, xxxiii - - ——, the low, xxxi, xxxii, xxxiii - - —— digestion, perfect, 394, 395 - - —— molecule, the, isolation of the tryptophane element of, 47 - - Physiology, experimental, 249; - can make no pretence to guide the field of medicine, 251; - merely confirms the precepts of instinct, 251 - - Psychic environment, 12 - - —— excitation, 259 - - —— influence, in digestion, 180-283 - - —— juice, the, 213, 257, 267 - - —— secretion, 261 - - —— stimulation, 249 - - Pultaceous foods, 95, 97 - - Pyloric sphincter, the, movements of, 314 - - Pylorus, the, stands guard over the intestines, 139, 141; - observations of Fallopius upon, 302; - ideas of early writers concerning, 303; - later experiments, 304, 307, 308, 315, 316, 317, 325, 326, 328, - 330, 331, 332, 333, 340, 341, 360 - - - R - - Rabbit, the, experiments upon, 344, 359, 371 - - - Rage, effect of, 388 - - Raiser, experiments of, 359, 371 - - Rectal injections, stimulating effect on movements of small - intestine of, 367 - - Rectum, the, 374, 379, 382 - - Reed, Dr. Major Walter (martyr to science), 70 - - Regina Margherita Laboratory, the, summit Monte Rosa, 64, 68 - - Regurgitation, 35 - - Rhinitis, 144, 148, 149 - - Rhythmic segmentation, of the intestinal contents, 347-355, 358, - 360, 362, 383, 386 - - Rice, 82, 132 - - Rickets, 144 - - Rigg’s disease, 159, 163 - - Rjasanzew, Professor, experiments of, 275 - - Roberts, Sir William, 75, 147 - - Rockefeller, John D., xxxv - - —— Institute of Preventive Medicine, the, 68 - - _Rollbewegung_, 345 - - Röntgen rays, the, Dr. Cannon’s studies with, 180, 284, 287-300, - 301-341, 342-388 - - Roosevelt, President Theodore, 70 - - Root, Secretary of War, Elihu, 70 - - Rosa, Monte, 64, 68 - - Rossbach, experiments of, 305, 309, 311, 313, 314 - - Roux, experiments of, 314, 315, 327, 328 - - Royal Society, the, 68 - - Rumination, 35, 98 - - Russell, Dr. William, 145 - - Russia, physicians in, 260; - food in, 267, 272 - - Russian Imperial Military School of Medicine, the, 68 - - —— peasant, the, 270 - - - S - - Sabbatani, experiments of, 378 - - St. Martin, Alexis, investigations on, 305, 309 - - Saliva, its chemical effect upon potato, 20; - upon syrup, 21, 33, 34, 35; - its action in infant life, 36; - an important therapeutic agent, 45, 93, 94, 95; - mastication promotes flow of, 96, 101; - dry food produces greater flow than moist, 97, 147; - complicated physiological functions of, 191-192, 337, 392, 393, - 395, 396 - - Salivary digestion, in the stomach, 335, 341; - effect of mastication and cooking of food upon, 391; - imperfect, 394 - - —— glands, the, 155; - analogy between the innervation mechanism and the glands of - digestion, 188-190; - the exciting agencies of the nervous mechanism of, 191; - their particular properties, 191-194; - differences between the exciting agencies of the different, - 194-198; - Professor Pawlow’s sham-feeding experiment, 198-211, 280 - - —— secretion, excitants of, 191 - - Sapidity, 44 - - Sauces, 269 - - Schäfer, 40, 82 - - Schmidt, experiments of, 202, 204, 231; - conditions for success, 204-206 - - Schütz, experiments of, 305, 308, 309, 310, 311, 313, 314, 327, - 332 - - Schwartz, experiments of, 303, 304 - - Scientific Assessors, Board of, 67, 68, 181 - - Secretions, digestive, 180 - - Secretory fibres, 183 - - —— nerves, 266 - - Segmentation, 386, 388 - - Selection, of nutriment, 7 - - Self-nutrition, secret of, xii - - Sensory nerves, 187 - - Sham feeding, experiments in, 198-211, 214-246; - psychic effect may become an absolute and independent factor in, - 209, 279 - - Sheffield Scientific School, the, experiments at, 53, 68 - - Sight, the sense of, 210 - - Sivén, experiments of, 81 - - Skatol, the odourous, 47 - - Sleep, exercises no restraining influence upon the gastric glands, - 206; - effect of, 383-386 - - Smell, the sense of, 210 - - Snyder, Dr., experiment in nutritive equilibrium, 37-38 - - Société de Biologie, the, 46 - - Sodium, salts of, 277; - promote a flow of gastric juice, 277, 278, 279, 281, 282 - - Soft foods, 97, 129, 136, 142, 160, 162 - - Solid foods, 94, 268 - - Solray Sociological Institute, the, 68 - - Sorbonne, Universitie de la, 68 - - Soups, 266, 267 - - South Africa, 11 - - —— America, 124 - - “Spectator,” the, 28 - - Sphincter, the, 315, 316, 317, 331, 333, 341 - - Spinach, 99 - - Spirits, 93, 94 - - Ssanozki, Professor, experiments of, 203, 228 - - Starch, needed by body, 20, 21, 78, 98; - changed into maltose, 101, 102; - danger to the stomach in receiving an excess of, 141-146; - the last constituent to leave the stomach, 145, 170, 171, 172, - 270, 337, 393, 395, 396; - - Starling, experiments of, 343, 344, 345, 346, 359 - - Stews, 266 - - Stomach, the, struggles bravely to overcome abuse, 19; - man’s ignorance concerning requirements of, 23; - mastication acts reflexly upon, 102; - a long-suffering organ, 138; - its danger of receiving an excess of starch, 141; - starch the last constituent to leave, 145; - necessity of alkali in, 146; - secretory work of, 182, 183, 229; - secretory nerves of, 210, 227; - the seat of certain definite sensations, 241; - the initial impulse towards awakening an appetite may originate - in, 244, 246; - no material progress in the physiology of, 250; - Nature endeavours to prepare lactic acid in, 269; - acids supplement weak action in, 270, 279; - catarrhal affections of, 280; - gives no obvious external sign of its workings, 301; - studied by means of the Röntgen rays, 301-341; - Galen’s observations on the functions of, 302; - Fallopius’s views upon, 302; - the motor functions of, 304; - the anatomy of, 306; - its relations to the shadow, 306; - the musculature of, 308; - normal movements of, 309; - the peptonising function of, 314; - its appearance at various stages of digestion, 319; - composed of two physiologically distinct portions, 324, 340; - its movements in vomiting, 325; - effect of its movements upon the food, 328; - attempts to perform function of teeth, 333; - salivary digestion in, 335; - inhibition of its movements during emotion, 337 - - —— fluids, 393, 394 - - Suffocation, caused by inefficient mastication, 137 - - Sugar, 21, 78, 89, 95, 169, 337, 393, 395 - - Sugar-cane, 123, 124, 169 - - “Sure and Certain Method of Attaining a Long and Healthful Life,” - Luigi Cornaro’s treatise upon, 28 - - Swallowing, facilitated by mastication, 97; - mechanism of, 284. - _See also_ Swallowing Impulse, the - - —— Impulse, the, xxxii, 8, 9, 93, 94 - - —— reflex, Dr. Van Someren’s, 26, 44 - - Sweet potato, 124 - - Sweets, why pleasant, 268, 269 - - Sympathetic nerve, the, an undoubted exciter of the gastric glands - and of the pancreas, 183 - - Syrup, chemical effect of saliva upon, 21 - - - T - - Tapioca, 132 - - Taplin, 125 - - Tasmanians, the, 122 - - Taste, delicacy of the sense of, 22, 23; - should be dissipated in the mouth, 93, 210; - necessary to give an impulse to the organs of, 253; - the nutritive value of food should be considered rather than, - 261 - - —— gratification, 93 - - Tea, 132 - - Tea-taster, the professional, methods of, 23, 93 - - Teeth, the, influence of mastication upon, 110; - changes during man’s evolution, 115-121; - instances of vigorous use, 122-126; - irregularity in, 156; - evils of imperfect use of, 157; - examination of, 174-179; - the - - stomach attempts to perform function of, 333 - - “Text-Book of Physiology,” Schäfer’s, 40 - - “That Last Waif: or Social Quarantine,” xxv - - Therapeutic experiments, pathological, 249 - - Therapeutics, precepts of, 272 - - Thierfelder, 39 - - Thirst, 95 - - Thompson, Dr., 142 - - —— Prof. W. H., 180, 181 - - Thorax, the, 290 - - Tobacco-chewing, 103, 129 - - Tokio, University of, 55 - - Tongue, the, needs exercise, 154 - - Tonic constrictions, the, 344; - the appearance of, 370-373, 385, 387 - - —— rings, the, 373 - - Tonsillitis, 144, 148 - - Tooth-brush, the, 177 - - Tooth-powder, 178 - - Toxins, absorbed into the blood, 40, 41, 44, 143 - - Training, for athletes, why necessary, 22 - - “Traité Analytique de la Digestion,” Blondlot’s, 181 - - Treves, Sir Frederick, on bolting of food, 140, 141 - - Trinity College, Dublin, 180 - - Trophic fibres, 183 - - Tryptophane, 47 - - Tuberculosis, 144 - - Turin, Italy, Congress of Physiologists at, 26, 48, 56, 91 - - ——, University of, 68, 284 - - - U - - Urine, should be inoffensive, 42, 93, 274 - - - V - - Vagus nerve, the, an undoubted exciter of the gastric glands and - of the pancreas, 183; - its functions almost interminable, 183, 249 - - Van Someren, Dr. Ernest, xxv, 7, 12; - his paper “Was Luigi Cornaro Right?” 26-46; - his swallowing reflex, 26, 44; - his experiments confirmed by Marckwald, 46; - Sir Michael Foster’s Note upon his paper, 48-52; - the Cambridge tests, 49-52, 53, 60, 91, 92, 98 - - Van Valzah, 146 - - Veal, 100 - - Veddahs, the, 128 - - Vegetable food, experiments with, 40; - necessitates more thorough mastication than animal, 97, 98, 173; - influenced more by cooking than animal, 118, 132, 170 - - Vegetables, 43, 78 - - Venice, Italy, 30, 63, 64, 91 - - Vermicelli, 132 - - Vermicular contraction, 343 - - —— wave, the, 345 - - Vermiform appendix, the, 140 - - Vice, traced to perversion of nutrition, 73 - - Vienna, 65 - - —— bread, 131 - - Vinegar, 269 - - Vivisection, 303, 305 - - Voice, the, requires lusty exercise in youth, 149 - - Voit diet, the, 76, 81, 84, 86 - - Vomiting, the act of, 193, 303; - movements of the stomach in, 325, 341 - - - W - - Wallace, Dr. G. Sim, 110, 113, 130, 154, 158, 161, 169, 174, 177 - - - Walther, Dr., experiments of, 267, 276 - - Washington, D. C., 70 - - Water, how to drink, 9, 34, 95, 268, 391, 392 - - —— biscuit, 391 - - Weight, must become normal, 43 - - Welch, Dr. Prof. William H., 67, 68 - - Wepfer, experiments of, 303, 304 - - Wheat, unground pearl, 392, 393, 394 - - —— flour, 392 - - Wine, how to take, 9, 22, 23 - - Wine-tasters, the professional, methods of, 23, 93 - - Wolves, experiments upon, 303 - - Wood, Maj. Gen. Leonard, 69, 70 - - Worry, causes indigestion, 7 - - Wulfson, Dr., 197 - - - X - - X-ray. _See_ Röntgen ray - - - Y - - Yale investigation, the, x, xi, xiii-xv, xvii, xviii, xix, xxxiii - - —— Gymnasium, the, 87 - - —— test, the, 5, 69, 75-91 - - —— University, 68 - - - Z - - Z, in the nutrition alphabet, 10, 12; - - Zuntz, Dr. Prof. N., 67, 68 - - - - -FOOTNOTES: - -[1] Appetite alone can judge accurately of the former, and the true -Swallowing Impulse is the limitation of the latter. If we study the -natural instincts, the rest will take care of itself. - -[2] This is very strong evidence that appetite knows what to do and -when to do it, if you study and consult it and give it a chance to -prescribe. - -[3] The Yale test reported herein by Professor Chittenden showed the -possibility of full alimentation according to the requirements of -Economic Nutrition in from 24 to 26 minutes daily, which is less than -1∕48 of a day. Beginners of the practice of careful mouth-treatment -of their food _may_ require more time, but, whatever it may be, it -is worth it. A little care for a short period will establish a right -habit, and then no further tedious attention nor unusual time will be -necessary to accomplish a perfectly healthy nutrition. - -[4] Physiological Economy in Nutrition: The Frederick A. Stokes -Company, New York. - -[5] William Heinemann: London. - -[6] The author is not yet permitted to publish the particulars of these -reforms in process, but he has official information regarding them and -is in full sympathy with them. - -[7] Dental surgeons now speak of the upper jaw as the maxilla, and of -the lower jaw as the mandible. - -[8] This subject I am obliged to deal with very briefly, and am -compelled to omit the reasons for my conclusions. - -[9] Recent observations go to show that man possesses no power of -digesting cellulose, though this substance is to a limited extent -capable of solution by the agency of bacteria in the lower portions of -his alimentary canal. - -[10] I am under great obligation to Miss Eva Dunn, who has collected -valuable information for me on this and kindred subjects. - -[11] Social History of the Races of Mankind, 1881. - -[12] S. Powers: Tribes of California, 1877. - -[13] E. M. Curr: The Australian Races, 1886-7. Taplin: The Narrinyeri; -an account of Tribes of South Australian Aborigines, 1879. - -[14] J. F. Nansen: Eskimo Life, 1893. - -[15] Dr. Kane: Arctic Exploration, 1854. - -[16] E. Astrup: With Peary near the Pole, 1898. - -[17] Sir George Grey: Journal of Two Expeditions in North-West and -Western Australia, 1841. - -[18] Muster: With the Patagonians, 1869. - -[19] Bailey: Transactions of the Ethnological Society, 1862. - -[20] E. M. Curr: The Australian Race, 1886-87. - -[21] The Causes and Prevention of Decay in Teeth, pp. 88, 89. London, -1902. - -[22] Gilbert Barling also traces the relationship between appendicitis -and diet. “In a considerable number of cases,” he writes, “the attack -of appendicitis can be directly attributed to unsuitable food--pork, -mackerel, over-ripe or under-ripe fruit, uncooked vegetables” (Brit. -Med. Jour., vol. i., 1903, p. 61). - -[23] My friend, Dr. Thompson, undertook, at my suggestion, some -experiments to test the digestibility of raw starch within the mouth; -he found that raw potato yields abundant sugar when subjected to -long-continued mastication. - -[24] _The Lancet_, March 21st, 1903, p. 806. - -[25] Brit. Med. Jour., Epitome, vol. i., 1903, p. 45. - -[26] A further aid to the circulation in the naso-pharynx is afforded -by the lusty use of the voice. It a natural for the young human to cry -and to shout, and unless this instinct is allowed full play the child -is apt to suffer in health. I cannot but think that the modern child -is too much repressed in this respect, and that he is not afforded, -especially in towns, proper opportunity of venting his vocal energy -in out-door play. May we not have here a contributory factor in the -causation of adenoids? - -[27] Among the Australian skulls I have examined in museums caries -of the wisdom teeth--_i.e._, in those very teeth which, as shown by -their atrophy, are least used--is by no means uncommon (though it is -possible that some of the skulls belong to natives who have embraced -the dietetic customs of the white man). I submit that this fact may -fairly be used as an argument in favour of the view that inefficient -use of the teeth predisposes them to caries by interfering with their -resisting power, though it must be acknowledged that the position of -the wisdom teeth places them at a disadvantage, owing to the tendency -of food to accumulate about them, especially in undeveloped jaws in -which they have not adequate room. - -[28] This film can be felt by the tongue as a somewhat rough covering, -which gives place to a smooth surface after the use of the tooth-brush. - -[29] By the term “external stimulus” I mean here without distinction -every outward agency of nature, as well as every agency which has -its seat within the organism. The word “external” applies here to -everything with the single exception of the nervous system itself. - -[30] One may be permitted to use this expression for the sake of -brevity. - -[31] _Kwas_ is a favourite Russian drink, prepared from water, bread -or meal, with malt and yeast. It contains a considerable quantity of -lactic acid, some acetic acid, and other products of fermentation. - -[32] An investigation by Cannon and Day (_American Journal of -Physiology_, 1903) has confirmed this conclusion. An hour after starchy -food mixed with saliva was ingested a unit volume of the food in the -cardiac end of the stomach contained almost twice the amount of sugar -found in a unit volume of the food in the pyloric end. - -[33] The results of this investigation were reported to the Boston -Society of Medical Sciences, November 19, 1901. - -[34] Without the possibility of seeing the relations of a movement to -the ends of the intestine, it cannot be stated absolutely whether the -movement is peristaltic or antiperistaltic. Such relations can be seen -on the fluorescent screen only near the stomach and near the ileocæcal -valve. The evidence that advancing peristalsis is the normal movement -is so overwhelming that I have assumed that when food is moving in -loops not visibly related to fixed points it is moving forward. - -[35] In this case the fæces were soft. - -[36] While Napoleon was building his power and fame he was very -careful and abstemious, but in later life succumbed to luxury and -gluttony; Bismarck’s rise and decline were similarly related to dietary -influences.--H. F. - - -*** END OF THE PROJECT GUTENBERG EBOOK THE A.B.-Z. OF OUR OWN -NUTRITION *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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- font-family:sans-serif, serif; - } - -/* Illustration classes */ -.illowp100 {width: 100%;} -.illowp30 {width: 30%;} -.x-ebookmaker .illowp30 {width: 100%;} -.illowp35 {width: 35%;} -.x-ebookmaker .illowp35 {width: 100%;} -.illowp40 {width: 40%;} -.x-ebookmaker .illowp40 {width: 100%;} -.illowp45 {width: 45%;} -.x-ebookmaker .illowp45 {width: 100%;} -.illowp50 {width: 50%;} -.x-ebookmaker .illowp50 {width: 100%;} -.illowp60 {width: 60%;} -.x-ebookmaker .illowp60 {width: 100%;} -.illowp68 {width: 68%;} -.x-ebookmaker .illowp68 {width: 100%;} -.illowp75 {width: 75%;} -.x-ebookmaker .illowp75 {width: 100%;} - - </style> - </head> -<body> -<p style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of The A.B.-Z. of our own nutrition, by Horace Fletcher</p> -<div style='display:block; margin:1em 0'> -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online -at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you -are not located in the United States, you will have to check the laws of the -country where you are located before using this eBook. -</div> - -<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: The A.B.-Z. of our own nutrition</p> -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: Horace Fletcher</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: February 5, 2022 [eBook #67326]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>Produced by: Mark C. Orton, Les Glloway and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK THE A.B.-Z. OF OUR OWN NUTRITION ***</div> -<hr class="chap" /> - -<div class="transnote"> - -<h4>Transcriber’s Notes</h4> - -<p>Obvious typographical errors have been silently corrected. Variations -in hyphenation and accents have been standardised but all other -spelling and punctuation remains unchanged.</p> - -<p>The cover was prepared by the transcriber and is placed in the public -domain.</p> -</div> - - -<p class="half-title"> -THE A. B.-Z.<br /> -<small>OF</small><br /> -OUR OWN NUTRITION</p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"></div> - -<div class="box"> -<p class="center">HORACE FLETCHER’S WORKS</p> -<hr class="small" /> -<div class="hangsection"> -<p>THE A. B.-Z. OF OUR OWN NUTRITION. -462 pp. Just issued.</p> - -<p>THE NEW MENTICULTURE; <span class="smcap">or, -The A-B-C of True Living</span>. Fortieth -thousand. 310 pp.</p> - -<p>THE NEW GLUTTON OR EPICURE; -<span class="smcap">or, Economic Nutrition</span>. -324 pp. Just issued.</p> - -<p>HAPPINESS <span class="smcap">as found in Forethought -minus Fearthought</span>. Tenth thousand. -251 pp.</p> - -<p>THAT LAST WAIF; <span class="smcap">or, Social -Quarantine</span>. 270 pp.</p> -</div></div> - -<div class="figcenter illowp100" id="titlepage" style="max-width: 40em;"> - <img src="images/titlepage.jpg" alt="Title page" /> -</div> - - -<h1> -<i>The</i> A. B.-Z.<br /> -<i>of</i> OUR OWN<br /> -<span class="smcap">NutritioN</span><br /> -</h1> - -<p class="center"><i>By</i> HORACE FLETCHER<br /> -<i><small>Author of “Menticulture,” “Happiness,” “That</small><br /> -<small>Last Waif,” “Glutton or Epicure,” Etc., Etc.</small></i></p> -<p class="center"> -<span class="smcap"><small>Experimentally Assisted by</small></span><br /> -DR. ERNEST VAN SOMEREN,<br /> -M. R. C. S., L. R. C. P., <i>of Venice, Italy</i><br /> -& DR. HUBERT HIGGINS, M.A.,<br /> -M. R. C. S., L. R. C. P., <i>of Cambridge, England</i></p> - -<p class="center"><i>NEW YORK</i> • FREDERICK A.<br /> -STOKES COMPANY • <i>PUBLISHERS</i></p> - - - -<p class="center space-above"> -<small>COPYRIGHT, 1903<br /> -BY HORACE FLETCHER</small></p> - -<p class="center spaced"> -<small>Published November, 1903<br /> -Reprinted February, 1904, August, 1904<br /> -February, 1905, August, 1905</small></p> - -<p class="center"> -<small>THE UNIVERSITY PRESS<br /> -CAMBRIDGE U. S. A.</small></p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_iii">[Pg iii]</span></p> - -<h2 class="nobreak" id="CONTENTS">CONTENTS</h2> -</div> - - - -<table class="standard" summary=""> -<tr> -<td></td> -<td class="tdr"><small>Page</small></td> -</tr> -<tr> -<td class="tdl"><span class="smcap">Introduction</span></td> -<td class="tdr"><a href="#Page_ix">ix</a></td> -</tr> -<tr> -<td class="tdl"><span class="smcap">Postintroductory</span></td> -<td class="tdr"><a href="#Page_xxvii">xxvii</a></td> -</tr> -<tr> -<td class="tdc" colspan="2">THE A. B.-Z. PRIMER</td> -</tr> -<tr> -<td class="tdl">Explanation</td> -<td class="tdr"><a href="#Page_3">3</a></td> -</tr> -<tr> -<td class="tdl">Some Pertinent Questions</td> -<td class="tdr"><a href="#Page_4">4</a></td> -</tr> -<tr> -<td class="tdl">A.—The Psychology of Nutrition</td> -<td class="tdr"><a href="#Page_6">6</a></td> -</tr> -<tr> -<td class="tdh">B.—The Mechanical and Chemical Physiology of -Nutrition</td> -<td class="tdr"><a href="#Page_8">8</a></td> -</tr> -<tr> -<td class="tdh">Method</td> -<td class="tdr"><a href="#Page_9">9</a></td> -</tr> -<tr> -<td class="tdh">Z.—The True Chemical End-Point of Digestion</td> -<td class="tdr"><a href="#Page_10">10</a></td> -</tr> -<tr> -<td class="tdh">A. B.-Z. Figure</td> -<td class="tdr"><a href="#Page_12">12</a></td> -</tr> -<tr> -<td class="tdh">Preface to 1906 Edition</td> -<td class="tdr"><a href="#Page_13">13</a></td> -</tr> -<tr> -<td class="tdc" colspan="2">HISTORY OF DEVELOPMENT AND SUPPORTING -EVIDENCE</td> -</tr> -<tr> -<td class="tdh">Summary of the Foregoing Pages by an Experimenter -of One Month’s Experience</td> -<td class="tdr"><a href="#Page_19">19</a></td> -</tr> -<tr> -<td class="tdh">First Scientific Recognition of the Principles of -Economic Nutrition Outlined in “Glutton or -Epicure.” H. F.</td> -<td class="tdr"><a href="#Page_26">26</a></td> -</tr> -<tr> -<td class="tdh">Was Luigi Cornaro Right? by Ernest Van Someren</td> -<td class="tdr"><a href="#Page_27">27</a></td> -</tr> -<tr> -<td class="tdh">The Cambridge Tests. H. F.</td> -<td class="tdr"><a href="#Page_47">47</a></td> -</tr> -<tr> -<td class="tdh">Experiments upon Human Nutrition, by Sir Michael -Foster, K. C. B., M. P., F. R. S.</td> -<td class="tdr"><a href="#Page_48">48</a><span class="pagenum" id="Page_iv">[Pg iv]</span></td> -</tr> -<tr> -<td class="tdh">Report of a Plan for the Institution of an International -Inquiry into the Subject of Human Nutrition. H. F.</td> -<td class="tdr"><a href="#Page_53">53</a></td> -</tr> -<tr> -<td class="tdh">Proposal to Found an International Laboratory of -Research for the Study of Nutrition in all Its Aspects. Recommended by the following</td> -<td class="tdr"><a href="#Page_55">55</a></td> -</tr> -<tr> -<td class="tdp1">Professors of Physiology, etc.:</td> -</tr> -<tr> -<td class="tdp2">Sir Michael Foster, Cambridge, England.</td> -</tr> -<tr> -<td class="tdp2">Angelo Mosso, Turin, Italy.</td> -</tr> -<tr> -<td class="tdp2">Hugo Kronecker, Bern, Switzerland.</td> -</tr> -<tr> -<td class="tdp2">N. Zuntz, Berlin, Germany.</td> -</tr> -<tr> -<td class="tdp2">Paul Heger, Brussels, Belgium.</td> -</tr> -<tr> -<td class="tdp2">A. Dastre, Paris, France.</td> -</tr> -<tr> -<td class="tdp2">Henry P. Bowditch, Harvard Medical School.</td> -</tr> -<tr> -<td class="tdp2">Russell H. Chittenden, Yale University.</td> -</tr> -<tr> -<td class="tdp2">William H. Welch, Johns Hopkins University.</td> -</tr> -<tr> -<td class="tdp2">J. P. Pawlow, Saint Petersburg, Russia.</td> -</tr> -<tr> -<td class="tdh">Nationality and Scientific Titles of the above Board -of Scientific Assessors</td> -<td class="tdr"><a href="#Page_68">68</a></td> -</tr> -<tr> -<td class="tdh">Persistent Scientific Doubts. H. F.</td> -<td class="tdr"><a href="#Page_69">69</a></td> -</tr> -<tr> -<td class="tdh">Physiological Economy in Nutrition, by Professor -Russell H. Chittenden</td> -<td class="tdr"><a href="#Page_72">72</a></td> -</tr> -<tr> -<td class="tdh">Introduction to Dr. Harry Campbell’s Contribution -on the Importance of Mastication. H. F.</td> -<td class="tdr"><a href="#Page_92">92</a></td> -</tr> -<tr> -<td class="tdh">Observations on Mastication, by Harry Campbell, -M. D., F. R. C. P.</td> -<td class="tdr"><a href="#Page_96">96</a></td> -</tr> -<tr> -<td class="tdh">Introduction to Professor Pawlow’s Demonstrations -of Psychic Influence in Digestion. H. F.</td> -<td class="tdr"><a href="#Page_180">180</a><span class="pagenum" id="Page_v">[Pg v]</span></td> -</tr> -<tr> -<td class="tdh">Selected Lectures by Professor J. P. Pawlow (Dr. -W. H. Thompson’s translation)</td> -<td class="tdr"><a href="#Page_182">182</a></td> -</tr> -<tr> -<td class="tdh">Lecture IV.: General Scheme of an Innervation -Mechanism—The Work of the Nervous Apparatus -of the Salivary Glands—Appetite, the First -and Most Potent Exciter of the Gastric Secretion</td> -<td class="tdr"><a href="#Page_182">182</a></td> -</tr> -<tr> -<td class="tdh">Lecture V.: Period of Occurrence and Importance -of the Psychic or Appetite Juice in the Secretory -Work of the Stomach—The Inefficiency of -Mechanical Stimulation of the Nervous Apparatus -of the Gastric Glands</td> -<td class="tdr"><a href="#Page_212">212</a></td> -</tr> -<tr> -<td class="tdh">Lecture VIII.: Physiological Action and the Teaching -of Instinct: Experiences of the Physician</td> -<td class="tdr"><a href="#Page_247">247</a></td> -</tr> -<tr> -<td class="tdh">Introduction to Dr. Cannon’s Papers on Movements -in the Alimentary Canal studied by Means -of the Röntgen Rays. H. F.</td> -<td class="tdr"><a href="#Page_284">284</a></td> -</tr> -<tr> -<td class="tdh">Swallowing and Movements of the Stomach and -Intestines, by W. B. Cannon, M.D.</td> -<td class="tdr"><a href="#Page_285">285</a></td> -</tr> -<tr> -<td class="tdh">The Movements of the Food in the Œsophagus, -by W. B. Cannon and A. Moser</td> -<td class="tdr"><a href="#Page_285">285</a></td> -</tr> -<tr> -<td class="tdh">The Movements of the Stomach, by W. B. Cannon</td> -<td class="tdr"><a href="#Page_301">301</a></td> -</tr> -<tr> -<td class="tdh">The Movements of the Intestines, by W. B. Cannon</td> -<td class="tdr"><a href="#Page_342">342</a></td> -</tr> -<tr> -<td class="tdh">The Battle Creek Laboratories. H. F.</td> -<td class="tdr"><a href="#Page_389">389</a></td> -</tr> -<tr> -<td class="tdh">Experimental Investigation of the Influence of -Mastication and Cooking of Food, etc., in the -Laboratories of the Battle Creek, Michigan, Sanitarium, -under the direction of Dr. J. H. Kellogg</td> -<td class="tdr"><a href="#Page_391">391</a><span class="pagenum" id="Page_vi">[Pg vi]</span></td> -</tr> -<tr> -<td class="tdh">Dr. Edward Hooker Dewey and the “No Breakfast -Plan.” H. F.</td> -<td class="tdr"><a href="#Page_396">396</a></td> -</tr> -<tr> -<td class="tdh">Professor Jaffa and the Fruitarians. H. F.</td> -<td class="tdr"><a href="#Page_397">397</a></td> -</tr> -<tr> -<td class="tdh">Dr. H. P. Armsby. H. F.</td> -<td class="tdr"><a href="#Page_397">397</a></td> -</tr> -<tr> -<td class="tdh">Explanation of the A. B. C. Series. H. F.</td> -<td class="tdr"><a href="#Page_399">399</a></td> -</tr> -<tr> -<td class="tdh"><span class="smcap">Index</span></td> -<td class="tdr"><a href="#Page_409">409</a></td> -</tr> -</table> - - -<p><span class="pagenum" id="Page_vii">[Pg vii]</span></p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_viii">[Pg viii]</span></p> -<h2 class="nobreak" id="INTRODUCTION">INTRODUCTION</h2> -</div> - - -<ul> -<li><i>DO WE EAT TOO MUCH?</i></li> -<li>CAN WE LEARN TO EAT RIGHT?</li> -<li>WITHOUT LOSS OF ENJOYMENT?</li> -<li>WITHOUT CARE BEING A NUISANCE?</li> -<li>WITHOUT SOCIAL INTERFERENCE?</li> -<li>WITH ASSURANCE OF HEALTH?</li> -<li>WITH INCREASE OF ENERGY?</li> -<li>WITH INCREASE OF ENDURANCE?</li> - -<li><hr class="small" /></li> - -<li>TO ALL THESE VITAL QUESTIONS,</li> -<li>THIS BOOK ANSWERS ONLY “YES.”</li> - -<li><hr class="small" /></li> - -<li>VERIFY THIS BY PERSONAL EXPERIMENT.</li> -<li>IRRESISTIBLE DESIRE FOR PHYSICAL EXERCISE</li> -<li>WILL FOLLOW, AS A MATTER OF COURSE,</li> -<li>PROBABLY FRUITING IN USEFUL ACCOMPLISHMENT</li> -<li>BY THE SAME INVITATION OF HEALTHY IMPULSE</li> -<li>WHICH CAUSES CHILDREN TO PLAY TIRELESSLY.</li> -<li>DO RIGHT YOUR FEEDING OF THE BODY.</li> -<li>NATURE WILL DO ALL THE REST FOR YOU ARIGHT.</li> -</ul> - - -<p><span class="pagenum" id="Page_ix">[Pg ix]</span></p> - - -<p class="half-title">Introduction<br /> - -DO WE EAT TOO MUCH?</p> - -<p class="center"><small>(<i>A propos of the Scientific-Military Experiments at Yale -University</i>)</small></p> - - -<p>Do we eat too much?</p> - -<p>Nine out of every ten physicians tell us -“Yes,” and tell us true!</p> - -<p>How much too much?</p> - -<hr class="tb" /> - -<p>Luigi Cornaro suggested that all persons in -his time ate more than was necessary; most -persons ate twice as much as was good for -them; and some, who were extravagantly gluttonous, -ate ten times as much as was their most -economic need; and Cornaro, who was a dissipated -wreck at forty, reformed his manner of -eating and lived to be a hundred to prove his -declaration.</p> - -<p>Experiments carried on in this country and -in Europe during the past five years confirm -this estimate of habitual excess; but fortunately -they have also revealed a natural protection,<span class="pagenum" id="Page_x">[Pg x]</span> -heretofore unappreciated, available to all, which -can regulate the appetite to suit the real needs -of nutrition and thus avoid the dangerous excess -which predisposes to discomfort and disease.</p> - -<hr class="tb" /> - -<p>Luigi Cornaro lived more than three hundred -years ago. His charmingly frank and interesting -autobiography has been published in English -upwards of forty times in different new -editions, and no one has disproved the possibility -or probability of his claim. We all know -that Cornaro was right. We know, in a general -way, that the great Italian dietitian and philosopher -was wise and uttered wisdom, and we -are told that most, if not all, of the diseases -which pain, worry, and afflict us are caused -by indigestion or mal-assimilation of food, the -result of some indiscretions of eating. The questions -then are “What are our indiscretions?” -“How can we avoid them?” and “What is the -new discovery that will protect us and, at the -same time, add to the pleasures of the palate -and of living?”</p> - -<p>The answers to all these queries will be -found herein, as will also an explanation of the -very active interest which is being taken just -now in the problem of human nutrition by -scientific and military authorities, as evidenced -by the Yale investigation.</p> - -<p><span class="pagenum" id="Page_xi">[Pg xi]</span></p> - -<p>The author has, in collaboration with several -others, found a way how <i>not to eat too much</i> -while eating <i>all that the appetite desires</i>, and in -a way that leads to a <i>maximum of good taste</i> -and at a <i>minimum of cost and waste</i>, but it is -necessary to test many persons of different physiques -and varying temperaments, and also to -test other methods of attainment of economy, -to learn what is best for general application, -and that is what is being done at Yale.</p> - -<hr class="tb" /> - -<p>The cost to the pocket that is saved by -economic nutrition is of little matter as compared -with the saving of the waste of energy -and the menace of disease.</p> - -<hr class="tb" /> - -<p>Nature certainly never intended that we -should weaken, depress, and distress ourselves -in the way that is common to present-day living, -as is made evident by the prevalence of discomfort -and disease relative to our daily food. -Nature’s plan of evolution does not work that -way in general, does not retrograde in the -progress of the improvement of plants and -dumb animals, and certainly does not intend -that Man, the First Assistant of Nature in the -cultivation of things and in the domestication -of the powerful natural forces, should suffer and -become degenerate contrary to her general law.</p> - -<p><span class="pagenum" id="Page_xii">[Pg xii]</span></p> - -<p>If we are agreed upon the foregoing, let us -ask ourselves a few questions.</p> - -<p>Without any undue egotism, may it not -be possible for a generation of human beings, -who have progressed so far in intelligence as -to be able to move things by steam, to communicate -across the ocean even without wires to -guide our messages, and to see clearly through -objects that are as dark as night to the unassisted -human eye with the aid of an artificial -light, to learn the secret of right self-nutrition -and practise it in a manner that will not deprive -us of the maximum of pleasure which Nature -invariably gives as a reward for conformity with -her beneficent requirements? May we not assume -that beings who have learned to breed and -train horses to race with human intelligence, -and to run, trot, or pace a mile in less than -two minutes, may also train themselves to have -the proportional relative speed, endurance, -and longevity that has been attained by race -horses through man’s care, and to enjoy the -pleasure of living that is evident in these favoured -animals, mere servitors of man though -they be?</p> - -<p>If this disparity of man is due to ignorance -arising in self-neglect, which is the usual accompaniment -of genius, may we not now, at the<span class="pagenum" id="Page_xiii">[Pg xiii]</span> -beginning of the pregnant twentieth century, -rest for a moment from discovering, developing, -and improving the world outside our personal -selves and concentrate our attention for a while -on learning to know and care for ourselves? -May we not, at least, give “horse sense” attention -to such a vital interest?</p> - -<hr class="tb" /> - -<p>In the midst of the present confusion which -exists among opinions as to the right conduct -of life and activity, and the best manner and -system of diet to be used to secure health -and efficiency, it seems almost a vain appeal to -call for concert of action in a matter of common -and persistent neglect. Each person, as -his own keeper, is careless, and in matters of -bodily management no one feels called upon -to be his brother’s keeper; but this is merely -the lethargy of oversight and consequent ignorance, -and this book is published to call attention -to the oversight and to attempt to dispel -the ignorance.</p> - -<hr class="tb" /> - -<p>At the present moment of writing (October, -1903) there are quartered at New Haven, Connecticut, -twenty privates of the Hospital Corps -of the United States Army and three non-commissioned -officers, under the command of Assistant -Surgeon, Lieutenant Wallace DeWitt.<span class="pagenum" id="Page_xiv">[Pg xiv]</span> -These men and officers, while they are under -regular army discipline and are performing duty -in conformity with their oath of enlistment, are -yet volunteers. They are from the same corps, -if they are not the same men, which furnished -volunteers to investigate the causes of yellow -fever in Cuba, whose heroism resulted in stamping -the fever out of the islands and in that more -effectually protecting our coast states from its -yearly incursions. These are the same men -who generously refused to accept the offered -bounty. This latter expression of exalted manhood -is evidence of what humanity is whenever -there is real need for heroes to serve the general -good. They refused to <i>sell</i> themselves as -risks for money, but they freely <i>offered</i> themselves -as subjects of scientific investigation for -the benefit of their fellows and of mankind at -large.</p> - -<hr class="tb" /> - -<p>The duty that the soldiers are engaged in at -Yale has no element of risk, and need not have -any feature of monotony or tediousness in it, -much less has it the romance of sacrifice, for it -deals with an attempt to restore normality and -does not consort with disease. But the service -being rendered by these guardians of our health, -these soldiers of hygiene, is even more important -than was the service rendered in stamping<span class="pagenum" id="Page_xv">[Pg xv]</span> -out yellow fever, for it deals with an enemy much -more subtle, treacherous, common, and deadly -than Yellow Jack. Yellow fever calls for a halt -and an immediate attempt at cure, and further, -for stringent defence to extermination; but indigestion -and the American plague, <i>dyspepsia</i>, -work their evils slowly but surely to cut off our -best men and loveliest women in their prime and -to rob us of their richest product and of their -maturest wisdom.</p> - -<hr class="tb" /> - -<p>The investigation at Yale is a link in a chain -of effort that has developed in logical sequence -and has been planned to effect a cure of the -common ignorance and practice relative to right -human nutrition in its relation to profitable -thinking and doing; and to discourage the personal -neglect which has been responsible for -the existing ignorance, this book is issued to -show what may easily be done and what has -been done, so far, in this direction. It is a -compilation of important knowledge which has -been born of recent scientific research but which -is hidden away from common comprehension in -scientific publications; and it relates the story -of the development of which this book is an -exponent. Herein are given the reasons why -the government and the most eminent scientists -in the line of researches in nutrition are<span class="pagenum" id="Page_xvi">[Pg xvi]</span> -coöperating so earnestly and so unusually in a -commonweal inquiry.</p> - -<hr class="tb" /> - -<p>About ten years ago, at the critical age of -forty-four, the author was fast becoming a physical -wreck in the midst of a business, club, and -social tempest. Although he was trained as an -athlete in his youth and had lived an active and -most agreeable life, he had contracted a degree -of physical disorder that made him ineligible as -an insurance risk. This unexpected disability, -with such unmistakable warning, was so much a -shock to his hopes of a long life that it led to -his making a strong personal effort to save himself. -The study was taken up in systematic -manner, account of which is too long to relate -here; but the eager auto-reformer soon learned -that his troubles came from <i>too much</i> of many -things, among them too much food and too -much needless worry; and realising the danger -ahead, he sought a way to cure himself of his -disabilities by the help of an economic food -supply, as did Luigi Cornaro; but what is even -more important, he found a way to enjoy the -smaller quantity of food much more than any -plethoric luxury can give, and arrived at the -method by a route that showed a means of -conserving a healthy economy and an increased -pleasure of eating, at the same time, in quite a<span class="pagenum" id="Page_xvii">[Pg xvii]</span> -simple and scientific manner, that any one may -learn and practise without any ascetic deprivation -whatever. Cornaro buried the real clew to -his economic and pleasurable success with his -body, owing to his vague generality of description -of his method. The author is determined -not to make the same mistake, and thereby bury -<i>his</i> key to a happy and easy life.</p> - -<hr class="tb" /> - -<p>The secret of the method is all told in this -book and is confirmed herein by both theoretically -scientific and scientifically practical authority; -but the experiments which are being -conducted at Yale by Professor Chittenden, in -coöperation with Surgeon-General O’Reilly of -the army, of which the <i>Daily Press</i> has given -notice, together with experiments which are in -progress in many university laboratories in this -country and in Europe, are for the purpose of -explaining the “reasons for things” by complete -scientific reasoning, so that none may -doubt the disadvantage and sin of dietic ignorance -and carelessness.</p> - -<p>The acceptance of the theory and method of -the author at the great Battle Creek Sanitarium, -after more than a year’s trial, and elsewhere -among curative agencies, and their adoption -and use as the first requisite of treatment, of -which the public have not so generally heard,<span class="pagenum" id="Page_xviii">[Pg xviii]</span> -are indorsements coming from practical, intelligent, -and expert sources of experience and -judgment, and hence they are of the utmost -value and significance.</p> - -<hr class="tb" /> - -<p>This introductory chapter is being written -after the “clippings” of newspaper comment -relative to the presence of the soldiers at Yale -have begun to come in. The majority of comments -are generous in spirit, but indicate a lack -of complete understanding which this “Introduction” -is intended to correct.</p> - -<hr class="tb" /> - -<p>Some of the comments are couched in ridicule, -and express pity for the poor soldiers who -are being “misused” as subjects of starvation -in an investigation which promises to make -starvation a rule in the army. To the writers -of such trifling and unfair paragraphs let me, -one of the fraternity in an amateurish way, beg -consideration of the following.</p> - -<p>The campaign that has been started is against -a common enemy of mankind, and of the American -and English nations in particular. In our -successes in agriculture, manufacture, and commerce -we have cultivated insidious, luxurious -temptations which bring all of us some ill and -many of us, or our loved ones, fatal disease -and premature death. The advance agent of<span class="pagenum" id="Page_xix">[Pg xix]</span> -these enemies of ours is Eating-and-drinking-too-much.</p> - -<hr class="tb" /> - -<p>The officers and men of the army and the -eminent scientists of our country and those of -all nationalities who have entered into the campaign -with us, and the great power of the sanitaria -joining as practical nurses, demonstrators, -and exponents of the reform, are all working -for you and for everybody. It is voluntary -service and has already cost some of the volunteers -much time and patience and also a considerable -sum in money.</p> - -<hr class="tb" /> - -<p>You, gentlemen of the Press, wielders of -the helpful or careless pen, have a conspicuous -pulpit and a far-reaching influence. No -one can escape you. In the search for the -news of the day you are encountered at every -turn in your editorials or your paragraphs. In -this campaign we need your assistance to make -the coöperation between the army and science -easy and effective. They are too busy working -for you and your best interest to stop to -argue to correct your misunderstanding, but -the cause will feel the benefit of your assistance.</p> - -<p>Encouragement has powerful influence in -stimulating effort and also in creating and conserving -conditions in which men may “do their<span class="pagenum" id="Page_xx">[Pg xx]</span> -best.” What we are trying to learn is, what -man <i>may</i> do, under favourable conditions of -knowledge and confidence, to relieve his body -of the <i>strain of energy-taxing labour</i> in disposing -of the waste <i>which any excess of food -imposes</i>. It is a constructive experiment and -not a mere statistical measurement. Appreciation -and applause assist; doubt and ridicule -obstruct.</p> - -<p>The soldiers and physiologists are too busy -studying indigestion and possible proteid poisoning -and what-not-other causes of intemperance, -disease, and suffering to ask you to assist in -spreading only serious report and right suggestion -relative to the importance and purport -of the investigation, but it is my privilege to -ask it for the general good.</p> - -<hr class="tb" /> - -<p>Just another word of introduction and then -will follow some <i>postintroductory</i> coincidences -relative to the work in hand, and then an -attempt to lay out a ten-page chart of the -personal responsibility in the care of the body -and the nourishment of the mind by aid of an -economic and most satisfactory nutrition, so as -to make conservation of energy as easy as possible -and life well worth the living. The scientific -support from the pens of professional -observers is, however, the real meat of the<span class="pagenum" id="Page_xxi">[Pg xxi]</span> -book, for which compiler and reader alike are -and should be grateful.</p> - -<hr class="tb" /> - -<p>In serving in the humanitarian ranks in a -commonweal campaign one should not need to -use the concealment of modesty, nor should he -fail to speak with all frankness. What are the -motives behind all this energy to reform the -eating habits of the people? The question has -been so often asked that it is better thus publicly -answered.</p> - -<p>No one concerned in the campaign has any -personal monetary interest in any kind of food, -prepared or otherwise. The movement began -in a suggestion carried by an accidental word -given to the author by a friend, an old-time -friend in Japan, and a friendship never to be forgotten, -as related in the author’s book “Menticulture.” -Pursuit of menticulture led further to -the discovery that the best mental results could -not be accomplished in a body weakened by -any indigestion, any mal-assimilation of nutriment, -any excess of the waste of indigestion. -Then came the quest for the causes of mal-nutrition, -which were soon found, by study of -the natural sequences and by going behind the -hypotheses of text-book authority, to arise in -the careless ingestion of food, its neglect in -the mouth, and the consequent glut of unas<span class="pagenum" id="Page_xxii">[Pg xxii]</span>similable -excess within the body, necessitating -enormous expense of brain and body energy -to get rid of the excess.</p> - -<p>When the secret of the potency for good of a -rationally economic alimentation was revealed to -the author, was confirmed by several colleagues -of different ages and both sexes, and was tested -by work and endurance measurement, and also -by the test time, it became necessary to have -given to it the indorsement of highest authority -in order to have the information credited. The -new rediscovery was a simple matter, something -everybody thought they knew all about because -it had been under their nose all their life and -was one of the commonplaces of every-day living, -but for that very reason it failed to receive -credence, and the backbone of the doubt was -habit—lifelong habit—and this was hard to -break even in those who accepted the theory -of economic nutrition as a logical conviction. -It was also necessary to prove that it was not -personal idiosyncrasy that favoured us, its -advocates.</p> - -<p>It is in pursuit of the latter desideratum that -the officers of the army, the scientists, and the -great humanitarian health-restoring institutions -have entered upon conclusive investigations, -each in their own way, to chart out a law of -economy that will be generally applicable and<span class="pagenum" id="Page_xxiii">[Pg xxiii]</span> -which, it is hoped, can be understood by kindergartners -and mothers for the benefit of the -present and of coming generations.</p> - -<hr class="tb" /> - -<p>It was just stated that no one concerned -in the inquiry was interested in any food -product or in any personally profitable business -concern, and mention of the Battle Creek -Sanitarium, so widely known as the pioneer -in fostering the pure food and prepared-cereal -manufacture, may cast a doubt upon the matter -in the minds of those who do not know that -the Sanitarium organisation, in its every department, -is a philanthropic, humanitarian -institution. It is the parent and feeder of the -American Medical Missionary Cause, which -already has established branches in something -over sixty localities situated in or near large -cities in different parts of the world, chiefly -America. By perpetual charter all the profits -revert to the spread of the work and the employees -serve for a mere pittance, deriving -their major compensation from enjoyment of -the altruistic work.</p> - -<hr class="tb" /> - -<p>The old prejudice against the human race -which declared that “everybody had an axe to -grind,” that there was “a nigger in every woodpile,” -and such like slanders, must be modified<span class="pagenum" id="Page_xxiv">[Pg xxiv]</span> -in the light of recent altruistic development. -Altruism has always been existent and had a -great new birth with the beginning of our era, -but it was never before so frankly put upon a -business basis as it is now, and this is fast being -applied to every department of business activity. -It is now done, not in the name of any -particular creed or cult, or for future reward, -but because <i>it pays</i>—first, last, and all the time.</p> - -<hr class="tb" /> - -<p>In the study and pursuit of menticulture the -author has found that working for the common -good is as necessary to happiness as working for -self, and that the retroactivity and reciprocity of -the idea multiplies the profits indefinitely.</p> - -<p>The sequence of profitable, altruistic interrelation -is stated in the “Explanation” of the -chain of the A. B. C. Life Series, of which this -book is one of the links.</p> - -<hr class="tb" /> - -<p>Aside from those actively engaged in the -several investigations to whom reference is often -made, the author wishes to express special gratitude -to Sir Michael Foster and to Professor -Henry Pickering Bowditch of the Board of Scientific -Assessors. Unselfish and unremitting in -their assistance and encouragement, the author’s -work has been made easy since their interest -was enlisted.</p> - -<p><span class="pagenum" id="Page_xxv">[Pg xxv]</span></p> - -<p>Sir Michael, as Member of Parliament in -England, and as a physiological savant, knows -that economic nutrition is the key to England’s -welfare, as well as the basic necessity of temperance, -morality, health, and efficiency, as is -expressed in the two documents from him -reproduced in the “Report of a Plan for an -International Investigation into the Subject of -Human Nutrition” and in his “Note” on the -Cambridge examination of the author and Dr. -Van Someren at Cambridge University laboratories, -given herein.</p> - -<p>Professor Bowditch, as a distinguished physiologist, -publicist, and especially as the President -of the Children’s Aid Society, of Boston, -Massachusetts, often mentioned as the model -institution of its kind in the world, realises that -the effort of the author to secure basic knowledge -relative to right nutrition, adaptable to -kindergarten teaching and home training during -the impressionable period of youth, is of -the greatest importance in social reform.</p> - -<p>A trial suggestion relative to ways and means -of <i>beginning right</i> with <i>all the children</i> and thus -insuring a regeneration of the classes most in -need of reform, in not longer than two decades, -is outlined in the author’s appeal for the waifs -of society, entitled “That Last Waif; or Social -Quarantine.”</p> - -<p><span class="pagenum" id="Page_xxvi">[Pg xxvi]</span></p> - -<p>Whenever there is any disposition to slack -up in patience or enthusiasm to accomplish the -ultimate end aimed at, the picture of the waif in -that story is flashed back by memory, and there -can be neither forgetfulness, indifference, nor -repose until “that last waif” has been given <i>at -least a chance of choosing</i> between the right and -the wrong, the good and the bad.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_xxvii">[Pg xxvii]</span></p> - -<h2 class="nobreak" id="POSTINTRODUCTORY">POSTINTRODUCTORY</h2> -</div> - - -<p>[Just before “going to press” the author has -received a letter from his esteemed colleague, -Dr. Hubert Higgins, giving the gist of interviews -with an eminent European physiologist -and with a famous American chemist and dietitian, -which so well describes the attitude of the -scientific mind towards the problem of human -nutrition that the scientific mentor of the writer -advises its addition to the book.</p> - -<p>By the same post there arrived a letter from -Dr. J. H. Kellogg, the life and director of the -Battle Creek Sanitarium, expressing practical -appreciation, the result of demonstration, of -what is being done to solve the problem.</p> - -<p>Eliminating the personal element and keeping -the ultimate object in view, these communications -are coincidentally <i>a propos</i> and intimate -to our “Introduction”; hence their reproduction -here.</p> - -<p>Numerous other letters and extracts from -communications received by the writer, bearing -upon this subject, from the above and other -sympathetic friends are reproduced in “The<span class="pagenum" id="Page_xxviii">[Pg xxviii]</span> -New Glutton or Epicure,” a free and easy companion -of this book, intended to appeal to a -variety of readers.</p> - -<p>When it is known that the proceeds of all -the publications of the author are dedicated to -the promotion of the objects they advocate, -reference to them or advertisement of them -cannot be considered inappropriate.—<span class="smcap">Horace -Fletcher.</span>]</p> - - -<p class="center"><span class="smcap">Extracts from Dr. Higgins’ Letter</span></p> - -<p class="psig small"> -<span class="smcap">Palazzina Tasso</span>,<br /> -<span class="smcap">Campo S. Polo</span>,<br /> -<span class="smcap">Venezia</span>.</p> - -<p><small>October 3, 1903.</small></p> - -<p><span class="smcap">Dear Mr. Fletcher</span>,—A. appears to me -to have an exceedingly broad and philosophic -grasp of the problem of nutrition.</p> - -<p>He recognises that all present data are subject -to criticism, and that there are no scientifically -accurate data available because</p> - -<div class="blockquot"> - -<p>(<i>a</i>) Observations are taken over too short a -period.</p> - -<p>(<i>b</i>) They have mainly dealt with one side -of the problem,—the output of -muscular work.</p> - -<p>(<i>c</i>) The observations are not sufficiently -complete.</p> -</div> - -<p><span class="pagenum" id="Page_xxix">[Pg xxix]</span></p> - -<p>He acknowledges that cleavage products -from food broken down in the intestines by -bacteria are the cause of</p> - -<ul> -<li> -(<i>a</i>) Inefficiency</li> -<li>(<i>b</i>) Diseases</li> -<li>(<i>c</i>) Mental derangements.</li> -<li><span style="margin-left: 4em;">(See Mott’s work.)</span></li> -</ul> - -<p>He recognises that the majority of people -eat far too much. He puts this in the following -way. If a “mediæval devil” had wished to -discover the most subtle and most effective way -to destroy mankind mentally, morally, and -physically, he would have arranged for them -to be supplied with tasty, well-cooked foods, -wines, etc.; in short, he would have used every -means to tempt, confuse, and pervert their appetite. -He would also have arranged every -possible means to prevent their being in the -fresh air and taking exercise. He thinks one -has here the picture of modern civilisation.</p> - -<p>He talked in a very interesting and instructive -manner about the necessity and value of -exercise and a muscular body for the maintenance -of good health. He has evidently worked -at and thought a good deal about this side of -the subject.</p> - -<p>He regrets that there are not more people -who realise the huge importance of under<span class="pagenum" id="Page_xxx">[Pg xxx]</span>standing -the nutrition problem for the sake -of the progress of humanity. He would like -to join all those who are interested in forming -an international society, as far as I understood -him.</p> - -<p>He is most keen on getting subjects, such -as myself, for study over a very long period of -time,—two to three years,—as he very justly -observed “Muscular output is a very small -part of the measure of a man’s efficiency. -Mental efficiency, manual dexterity, and other -psychological tests are necessary.” He seemed -very much interested in my idea of making a -large number of curves of daily observations. -He said that it appeared to him to offer the -best means of ultimately measuring the degree -of deviation from the subject’s optimum state -of health.</p> - -<p>He argues the necessity of getting some -scientific definition of health.</p> - -<hr class="tb" /> - -<p>The phrase that reduces all these people to -contemplative silence is this.</p> - -<p>“You acknowledge that the state of knowledge -is insufficient to prescribe a diet for any -individual that he should take daily; or in -other words, that there is very little accurate -knowledge of the nutrition problem.”</p> - -<p>Reply. “Yes. I do not feel I could pre<span class="pagenum" id="Page_xxxi">[Pg xxxi]</span>scribe -a diet for any one with any degree of -confidence.”</p> - -<p>“Very well, then. Why should not the -body have or acquire the quality that all animals -have, in a free, natural state, of knowing -what their body wants by appetite and taste?”</p> - -<p>This is more or less how you put it to me -when I first met you at Cambridge. Its full -significance did not dawn on me till much later; -till, in short, I commenced the study of my -desires at Cambridge.</p> - -<p>Now this point of view is the rock on which -we stand, and is the cause of H.’s and A.’s interest, -and as H. said, is the “most fascinating -idea” he ever heard.</p> - -<p>It had very much the same effect on A. He -was reduced to silence. The more you think -of it the more you see there is no answer that -could contradict it.</p> - -<p><i>He then admits that</i></p> - -<div class="blockquot"> - -<p>(<i>a</i>) The food should be finely divided.</p> - -<p>(<i>b</i>) That it should be thoroughly insalivated.</p> - -<p>(<i>c</i>) That in all probability most diseases are -caused by dietetic error.</p> - -<p>(<i>d</i>) That we have still to find the optimum -health and the optimum diet.</p> -</div> - -<p>He only kicks at the low proteid. Now I -don’t care a “kuss” for the low proteid, as<span class="pagenum" id="Page_xxxii">[Pg xxxii]</span> -such, or high proteid. Proteid like everything -else will be demanded by the appetite when it -is wanted.</p> - -<p>Our great danger, to my mind, is the tendency -so strongly exemplified by some of prescribing -diets and quantities and the length -of time food should be chewed.<a id="FNanchor_1" href="#Footnote_1" class="fnanchor">[1]</a> Now the very -errors we are fighting against are the prescription -of methods on insufficient information or -knowledge. <i>You have gone straight back to -Nature.</i> <i>There is your strength</i> in convincing -the scientific world, and we must study the -problem from that point of view if we are to get -any great degree of success.</p> - -<p>A. had nothing to say when I told him that -I did not hold by either high or low proteid but -only by my appetite and taste, developed by -ample mouth opportunity to discriminate, which -I hoped, in time, to understand more thoroughly -than I do now. He told me that he -feared that there would be great physical deterioration -after a long period of low proteid. -I said that I did not believe it would be the -case by your method. For instance, right in -the midst of a long period of most satisfactory -low-proteid supply, I once ate nearly a whole<span class="pagenum" id="Page_xxxiii">[Pg xxxiii]</span> -chicken with some ham at Penegal. I could not -get saliva for anything else.<a id="FNanchor_2" href="#Footnote_2" class="fnanchor">[2]</a> In short, then, I -insisted only on thorough mastication to protect -taste and appetite, and had no other theories. -I was only concerned in observing the factors -determining my taste and appetite. I would be -more than contented to leave the question of -minimum and maximum quantity of proteid to -be settled in the future after normality had been -established by practical demonstration.</p> - -<p class="psal"> -Yours faithfully,</p> -<p class="psig"><span class="smcap">Hubert Higgins</span>.</p> - - -<p class="center"><span class="smcap">Extracts from Dr. Kellogg’s Letter</span></p> - -<p class="psig"> -<small><span class="smcap">Battle Creek, Mich.</span></small><br /> -<small>October 7, 1903.</small></p> -<p><small><span class="smcap">Mr. Horace Fletcher.</span></small><br /> -</p> - -<p><span class="smcap">Dear Friend</span>,—Yours of September 30th -just reached my hands and I hasten to reply.</p> - -<p>I saw a newspaper note in reference to the -soldiers which the government has selected for -the dietetic experiments, and also read an interesting -article in the <i>Popular Science Monthly</i>. -You have accomplished a great good thing in -enlisting these scientific and military men and -interesting them in the investigation of this<span class="pagenum" id="Page_xxxiv">[Pg xxxiv]</span> -wonderful reform. The marvellous thing about -it is that these busy men of science should have -so readily undertaken an investigation which -involves so much surrender and self-denial, at -least, at the start. I know you are absolutely -right. My personal experiences and observations -confirm me. In the experiments you -mention, which I made in reference to the daily -ration for ordinary persons, I simply sought to -ascertain, as have others, how much and what -kinds of food people are in the habit of using, -taking no account of the possible excess or the -careless manner in which they eat. The figures -I got were sixteen ounces of starch; 1.2 ounces -fat, and three ounces proteids,—approximately -2,500 calories. In observation of patients I have -seldom found one able to eat this amount. -Personally, I habitually eat scarcely half as -much. My breakfast to-day was the yolks of -two eggs, two or three tablespoonfuls of corn -flakes, a moderate-sized potato, and a couple of -peaches. At dinner I shall take a little more.</p> - -<p>I have been so busy with my patients and -the new building, getting things organised, that -I have not done as much as I ought to in the -way of promoting your splendid reform; but I -am going at it now in good earnest. I feel it is -one of the greatest things in sight, and it fits -right in to all the other things I am trying to<span class="pagenum" id="Page_xxxv">[Pg xxxv]</span> -do. I feel that I owe you continually a great -debt for the efforts you have made and the -splendid work you are doing, which will accomplish -more for the uplifting of humanity than -all that Carnegie and Rockefeller are doing with -their millions. What they are doing is mainly -to perpetuate old errors, while you are bringing -out new truth of basic importance, and a kind -Providence has certainly inspired you to do this -grand work.</p> - -<p>I thank you for all your good thoughts -towards us, and assure you the loving encouragement -your letters always contain is very -much appreciated, and sometimes it gives us a -mental uplift just when we need it. The road -we are travelling over is not altogether free from -thorns. All your suggestions are gratefully -received. I remain,</p> - -<p class="psal"> -Faithfully yours,</p> -<p class="psig"> -<span class="smcap">J. H. Kellogg</span>. -</p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_3">[Pg 3]</span></p> -<h2 class="nobreak" id="A_B-Z_PRIMER">A. B.-Z. PRIMER</h2> -</div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="EXPLANATION">EXPLANATION</h3> -</div> - - -<p>This is a condensed presentment of a subject -of basic importance to everyone, -supported by numerous appendices of great -scientific weight.</p> - -<p>The special object of such brevity and elementary -treatment of the subject is:</p> - -<p><b>1.</b> To accentuate the facts showing how little -we really have to know and do in connection -with our sustenance in order to have the -<span class="smcap">Natural Automatic Processes</span> done rightly -and healthfully.</p> - -<p><b>2.</b> To permit busy persons who will take our -dictum as gospel and our advice as sound -to learn their necessary share in their own nutrition -in the least possible time, leaving the less -credulous and more curious to study the appendices -at leisure and at will.</p> - -<p><b>3.</b> For some ten years it has been the ambition -and the aim of the older and non-professional -author to embody the fundamental essentials of -human responsibility in self-understanding and -self-management in not more than ten pages of -coarse print that a child could understand and -that mothers and teachers might commit to -memory and never forget.</p> - -<p>This is only a first trial-attempt to fulfil the -ambition and the aim; but the appendices show -the assembling and concentration of scientific -and militant forces which will not allow this subject -of primal human interest to remain longer -the most neglected of educational departments.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_4">[Pg 4]</span></p> - -<h3 class="nobreak" id="SOME_PERTINENT">SOME PERTINENT -QUESTIONS</h3> -</div> - - -<p>Will the reader not ask himself the following -questions?</p> - -<p><b>1.</b> How much do I know about my own nutrition?</p> - -<p><b>2.</b> Do I know the particular need and purpose -of my last meal and what it is likely to -accomplish?</p> - -<p><b>3.</b> Considering my body as an engine, would -I accept myself as a competent engineer on -my own examination and confession?</p> - -<p><b>4.</b> Were I an iron and steel automobile, instead -of a flesh and blood automobile, which I -really am, could I get a license for myself, as a -<i>chauffeur</i>, to run myself with safety, based upon -my knowledge of my own mechanism and the -theory and development of my power?</p> - -<p><b>5.</b> Were I an owner of valuable live-stock, -would I employ a farm-hand or a stable -man, even at so low a wage as fifteen dollars a -month, who knew as little about the proper -feeding of my animals as I know about the -proper feeding of myself and my children?</p> - -<p><b>6.</b> Should I employ such an ignorant attendant -for my live-stock, and catch him worrying -them during their feeding, and hurrying them -away from their fodder to hitch them up for work, -would I not have the man arrested for cruelty -to animals? And yet this is what is habitually -done to children!</p> - -<p><span class="pagenum" id="Page_5">[Pg 5]</span></p> - -<p><b>7.</b> Do I appreciate how important it is to learn -sufficient of the requirements of economic -and healthy nutrition to enable me to escape -the depressing and debilitating effects of a -faulty nutrition.</p> - -<p><b>8.</b> How can I religiously “ask a blessing” -upon food and then immediately sin by -treating it in a manner abhorrent to the natural -requirements?</p> - -<p><b>9.</b> If “cleanliness is next to godliness” is it -respectable for me to slight my proper -feeding in a manner that I know may induce -putridity of excreta through indigestion and -that <i>may</i> produce fatal disease?</p> - -<p><b>10.</b> With All Eternity ahead of me, cannot I -afford at least 1/48<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">[3]</a> of my time for careful -feeding of my body in a manner known to -favour physical health; mental keenness; firmness -of character; enjoyable temperance; sexual -vigour without morbidity. In fact, general -respectability and efficiency?</p> - -<p>Having duly reasoned out logical answers to -the questions, may they not seem sufficiently -important to be remembered and respected as -a <span class="smcap">Dietary Ten Commandments</span>?</p> -<hr class="chap x-ebookmaker-drop" /> - - -<p><span class="pagenum" id="Page_6">[Pg 6]</span></p> - -<div class="chapter"> -<h3 class="nobreak" id="A"></h3> -<table class="center" summary=""> -<tr> -<td class="tdc"><span class="xxl">A</span> </td> -<td class="tdc"><big><span class="u">The Psychology of Nutrition</span></big><br /> -APPETITE ATTENTION<br /> -APPRECIATION</td> -</tr> -</table> -</div> - - -<p><span class="smcap">Appetite</span> is the most important factor in -digestion (vide Pawlow).</p> - -<p><span class="smcap">Normal Appetite</span> is indicated by a desire -for <i>some particular</i> simple food accompanied -by a “watering of the mouth.”</p> - -<p><span class="smcap">False Appetite</span> is a general discontent of -the body, indefinite of description. It is often -expressed by “all gone-ness,” or stomach craving, -and calls for <i>something</i>, <span class="smcap">Anything!</span> to -smother the discomfort of present or recent indigestion. -It is like the thirst which follows a -debauch.</p> - -<p><span class="smcap">Ignore False Appetite</span>, and <span class="smcap">Wait</span> for -a <span class="smcap">Return</span> of <span class="smcap">Normal Appetite</span>. It will come -as soon as body repairs have been effected by -natural agencies and more material is required. -No one was ever injured by intelligently and -calmly waiting for an appetite. No one ever -starved to death for lack of appetite. Most -human ills come from forcing appetite, anticipating -appetite, abuse of appetite in some form.</p> - -<p><span class="smcap">Appetite</span> is the most important factor in -nutrition. This estimation is based upon evidence -given more fully in the various appendices, -but the measure of its importance may be -briefly stated, as follows:—</p> - - -<p><i>First</i></p> - -<p>In its normal state, Appetite is a perfect -indicator of the bodily need of -nutriment and moisture, both as to quantity and -as to the chemical elements required at the -moment.</p> - -<p><span class="pagenum" id="Page_7">[Pg 7]</span></p> - - -<p><i>Second</i></p> - -<p><span class="smcap">Appetite</span> is a creature of the mind -and does not attach to a tissue. It -can be as easily changed, from abnormal to -normal, by suggestion, as can the mind itself, -and is not like a solid, the form or habit of -which has been set in a mould. Whoever has -once experienced a bad oyster and has abhorred -oysters ever after will substantiate this claim -regarding the caprices of appetite.</p> - - -<p><i>Third</i></p> - -<p><span class="smcap">Appetite</span> can be easily comprehended -and read and the degrees of its satisfaction -understood by simple attention and -study for a brief period (vide Van Someren).</p> - - -<p><i>Fourth</i></p> - -<p><span class="smcap">Attention</span> is necessary to create -<span class="smcap">Appreciation</span>, and appreciation is -absolutely necessary to stimulate the secretion -and flow of gastric and other digestive juices -(vide Pawlow).</p> - - -<p><i>Fifth</i></p> - -<p><span class="smcap">Anger</span>, or shock of any kind, and -<span class="smcap">Worry</span>, or any of the pessimistic depressants, -stop digestive activity and cause indigestion -(vide Cannon).</p> - - -<p><i>Sixth</i></p> - -<p><span class="smcap">Menticulture</span> should begin with its -application to selection (through a -normalised appetite) of nutriment for the body, -and continue to aid digestion by right thinking.</p> - -<p>It is very easy to cultivate calm and fortify -against surprise, shock, and anger if the nutrition -of the body is carefully attended to. The -physical and the mental equipments are beautifully -reciprocal and necessary to each other in -promoting <span class="smcap">Menticulture</span>.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_8">[Pg 8]</span></p> - - -<h3 class="nobreak" id="B"></h3> -<table class="center" summary=""> -<tr> -<td class="tdc"><span class="xxl">B</span> </td> -<td class="tdc"><big>The Mechanical and Chemical<br /> -<span class="u">Physiology of Nutrition</span></big><br /> -</td> -</tr> -</table></div> - - -<p class="center"><big>BUCCAL DIGESTION</big><br /> - -THROUGH<br /> - -<big>MOUTH THOROUGHNESS</big></p> - - -<p>Mouth treatment of food, which permits, aids, -and includes insalivation (mixing with saliva), -and which is both actively digestive in its functions -and preparatory to final digestion, is the -only <i>actual mechanical responsibility</i> we have in -our nutrition; and, in connection with favourable -A conditions, insures perfect digestion. It -has been so fully and clearly explained in some -recent articles, “Observations on Mastication,” -by Dr. Harry Campbell, F.R.C.P., physician to -the Northwest London Hospital, printed in the -“Lancet” of July 11th, 18th, 25th, and August -8th, 1903, that reference to the articles, reprinted -herewith, is all that is necessary here.</p> - -<p>In giving attention to careful mouth-treatment -of soft or liquid foods until they are absorbed -by the Swallowing Impulse the best health and -economic results are obtained. It should, at -least, be tried.</p> - -<p>This will not be found to be a tedious operation -after a little practice, when the habit of -attention and care has been formed. On the -contrary, a new appreciation and enjoyment of -taste will be acquired, the delight of which has -to be experienced to be understood.</p> - -<p>Some hints on learning how to <i>read</i> the appetite, -<i>command</i> the attention, and <i>masticate</i> and -<i>swallow</i> food material <i>properly</i> follow.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_9">[Pg 9]</span></p> - -<h4 class="nobreak" id="METHOD">METHOD</h4> -</div> - - -<p><i>First; Last; -and -All the Time</i></p> - -<p>Be sure that you are really -hungry and are not pampering -False Appetite. -If true appetite that will -relish plain bread alone is not present, wait for -it. Especially beware of the early-morning -habit-craving. Wait for an <i>earned</i> appetite, if -you have to wait till noon. Then: “Chew,” -“Masticate,” “Munch,” “Bite,” “Taste” everything -you take in your mouth (except water, -<i>which has no taste</i>), until it is not only thoroughly -liquefied and made neutral or alkaline -by saliva, but until the reduced substance all -settles back in the (glosso-epiglottidean) folds -at the back of the mouth and excites the -Swallowing Impulse into a strong inclination -to swallow. Then swallow what has collected -and has excited the impulse, and continue to -chew <i>at</i> the remainder, liquid though it be, -until the last morsel disappears in response to -the Swallowing Impulse. Never forcibly swallow -anything that the instincts connected with -the mouth show any disposition to reject. It -is safer to get rid of it beforehand than to risk -putting it into the stomach.</p> - -<p>Sip and taste milk and all liquids that have -taste as the wine-tasters do. They never drink -wine and yet they get all the enjoyment there -is in it and waste none. In a very short time -sipping and tasting liquids and masticating and -tasting solid food for “all they are worth” will -become an agreeable and profitable fixed habit.</p> - -<p><span class="smcap">Whether We “Eat To Live or Live to -Eat,” why not do as Above?<span class="pagenum" id="Page_10">[Pg 10]</span></span></p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="Z"></h3> -<table class="center" summary=""> -<tr> -<td class="tdc"><span class="xxl">Z</span> </td> -<td class="tdc"><big>The True Chemical End-Point<br /> -<span class="u">of Digestion</span></big> -</td> -</tr> -</table> -</div> - -<p class="center"><big>THE DIGESTION-ASH WHAT IT<br /> -SHOULD BE LIKE WHEN<br /> -IT IS NORMAL</big></p> - - -<p><i>First</i></p> - -<p>In adults; or, in children after the -eruption of teeth and the ingestion of -solid food: The non-liquid and non-gaseous -waste of the human body, which, in its normal -state, is not offensive, should be very small, -in quantity, should be pillular in form, either -separate or massed together; should have no -odour when released, should take on no odour -on standing, should be entirely aseptic (non-poisonous); -should drop freely from the exit, -leaving nothing behind to wash or wipe away. -It <i>may</i> not be collected in the intestines of full-grown -and elderly persons, when normal, as -above, in sufficient quantity to require or necessitate -emptying oftener than from twice a week -to once in two weeks; according to age, activity, -etc.; and should neither invite nor justify -the description “it is not that which goeth into -a man that defileth him but that which cometh -out.”</p> - - -<p><i>Second</i></p> - -<p>Economic Digestion-Ash (solid <i>excreta</i>), -as a daily average for an -adult of 140 lbs. (10 stone; 63.5 kilos), including -moisture, when released, should not weigh -more than two ounces (56.70 grams). An average -of less than one half this amount of waste -has been secured in test experiments.</p> - -<p><span class="pagenum" id="Page_11">[Pg 11]</span></p> - - -<p><i>Third</i></p> - -<p>The true test of healthy Z is absence -of odour and completeness, ease and -cleanliness of delivery. Frequency or otherwise, -does not so much matter. Quantity too, -is not so important; but with foul odour there -is disturbance, strain and danger.</p> - -<p>The normal man is a cleanly being with all -excreta inoffensive; and by these tokens he -may be his own private judge.</p> - -<p>Why is it that barn-yards are tolerable to -the human senses while open <i>dépôts</i> of human -excreta are fever-breeding nuisances and intolerable -to beasts and humans alike?</p> - -<p>This curse of putrid excreta caused more -deaths from enteric fever during the Boer War -in South Africa than all other causes. It is -equally a menace to health and even to life -while being formed and carried in the body.</p> - - -<p><i>Fourth</i></p> - -<p>Offensive excreta are quite certain -evidence of neglect of the self-controllable -parts of our own nutrition. They are -the tell-tale condemnation of ignorance or carelessness. -Each person should learn to read the -true bulletins of his health conditions in his -waste-products of digestion.</p> - - -<p>Z</p> - -<p>is the form the body <i>must</i> assume to render -emptying of the digestion-ash natural and -easy. Man was built to squat on his heels in -defecating, and sitting erect on a modern seat -is like trying to force a semi-solid through a -kinked hose. <span class="smcap">Healthy Human Excreta are -no more Offensive than Moist Clay and -have no more Odour than a Hot Biscuit.<span class="pagenum" id="Page_12">[Pg 12]</span></span></p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="A_B-Z_FIGURE">A. B.-Z. FIGURE<br /> - -<small>TO ILLUSTRATE THE “DIVISION OF -LABOUR”</small></h3> -</div> -<hr class="full" /> - -<table class="standard" summary=""> -<tr> -<td class="tdl" rowspan="2"><span class="xxl"><i>First.</i> A</span></td> -<td class="tdl">Psychic Environment</td> -<td class="tdl" rowspan="2"> - <img src="images/brace50rl.jpg" alt="}" /> -</td> -<td class="tdl">This</td> -</tr> -<tr> -<td class="tdl">Mental State</td> -<td class="tdl">involves:</td> -</tr> -<tr> -<td class="tdl" colspan="2"><span class="smcap">Appetite</span> (to select for)</td> -<td class="tdl" rowspan="3"> - <img src="images/brace50rl.jpg" alt="}" /> -</td> -<td class="tdl" rowspan="3">DIGESTION</td> -</tr> -<tr> -<td class="tdl" colspan="2"><span class="smcap">Attention</span> (to prepare for)</td> -</tr> -<tr> -<td class="tdl" colspan="2"><span class="smcap">Appreciation</span> (to assist in)</td> -</tr> -</table> - -<p>(Absolutely necessary to secure secretion and -flow of the digestive juices: Vide Pawlow and -Cannon.)</p> - -<table class="standard" summary=""> -<tr> -<td class="tdl" rowspan="2"><span class="xxl"><i>Second.</i> B</span></td> -<td class="tdl"><span class="allsmcap">BUCCAL-DIGESTION</span></td> -<td class="tdl" rowspan="2"> - <img src="images/brace50rl.jpg" alt="}" /> -</td> -<td class="tdl">This</td> -</tr> -<tr> -<td class="tdl"><span class="allsmcap">MOUTH-TREATMENT</span></td> -<td class="tdl">involves:</td> -</tr> -<tr> -<td class="tdl" colspan="2"><span class="smcap">Mechanical</span> (teeth)</td> -<td class="tdl" rowspan="2"> - <img src="images/brace50rl.jpg" alt="}" /> -</td> -<td class="tdl" rowspan="2">THOROUGHNESS</td> -</tr> -<tr> -<td class="tdl" colspan="2"><span class="smcap">Chemical</span> (salival)</td> -</tr> -</table> - -<p>(Absolutely necessary to secure complete digestion -and avoid the putridity incident to bacterial -decomposition: Vide Campbell and Van Someren.)</p> - - -<p>INTERMEDIATE</p> - -<p>The twenty-three letters -between “<b>B</b>” and “<b>Z</b>” -represent but an inadequate proportion for the -spelling of the enormous share Nature assumes -in our welfare, marvellously performing her -forty-seven forty-eighths share in the secret -laboratory of the alimentary canal.</p> - - -<p><span class="xxl"><i>Third.</i> Z</span></p> - -<p>The true chemical end-point of -digestion, by which each self-respecter -may know how well he has respected -his “A” and his “B,” and how faithfully he -has performed his one forty-eighth share in -the promotion of his own most fundamental -interest.</p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_13">[Pg 13]</span></p> - -<h3 class="nobreak" id="PREFACE">PREFACE -TO 1906 EDITIONS</h3> -</div> - - -<p>Since the former introductions were written -much success has been attained in further advancing -the reforms advocated in the <i>A. B. C. -Life Series</i>. Professor Chittenden has published -his report on the Yale experiments in -book form in both America<a id="FNanchor_4" href="#Footnote_4" class="fnanchor">[4]</a> and England,<a id="FNanchor_5" href="#Footnote_5" class="fnanchor">[5]</a> -and his results have been accepted in scientific -circles the world over as authoritatively conclusive.</p> - -<p>At the present writing the most important -Health Boards of Europe<a id="FNanchor_6" href="#Footnote_6" class="fnanchor">[6]</a> are planning to put the -new standards of dietary economy into practical -use among public charges in a manner that can -only result in benefit to the wards of the nations -as well as make an important saving to the tax-payers. -In the most important of these foreign -public health departments the Health Officer of -the Board has himself practised the newly established -economy for two years, and his plans<span class="pagenum" id="Page_14">[Pg 14]</span> -are formulated on personal experience which -fully confirms Professor Chittenden’s report and -that of the author as herein related.</p> - -<p>At a missionary agricultural college, situated -near Nashville, Tenn., where the students earn -their tuition and their board while pursuing -their studies, a six months’ test of what is termed -“Fletcherism” resulted in a saving of about one -half of the drafts on the commissary, immunity -from illness, increased energy, strength and endurance, -and general adoption of the suggestions -published in the several books of the author included -in the <i>A. B. C. Life Series</i>.</p> - -<p>In the various departments and branches of -the Battle Creek Sanitarium in America, and -widely scattered over the world, some eight -hundred employees and thousands of patients -have been accumulating evidence of the efficacy -of “Fletcherism” for more than three years, and -scarce a month passes without a letter from Dr. -Kellogg to the author containing new testimony -confirming the <i>A. B. C.</i> selections and suggestions.</p> - -<p>The author has received within the past two -years more than a thousand letters bearing the -approval of the writers with report of benefits -received which seem almost miraculous, and -these include the leaders in many branches -of human occupation—physiologists, surgeons,<span class="pagenum" id="Page_15">[Pg 15]</span> -medical practitioners, artists, business men, literary -workers, athletes, working men and women, -and almost every degree of mental and physical -activity.</p> - -<p>One of the medical advisers of King Edward, -of whom the King once said: “He is a splendid -doctor but a poor courtier,” follows the suggestions -of these books in prescribing to his -sumptuous clients.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_17">[Pg 17]</span></p> - -<h2 class="nobreak" id="HISTORY_OF_DEVELOPMENT">HISTORY OF DEVELOPMENT<br /> - -<small>AND</small><br /> - -SUPPORTING EVIDENCE</h2></div> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_19">[Pg 19]</span></p> - -<h3 class="nobreak" id="SUMMARY_OF_THE_FOREGOING_PAGES">SUMMARY OF THE FOREGOING PAGES -BY AN EXPERIMENTER OF ONE -MONTH’S EXPERIENCE<br /> - - -<small>(<i>Requested and given as a test of effectiveness</i>)</small></h3> -</div> - -<p>The entire principle of economic nutrition -is simple and practical. It does not prescribe -that we shall follow any special diet nor do away -with any of our meals. It simply requires you -to throw present habits and conventions to the -winds, and for a little time try the experiment -of giving the matter of your every-day living -honest, intelligent thought.</p> - -<p>Eat all you crave, but do not eat more than -this simply because you have been in the habit -of doing so. See to it that each morsel put -into your mouth is thoroughly masticated and -mixed with the saliva before going down into -the stomach, which is not equipped to perform -the work which the teeth and salivary glands -were given you for. The stomach will struggle -bravely to overcome the abuse which you heap -upon it, but in spite of all it can do to manage -hastily chewed food, undigested portions remain<span class="pagenum" id="Page_20">[Pg 20]</span> -which clog the intestines and interfere with the -healthy conditions which Nature intended.</p> - -<p>The appetite is given as an indicator of what -the body requires. If you crave potato, the system -needs starch, which the saliva makes digestible, -but which the acids of the stomach cannot -dissolve. Other needs of the system are similarly -indicated. Take the trouble of asking -your appetite the question, instead of accepting -the conventional number of courses simply -because they are set before you. The appetite -will close the valve when you have eaten enough, -if you will give it a chance.</p> - -<p>Suppose your time for eating is limited; in -twenty minutes you could not eat slowly the -luncheon which you usually select. Then eat -that much less. The amount of food which you -can eat and thoroughly masticate in twenty minutes -will give you more nourishment and will -sustain you better than twice the amount thrown -into the stomach in the same manner in which -a man usually packs a trunk.</p> - -<p>Why is it that so many men require a -“bracer” at eleven o’clock? Because they have -loaded their stomachs with a heavy breakfast, -and instead of gaining nourishment from it, the -smothered organ is doing its best to tear the -undigested morsels to pieces, that they may -pass into the intestines and prevent sickness, or<span class="pagenum" id="Page_21">[Pg 21]</span> -even death. The time finally arrives when it -finds itself unable to do this, and then comes -acute indigestion, or something worse, and the -system becomes run down, ready to receive -typhoid, or any other germs which happen to -come along.</p> - -<p>Do you know why griddle-cakes hurt you? -Because the syrup, which is cane-sugar,—and -as such is indigestible,—is allowed to pass -through the mouth and down into the stomach, -without being properly mixed with the saliva, -which makes it digestible. As soon as it enters -the stomach it becomes acid and interferes with -everything it meets. Had the cakes been properly -masticated and mixed with the saliva, the -cane-sugar would have become grape-sugar, and -in this form it is easily digested.</p> - -<p>Why is it that stout people are advised to -avoid starchy foods? Economic nutrition does -not advise this. Potatoes, eaten too hastily, -when not craved by the appetite, supply the -system with a superabundance of starch, and -this is fat-inducing. Potatoes are supposed -to produce fat; but if your appetite craves -potato, and you properly masticate it, eating -only as much of it as satisfies your appetite, the -system absorbs it all, leaving nothing to produce -fat. On this same principle economic -nutrition assures that the same food, taken in<span class="pagenum" id="Page_22">[Pg 22]</span> -accordance with its requirements, will add to one -man’s weight and decrease another’s, simply -because proper care of the stomach supplies the -vital organs with the necessary materials to form -each individual person after the model which Nature -intended for him. If Nature intended him -to be slight, economic nutrition will not make -him heavy; if Nature intended him to be muscularly -strong and heavy, economic nutrition will -not reduce his weight. In each case he will enjoy -that perfect condition which Nature intended -him to possess without fat encumbrance.</p> - -<p>Did you ever try to reason out why it is -necessary for athletes to go into training? Simply -because, in order to get the best use of their -strength, they are obliged to spend some number -of weeks or months in overcoming false -conditions which they have brought upon themselves. -Any person who lives in accordance -with the simple requirements of economic nutrition -has nothing of this kind to overcome, but -is in perfect condition all the time.</p> - -<p>The requirements of economic nutrition are -not hardships but pleasures. Proper mastication -and insalivation (mixing with saliva), give -your sense of taste far greater gastronomic enjoyment -than you have ever before had. If you are -a wine drinker, try insalivating a little port wine; -but it must be good wine, for this is a severe<span class="pagenum" id="Page_23">[Pg 23]</span> -test. A sip will quench your immediate desire -and give you more pleasure than a whole glass -gulped down. The professional tea-taster does -this in tasting tea; he never allows himself to -drink any tea at all, for drinking anything that -has taste destroys the delicacy of the sense -of taste. But he will tell you that he gets more -real enjoyment out of the little he takes than -he previously gained from drinking a larger -amount. The same thing applies to the professional -wine-tasters; they never drink any wine, -and yet they enjoy the taste of wine as drinkers -never can do. These men adopt this method as -a business; is their commercial advantage of -greater importance than your health and happiness, -and even life itself?</p> - -<p>Is it not ridiculous that the average man is -so ignorant of the engine which supplies him -with all his activity and upon which depends -every action of his life? Could you tell, were -you asked, the particular need and purpose of -your last meal and what it is likely to accomplish? -Consider your body as an engine: -would you accept yourself as a competent engineer -on your own examination and confession? -Would you employ a chauffeur to run -your automobile who knew as little about its -mechanism and requirements as you do about -your own stomach? Yet which is of greater<span class="pagenum" id="Page_24">[Pg 24]</span> -importance? Were you the owner of valuable -live-stock, would you dare entrust their care -to a farm-hand or stableman who knew as little -about their proper feeding as you know -about your own proper feeding or that of your -children?</p> - -<p>Have you ever stopped to think why the -excrements are foul and odorous? Simply because -undigested food, which should have been -so masticated as to give the body nourishment, -is thrown off by the stomach into the intestines, -there to decay and produce this unclean condition. -If the dead carcass of a cow is lying in -the road, it is removed before it has an opportunity -to decay and thus become filthy and -dangerous. Yet how much more safe it would -be for the carcass to lie where it was than for -you to take portions of it into your intestines -and allow it to decay there instead of in the -road? In other words, food is intended to be -eaten that nourishment may be gained from it, -and when you only gain a part of the nourishment, -you prostitute your stomach and take tremendous -risks of germ diseases in your body.</p> - -<p>These facts are set forward thus simply in -the hope that they may impress the reader as -they have impressed the writer. Economic -nutrition is not a joke, is not a fad; it is -solely an appeal to self-examination and self<span class="pagenum" id="Page_25">[Pg 25]</span>-instruction -in the most vital question of all the -world, since upon perfect nutrition depends not -only health, but strength, mental acuteness, -moral tendencies, attractability to others, happiness, -and, in fact, life itself.</p> - -<hr class="chap x-ebookmaker-drop" /> -<p><span class="pagenum" id="Page_26">[Pg 26]</span></p> - - - - -<div class="chapter"> - -<h3 class="hang">FIRST SCIENTIFIC RECOGNITION OF THE -PRINCIPLES OF ECONOMIC NUTRITION -OUTLINED IN “GLUTTON OR EPICURE”</h3> -</div> - - -<div class="blockquot"> -<p>[With the exception of a brief review of <i>Glutton or Epicure</i>, -by Dr. Joseph Blumfield, of London, published in <i>The Lancet</i>, -no scientific or professional recognition of the principles of an -economic nutrition attained by means of thorough buccal -digestion was gained until issue of the following paper by -Dr. Ernest Van Someren, of Venice, Italy.</p> - -<p>The previous autumn and winter had been devoted to experiments -by Dr. Van Someren and the writer, in co-operation -with Dr. Professor Leonardi, for twelve years Professor of -Chemistry in the University of Pavia, Italy. In the spring -and summer of 1901 the field of experiments was changed to -Mendel Pass, <i>bei</i> Bozen, Süd Tirol, Austria, and related to -endurance work in climbing mountains and bicycle runs among -the Dolomites.</p> - -<p>Dr. Van Someren’s paper attracted the attention of Sir -Michael Foster, Professor of Physiology at the University of -Cambridge, England, and Permanent Honorary President of -the International Congress of Physiologists.</p> - -<p>Professor Foster entered into correspondence with Dr. Van -Someren, and this was followed by an invitation to Dr. -Van Someren and the writer to attend the Congress which -was to convene in Turin, Italy, during the month of September -following. At the Congress Dr. Van Someren presented -a technical thesis on the probable causes of the economy attained, -and gave a demonstration of the movement of his -Swallowing Reflex in relation to food in the process of liquefaction -and preliminary digestion in the mouth.</p> - -<p>Following the Congress we received an invitation to visit -Cambridge, England, and submit to tests of nitrogenous measurements -in the Physiological Laboratory of the University, -under the direction of Dr. F. Gowland Hopkins; and also to an -examination of the bacterial flora incident to the nitrogenous -estimations, under the direction of Dr. George H. F. Nuttall.</p> - -<p>The report of the experiments in the Chemical-Physiological -Department is given in the “<span class="smcap">Note</span>” of Sir Michael Foster, -which follows Dr. Van Someren’s paper, but the bacterial -examination was not carried far enough to warrant a scientific -report, owing to difficulty of obtaining, at the time, sufficient -data.—<span class="smcap">Horace Fletcher.</span>]</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_27">[Pg 27]</span></p> - -<h3 class="nobreak" id="WAS_LUIGI_CORNARO_RIGHT">WAS LUIGI CORNARO RIGHT?</h3> -</div> - -<p class="center"><span class="smcap">A Paper read before the Physiological Section -of the British Medical Association, August, -1901, by Ernest Van Someren</span></p> - - -<p><i>Mr. President and Gentlemen:</i></p> - -<p>Being a general practitioner, it is with some -trepidation and an apology that I present myself -before this section. The reasons for my doing -so are: First, that I believe that a hitherto -unsuspected reflex in deglutition has come to -light which has an important bearing on health, -the prevention of disease and on metabolism. -Second, that any theory whatever, based on a -possible physiological function, claiming to -diminish, as this does, the amount of sickness -and suffering now existent, should have serious -investigation. Third, that I desire to enlist -your skilled help in the consideration of the -theories I have doubtless crudely erected on -my premise.</p> - -<p>According to the “Encyclopædia Britannica,” -“Luigi Cornaro (1467-1566) was a<span class="pagenum" id="Page_28">[Pg 28]</span> -Venetian nobleman, famous for his treatises on a -temperate life. From some dishonesty on the part -of his relatives, he was deprived of his rank and -induced to retire to Padua, where he acquired the -experience in regard to food and regimen which -he has detailed in his work. In his youth he lived -freely, but after a severe illness at the age of -forty, he began under medical advice gradually -to reduce his diet. For some time he restricted -himself to a daily allowance of 12 ozs. of solid -food and 14 ozs. of wine. Later in life he still -farther reduced his bill of fare, and he found -that he could support his life and strength -with no more solid meat than an egg a day. So -much habituated did he become to this simple -diet that when he was about seventy years of -age the addition, by way of experiment, of -2 ozs. a day had nearly proved fatal. At the -age of eighty-three he wrote his treatise on the -‘Sure and Certain Method of Attaining a Long -and Healthful Life.’ And this work was followed -by three others on the same subject, composed -at the ages of eighty-six, ninety-one, and ninety-five, -respectively. ‘They are written,’ says Addison -(‘Spectator,’ No. 195), ‘with such a spirit -of cheerfulness, religion, and good sense, as are -the natural concomitants of temperance and -sobriety.’ He died at the age of ninety-eight. -Some say of 103!</p> - -<p><span class="pagenum" id="Page_29">[Pg 29]</span></p> - -<p>Now, was Luigi Cornaro right? Did he -make use of a physiological process unknown to -us of the value of which he was not cognisant? -To live to an advanced age, must we be as temperate -as he, reducing the quantity of our food -to a minimum required by Nature?</p> - -<p>That we all eat more than we can assimilate -is unquestionable. How can we determine the -right quantity? Instinct <i>should</i> guide us, but -an abnormal appetite often leads us astray. -Nature’s plans are perfect if her laws are obeyed. -Disease follows disobedience. Wherein do we -disobey?</p> - -<p>We live <i>not</i> upon what we eat, but upon what -we digest; then why should undigested food, -recognisable as such, be deemed a normal -constituent of our solid egesta?</p> - -<p>Something like the following must be a common -experience to general practitioners, especially -to those practising on the Continent. The -patient comes to see us and volunteers the information -that he or she has the “gout,” -“rheumatic gout,” or “dyspepsia.” Symptoms -are asked for. The case is gone into carefully -for causation. An appropriate diet and an -appropriate bottle of medicine prescribed. As -the patient leaves the room, we may, or may -not, call attention to the fact that both teeth -and saliva are meant to be used. The patient<span class="pagenum" id="Page_30">[Pg 30]</span> -returns, better, <i>in statu quo</i>, or worse. If better, -he remains so while under treatment, and relapses -when he returns to ordinary habits. If -unaffected, or worse, we try again and again, -until we despair, then take or send him to a -consultant. Temporary benefit, possibly owing -to renewed hope, results; but finally the unfortunate -gets used to his sufferings and, if he -can afford it, is sent to join the innumerable -hosts that wander from one <i>Bad</i> to another, -all Europe over, trying, praising, and damning -each in turn. Their manner of living is, of -course, at fault. Nature never intended that -man should be perpetually on a special diet and -hugging a bottle of medicine, nor did she ordain -that he should go wandering over the map of -Europe drinking purgative and other waters.</p> - -<p>Though early yet to speak with certain voice, -it would seem that we are provided with a Guard, -reliance on which protects us from the results of -mal-nutrition. There seems to be placed in the -fauces and the back of the mouth a Monitor to -warn us what we ought to swallow and when we -ought to swallow it. The good offices of this -Monitor we have suppressed by habits of too -rapid eating, acquired in infancy or youth.</p> - -<p>Last November my attention was called by -Mr. Horace Fletcher, an American author living -in Venice, to the discovery in himself of a<span class="pagenum" id="Page_31">[Pg 31]</span> -curious inability to swallow, and a closing of the -throat against food, unless it had been completely -masticated. My informant stated that -he noticed this peculiarity after he had begun to -excessively insalivate his food, both liquid and -solid, until all its original taste had been removed -from it. Any tasteless residue in the -mouth, being refused by the fauces, required a -<i>forced</i> muscular effort to swallow. He further -told me that since adopting this method of eating -he had been cured of two maladies, adjudged -chronic, the suffering from which rendered him -ineligible for Life Insurance. His weight now -became reduced from 205 lbs. to 165 lbs. He -had practised no abstemiousness, had indulged -his appetite, both as to selection and to quantity, -without restraint, and for the last three -years had enjoyed perfect health.</p> - -<p>After his cure, he was accepted without difficulty -for insurance, the last examination finding -him an unusually healthy subject for his age. -Having leisure, he had spent three years in -investigating the cause of his cure, had pursued -experiments upon others, and had extended his -inquiries, both in America and Europe, until our -meeting in Venice. He had also published a -statement and inquiry in book form, entitled -“Glutton or Epicure,” which had been reviewed -by the “Lancet.”</p> - -<p><span class="pagenum" id="Page_32">[Pg 32]</span></p> - -<p>For nearly a year I also had been experimenting -on myself and others with various diets, -and was ready to believe that in the <i>manner</i> of -taking food and not altogether in its varying -<i>matter</i> lay perhaps its protean effects on our -system. I at once adopted the same method of -eating. At the end of six weeks, I noticed that -not only did the fauces refuse to allow of the -passage of imperfectly prepared food, but that -such food was returned from the back to the -front of the mouth by an involuntary, though -eventually controllable, muscular effort taking -place in the reverse direction to that occurring at -the inception of deglutition.</p> - -<p>What actually happens is this: Food, as it is -masticated, slowly passes to the back of the -mouth, and collects in the glosso-epiglottidean -folds, where it remains in contact with the -mucous membrane containing the sensory end-organs -of taste. If it be properly reduced by the -saliva it is allowed to pass the fauces,—a truly -involuntary act of deglutition occurring. Let -the food, however, be too rapidly passed back -to these folds, <i>i.e.</i>, before complete reduction takes -place, and the reflex muscular movement above -referred to occurs. The process of this reflex -is as follows: The tip of the tongue is involuntarily -fixed at the backs and bases of the lower -central incisor teeth by the anterior fibres of<span class="pagenum" id="Page_33">[Pg 33]</span> -the geniohyoglossi muscles. With this fixed -point as fulcrum, the lower and middle fibres of -these muscles, aided by those of the stylohyoid -and styloglossi muscles raise the hyoid bone, -straighten out the glosso-epiglottidean folds, -passing their contents forward, by the fauces, -the opening of which is closed by approximation -of its pillars and contraction of the -superior constrictor. The tongue, arched postero-anteriorly -by the geniohyoglossi, palato, -and styloglossi muscles, laterally, by its own -intrinsic muscles, is approximated to the fauces, -soft and hard palates in turn, and thus, the -late contents of the glosso-epiglottidean folds -are returned to the front of the mouth for -further reduction by the saliva preparatory to -deglutition.</p> - -<p>The word reduction is used for the reason -that all foods tested, without exception, give an -acid reaction to litmus, when served at table. -The reflex muscular movement occurs in the -writer’s case from five to ten times during the -mastication of each mouthful of food, according -to its quantity and its degree of sapidity. -As often as it recurs, the returned food continues -to give an acid reaction, while food -allowed to pass the fauces is alkaline.</p> - -<p>Saliva, flowing in response to the stimulation -of taste, seems more alkaline than that secreted<span class="pagenum" id="Page_34">[Pg 34]</span> -in answer to mechanical tasteless stimulation. -It is found that the removal of original taste -from any given bolus of food coincides with -cessation of salivary flow and complete alkaline -reduction. The fibre of meat, gristle, connective -tissue, the husk of coarse bread and -cellulose of vegetables are carefully separated -by the tongue and buccal muscles and rejected -by the fauces. To swallow any of these necessitates -a <i>forced</i> muscular effort, which is -abnormal.</p> - -<p>Adult man was not originally intended to -take his nourishment in a liquid form, consequently -all liquids having taste, such as soup, -milk, tea, coffee, cocoa, and the various forms -of alcohol, must be treated as sapid solids and -insalivated by holding them in the mouth, -moving the tongue gently, with straight up and -down masticatory movements, until their taste -be removed. Water, not having taste, needs -no insalivation and is readily accepted by the -fauces.</p> - -<p>In explanation of the phenomenon described, -the following theory is advanced: The fauces, -back of the tongue, epiglottis, in short, those -mucous surfaces in which are placed the sensory -end-organs of taste and “taste-buds” (the distribution -of which, by the way, has yet to be explained), -that these surfaces, readily becoming<span class="pagenum" id="Page_35">[Pg 35]</span> -accustomed to an alkaline contact by excessive -insalivation and consequent complete -alkaline reduction of the food, afterwards resent -an acid contact and express their resentment -by throwing off the cause of offence by the -muscles underlying them.</p> - -<p>This phenomenon must not be confused with -the cases of rumination and regurgitation, which -from time to time are recorded. The food in -this case is not swallowed, nor does it pass any -point from which it can be regurgitated. Eighty-one -individuals of different nationalities and from -several classes of society whom we have studied -are now in conscious possession of their reflexes. -These seem readily educated back to normal -functions by all who seriously and patiently -adopt the habit of what seems only at first to -be excessive insalivation.</p> - -<p>The dictum “bite your food well” that we -so often use, has no meaning to those suffering -from the results of mal-assimilation and -mal-nutrition, especially should they have few -or no teeth of their own. I make so bold as to -state that dyspepsia <i>et morbi hujus generis omnis</i> -will cease to exist if patients be persuaded to -bite their food until its original taste disappears, -and it is carried away by involuntary deglutition.</p> - -<p>The important point of the whole question -seems to be this alkaline reduction of acid food<span class="pagenum" id="Page_36">[Pg 36]</span> -before it passes on to meet subsequent digestive -processes elsewhere, which then become alternately -acid and alkaline.</p> - -<p>In the first few months of infant life, when -saliva is not secreted, Nature ordains that -mammary secretion be alkaline. With the -eruption of teeth come an abundant flow of -saliva and a synchronous infantile capacity for -managing other foods. This flow of saliva -depends on a thorough demand and use to -maintain its generous supply. It is just at this -time that children learn to bolt their food,—the -demand fails, with a consequent detriment to -the salivary glands, digestive processes, and the -system generally.</p> - -<p>A, B, C, and D were placed on an absolute -milk diet. A drank his milk in the ordinary -way, and at the end of three days begged to -discontinue the experiment owing to disgust -at the monotony of the diet. B, C, and D -continued the experiment for seventeen days, -insalivating the milk, but to a varying extent, B -the least and D the most. Though D took -most milk, he excreted least solid egesta, C -excreting less than B. Can one infer that increased -insalivation of a non-starchy food insured -its better digestion and assimilation? Each subject -took as much milk only as his appetite -demanded, D taking the most, which never<span class="pagenum" id="Page_37">[Pg 37]</span> -exceeded two litres daily. The weights of the -subjects after the usual sudden drop of the first -three days remained remarkably even until the -end of the experiment. B, C, and D all relished -the diet, and it satisfied the requirements of their -appetites, but they experienced an increasing -monotony.</p> - -<p>As long ago as the seventeenth century, -before the transformation of matter into energy -by the animal organism, known as Metabolism, -was understood, the fact was recognised that by -the lungs, kidneys, skin, and intestines, substances -no longer useful to the organism were -eliminated, the retention of which proved -harmful. The nature of these substances -was unknown, but it was noted that however -much the food was increased the weight -of the body remained the same. In other words, -a state of complete nutritive equilibrium was -maintained.</p> - -<p>The following table contains the <i>résumé</i> of two -experiments in which a state of complete nutritive -equilibrium was maintained by individuals -of about the same weight, on widely different -quantities of food similar in quality. The subjects -of the experiments were a laboratory assistant -of Dr. Snyder, of the U. S. Department of -Agriculture, and the writer. The experiment -of the former was made primarily to show the<span class="pagenum" id="Page_38">[Pg 38]</span> -relative digestibility of the several articles of Writer’s Experiment. -diet, potatoes, eggs, milk, and cream:</p> - -<table class="standard" summary=""> -<tr> -<th class="tdc"></th> -<th class="tdc">Dr. Snyder’s Experiment.<br />Published in Bulletin 43</th> -<th class="tdc">Writer’s Experiment.</th> -</tr> -<tr> -<td class="tdc_br">Age of subject</td> -<td class="tdc_br">22 years</td> -<td class="tdc">30 years</td> -</tr> -<tr> -<td class="tdl_br">Duration of experiment</td> -<td class="tdc_br">4⅓ days</td> -<td class="tdc">5 days</td> -</tr> -<tr> -<td class="tdl_br">Number of meals</td> -<td class="tdc_br">13</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdl_br">Weight at beginning</td> -<td class="tdc_br">62.5 kilos.</td> -<td class="tdc">57.3 kilos.</td> -</tr> -<tr> -<td class="tdl_br">Weight at end</td> -<td class="tdc_br">62.6 kilos.</td> -<td class="tdc">57.5 kilos.</td> -</tr> -<tr> -<td class="tdl_br">Potatoes (daily average)</td> -<td class="tdc_br">1587.6 grammes</td> -<td class="tdc">159.4 grammes</td> -</tr> -<tr> -<td class="tdl_br">Eggs (daily average)</td> -<td class="tdc_br">411.08 grammes</td> -<td class="tdc">124.7 grammes</td> -</tr> -<tr> -<td class="tdl_br">Milk (daily average)</td> -<td class="tdc_br">710 c.c.</td> -<td class="tdc">710 c.c.</td> -</tr> -<tr> -<td class="tdl_br">Cream (daily average)</td> -<td class="tdc_br">237 c.c.</td> -<td class="tdc">237 c.c.</td> -</tr> -<tr> -<td class="tdl_br">Daily urine</td> -<td class="tdc_br">1108 grammes</td> -<td class="tdc">1098 grammes</td> -</tr> -<tr> -<td class="tdl_brb">Daily fæces</td> -<td class="tdc_brb">204 grammes</td> -<td class="tdc_bb">18.9 grammes</td> -</tr> -</table> - -<p>The daily diet of Dr. Snyder’s subject consisted -of three and one-half pounds of potatoes, -eight eggs, a pint and a half of milk, and half -a pint of cream. The writer’s diet of twelve -ounces of solid food (like Luigi Cornaro) consisted -of three eggs, the remainder of the twelve -ounces in potatoes, and an equal quantity of -similar liquid food to that taken by Dr. Snyder’s -subject. The exercise of the laboratory assistant -comprised his daily routine of laboratory -work, while that of the writer consisted of six -sets of tennis, or an hour and a half on horseback, -with an hour to an hour and a half’s walk -or climb daily, in addition to much reading and -writing.</p> - -<p>In each case complete nutritive equilibrium -was maintained, although the author subsisted<span class="pagenum" id="Page_39">[Pg 39]</span> -on three-seventeenths of the solid food taken -by the other subject.</p> - -<p>Again, cannot one infer that better assimilation -and less waste resulted from the better -preparation of the smaller quantity of food by -insalivation? Surely, too, there must be less -daily strain on the intestinal canal, and body -generally, in getting rid of 18.9 grammes of -inoffensive dry waste, than in getting rid of 204 -grammes of humid, decomposing, and offensive -matter.</p> - -<p>“Considerable importance has been attached -to the normal action of the bacteria in the -intestines; and it has even been supposed that -the presence of bacteria is essential to life. -Such a view has recently been shown to be -erroneous by an elaborate and painstaking research -carried out by Nuttall and Thierfelder, -who obtained ripe foetal guinea-pigs by means -of Caesarean section carried out under strict -antiseptic precautions. They introduced the -animals immediately into an aseptic chamber -through which a current of filtered air was -aspirated, and fed them hourly on sterilised -milk day and night for over eight days.</p> - -<p>“The animals lived, and throve, and increased -as much in weight as healthy normal -animals subjected to a similar diet for the purpose -of controlling the results. Microscopic<span class="pagenum" id="Page_40">[Pg 40]</span> -examination at the end of the experiment -showed that the alimentary canal contained no -bacteria of any kind, nor could cultures of any -kind be obtained from it.</p> - -<p>“The same authors, in a subsequent paper, -described the extension of their research to -vegetable food. This was also digested in the -absence of bacteria. Under such conditions cellulose -was not attacked. Hence they consider -that the chief function of this material is to give -bulk and proper consistency to the food so as -to suit the conditions of herbivorous digestion.” -(Schäfer’s “Text-Book of Physiology,” vol i. -p. 465.)</p> - -<p>Now, inasmuch as bacterial digestion has no -place in the animal economy, surely it can only -occur at the expense of the organism?</p> - -<p>Can micro-organic action take place in the -intestines without the production of toxins and -the consequent absorption of these toxins into -the blood?</p> - -<p>We know that the metabolism of a cell is -determined by the general physical environment -of the whole organism, by supplies of -oxygen and water, on nervous impulses, and, -what chiefly concerns this argument, on the nature -and amount of the pabulum supplied to it. -This pabulum is derived from the alimentary -canal.</p> - -<p><span class="pagenum" id="Page_41">[Pg 41]</span></p> - -<p>Are not even those of us who may be enjoying -seemingly the best of health supplying to -our tissues pabulum containing mild toxins, thus -causing an increased katabolic action to occur in -each individual cell of our bodies?</p> - -<p>Are not the blood elements, floating in -a plasma containing such toxins, rendered -resistant, weaker, less capable of fulfilling -their functions as carriers and combatants of -disease?</p> - -<p>Are not their and our lives, in consequence, -more painful and shorter than they need be?</p> - -<p>Would not the elimination of these toxins -render us less liable to disease? And is not -their presence an important element in predisposition -to disease?</p> - -<p>When this reflex is restored micro-organisms -get no further than the stomach. They are destroyed -there by the acid gastric juices, then -only stimulated to their full and normal secretion -by the presence of a sufficiency of alkaline -substance. Undigested matter having been -eliminated, micro-organisms, still existing in the -intestines, deprived of their means of subsistence, -decrease, and, in time, may cease to -exist. The body no longer absorbs the toxins -these produced. To this fact may be ascribed -the increase of mental energy, the general physical -betterment, the cessation of morbid cravings<span class="pagenum" id="Page_42">[Pg 42]</span> -for food and drink and of those of a sexual -nature, which are noticed and experienced.</p> - -<p>What has just been stated is based not entirely -on experimental evidence but somewhat -upon inference. The inference seems justified -because the excreta, more especially of the -intestines, but also of the kidneys and skin, -become almost odourless and entirely inoffensive. -The solid egesta are voided thickly covered -with mucus, leaving the end of the bowel -dry and clean. The sense of cleanliness can -only then be appreciated to the full, for it is -internal as well external. <i>Flatus</i> is no longer -produced. The urine is inoffensive and seems -to be materially changed in quality, as shown -by chemical analysis. Uric acid, the chlorides, -and, more markedly, aromatic sulphates are reduced -in quantity.</p> - -<p>Owing to deliberation in eating, necessitated -by this new habit, satiety occurs on the ingestion -of considerably less food. By carefully studying -one’s self I believe it possible to cultivate an instinct -which will regulate not only the quantity -but the quality of food that the body may need, -and that in the <i>normal health</i> of a full-grown -body, no more food either in quantity or quality -should be supplied than suffices to supply diurnal -waste. Any excess must result in pathological -processes.</p> - -<p><span class="pagenum" id="Page_43">[Pg 43]</span></p> - -<p>Although there results enhanced pleasure in -the taking of all foods, rich and simple, and especially -in the appreciation of good wines, the -quantities of these foods and beverages that suffice -to fully satisfy the appetite are much smaller -than before, while there is a marked preference -for the simpler kinds of food. The writer now -can imagine no more pleasurable meal than -one consisting of good brown bread, eggs, butter, -cheese, and cream. These, with fresh vegetables -and a very little fruit, form his staple -diet. This tendency and preference for simple -foods is the general experience among those who -have recovered their reflexes of deglutition.</p> - -<p>Following on the ingestion of a lessened -quantity of food and on its better assimilation, -there is less waste, the egesta are voided less -frequently, sometimes only once in five to eight -days.</p> - -<p>The lower bowel is not the reservoir it formerly -was. So hæmorrhoids cease from troubling -and constipation cannot exist. For this -same reason the body, at the beginning of the -practice, commences to approximate to its normal -weight, increasing or decreasing as the -individual’s environment demands.</p> - -<p>A few more words only need be said. It has -been easy to state the results of experiments and -observations: but the acquiring of this new<span class="pagenum" id="Page_44">[Pg 44]</span> -reflex, while pursuing daily occupations, is not -easy, and needs more than a little patience and -much serious thought. The habits of a lifetime -cannot be changed in a few days or weeks. The -shortest time in which the reflex has been re-established -is four weeks, and this only by avoiding -conversation at meal-time and concentrating -the attention on keeping the food in the mouth -until complete alkaline reduction has taken place -and sapidity has disappeared.</p> - -<p>In closing I wish to maintain as a fact, gentlemen, -of the truth of which you will only be -convinced by actual experience, that by the -restoration of this reflex and in complete dependence -on its use, there lies true health, the -establishment of a condition of stable nutrition -and the possible abrogation of two great predisposing -factors of disease, mal-assimilation and -mal-nutrition. Unless there be among you, as -in the “Cities of the Plain,” a parlous minority -who possess this reflex and take your food as -you ought, none of you are in the enjoyment -of such health as you might have. A like punishment -will be meted out to you as was visited -on those cities, for you will all be consumed -long before your day by the unnecessary combustion -in your bodies caused by the circulation -in them of toxins, the product of undigested and -decomposing food.</p> - -<p><span class="pagenum" id="Page_45">[Pg 45]</span></p> - -<p>The writer, bearing in mind the warning suggested -by the Frenchman whose donkey died as -soon as he had reduced his food to a single wisp -of straw, finds that he is taking less and less -food. While his mind is open as to his arriving -at the final diet of Luigi Cornaro, yet it is -easily conceivable that living a similar life of -retirement in a placid environment, it would be -quite possible to do as he did. Hence the -title of this paper and the queries at the -commencement.</p> - -<p>The objects in publishing and distributing -this paper are twofold: to make the subject -as widely known as possible, and to solicit the -aid of colleagues in investigating it more fully.</p> - -<p>There is ready at the service of the general -practitioner an important and potential therapeutic -agent in the saliva of his patients and in -the use <i>ad finem</i> of their salivary digestions.</p> - -<p>By any chance should readers of this paper -wish to ask any questions, the writer will be -happy to communicate with them.</p> - -<p class="center small"> -183, <span class="smcap">Calle del Capello Nero</span>,<br /> -Piazza San Marco,<br /> -Venice, Italy.</p> - -<p><i>Editor’s notes.</i> (1) Confirmatory evidence of -the correctness of the deductions made in this -paper has begun to come in from many professional -sources and notably from a famous child<span class="pagenum" id="Page_46">[Pg 46]</span> -specialist who avers that children would follow -the natural requirements in eating were it not for -artificial food, bad example, and bad teaching.</p> - -<p>(2) In a report of a paper read before the -<i>Société de Biologie</i>, Paris, France, March 15th, -1902, by M. Max Marckwald, of Kreuznach, -“<span class="smcap">On Digestion of Milk in the Stomach -Of Full-grown Dogs</span>,” the following appears: -“Hence these experiments confirm those of -Horace Fletcher and Ernest H. Van Someren -on the importance of prolonged mastication” -(<i>translation</i>). Referring, as the latter statement -does, to mastication (insalivation) of liquid, it -gives an important suggestion relative to some -probable causes of uncertain or defective digestion -in human nutrition.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_47">[Pg 47]</span></p> - -<h3 class="nobreak" id="THE_CAMBRIDGE_TESTS">THE CAMBRIDGE TESTS</h3> -</div> - -<div class="blockquot"> -<p>[In connection with a report of the Cambridge Examination -the writer wishes to acknowledge the interest and assistance of -Dr. Francis Gowland Hopkins, head of the Physiological-Chemical -Department of the Physiological Laboratory of the -University; Dr. George H. F. Nuttall, in charge of the Bacteriological -Section of the Pathological Laboratory; Mr. Sidney -W. Cole, Mr. Robert Barrett, and Dr. Hubert Higgins, -both for practical work in the laboratory and in serving as test-subjects. -To Dr. Higgins so much is due that it is difficult to -measure. Since our first meeting in Cambridge, Dr. Higgins -has been unremitting in his study of the subject and in consideration -of its application to human betterment. Having -the altruistic temperament inborn and not yet smothered by -disappointment, the good doctor has consecrated himself to -the service of poorer humanity, and his inspiration in so good -a cause is wonderful motive power behind the native desire to -do good. The statement of Dr. Higgins’ experiences in pursuit -of an Economic Nutrition is given in his own manner in -the new edition of <i>Glutton or Epicure</i>, which is being published -coincidently with this volume in the A. B. C. Life Series.</p> - -<p>At the time we were in Cambridge, Dr. Hopkins and Mr. -Cole had just published their paper in the <i>Journal of Physiology</i> -(English), describing their isolation of the tryptophane element -of the proteid molecule which had eluded chemists from the -beginning. In tryptophane they found embodied the odourous -indol and skatol which appear so offensively in the putrid -decomposition of proteid. In the excreta of the test-subjects -in our Economic-Nutrition-Inquiry these malodorous substances -did not appear, and hence another question is opened -up to investigation relative to the putridity of human excrement -under ordinary conditions of carelessness, and the -absence of putridity in the case of nutrition accomplished -by aid of thorough buccal treatment of food preparatory to -digestion.</p> - -<p>It is a matter of interest, relative to the patience required in -science, to state that Dr. Hopkins and Mr. Cole were fourteen -months searching for the fugitive tryptophane element after -they received their first clew to its whereabouts. When -isolated, tryptophane masses in a substance having the appearance -of silver, but not the solidity of that metal.—<span class="smcap">Horace -Fletcher.</span>]</p></div> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_48">[Pg 48]</span></p> - -<h3 class="nobreak" id="EXPERIMENTS_UPON_HUMAN">EXPERIMENTS UPON HUMAN -NUTRITION<br /> - -<small><span class="smcap">Note by Sir Michael Foster, K.C.B., M.P., F.R.S.</span></small></h3> -</div> - -<p>In 1901 Dr. Ernest Van Someren submitted -to the British Medical Association, and afterwards -to the Congress of Physiologists at Turin, -an account of some experiments initiated by -Mr. Horace Fletcher. These experiments went -to show that the processes of bodily nutrition -are very profoundly affected by the preliminary -treatment of the food-stuffs in the mouth, and -indicated that great advantages follow from the -adoption of certain methods in eating. The -essentials of these special methods, stated briefly -and without regard to certain important theoretical -considerations discussed by Dr. Van -Someren, consist of a specially prolonged mastication -which is necessarily associated with an -insalivation of the food-stuffs much more thorough -than is obtained with ordinary habits.</p> - -<p>The results brought to light by the preliminary -experimental trials went to show that -such treatment of the food has a most important<span class="pagenum" id="Page_49">[Pg 49]</span> -effect upon the economy of the body, involving, -in the first place, a very notable reduction in the -amount of food—and especially of proteid food—necessary -to maintain complete efficiency.</p> - -<p>In the second place this treatment produced, -in the experience of its originators, an increase -in the subjective and objective well-being of -those who practise it, and, as they believe, in -their power of resistance to the inroads of -disease. These secondary effects may indeed -be almost assumed as a corollary of the first -mentioned; because there can be little doubt -that the ingestion of food—and perhaps especially -of proteid food—in excess of what is, -under the best conditions, sufficient for maintenance -and activity, can only be deleterious to -the organism, clogging it with waste products -which may at times be of a directly toxic -nature.</p> - -<p>In the autumn of 1901 Mr. Fletcher and Dr. -Van Someren came to Cambridge with the -intention of having the matter more closely inquired -into, with the assistance of physiological -experts. The matter evoked considerable interest -in Cambridge, and observations were -made not only upon those more immediately -interested, but upon other individuals, some -of whom were themselves medical men and -trained observers.</p> - -<p><span class="pagenum" id="Page_50">[Pg 50]</span></p> - -<p>Certain facts were established by these observations, -which, however, are to be looked -upon as still of a preliminary nature. The -adoption of the habit of thorough insalivation -of the food was found in a consensus of opinion -to have an immediate and very striking effect -upon appetite, making this more discriminating, -and leading to the choice of a simple dietary, -and in particular reducing the craving for flesh -food. The appetite, too, is beyond all question -fully satisfied with a dietary considerably less in -amount than with ordinary habits is demanded.</p> - -<p>Numerical data were obtained in several -cases, but it is not proposed to deal with these -in detail here, as they need the supplementary -study which will be shortly referred to.</p> - -<p>In two individuals who pushed the method to -its limits it was found that complete bodily -efficiency was maintained for some weeks upon -a dietary which had a total energy value of less -than one-half of that usually taken, and comprised -little more than one-third of the proteid -consumed by the average man.</p> - -<p>It may be doubted if continued efficiency -could be maintained with such low values as -these, and very prolonged observations would -be necessary to establish the facts. But all -subjects of the experiments who applied the -principles intelligently agreed in finding a very<span class="pagenum" id="Page_51">[Pg 51]</span> -marked reduction in their needs, and experienced -an increase in their sense of well-being -and an increase in their working powers.</p> - -<p>One fact, fully confirmed by the Cambridge -observations, consists in the effect of the special -habits described upon the waste products of the -bowel. These are greatly reduced in amount, -as might be expected; but they are also markedly -changed in character, becoming odourless and -inoffensive, and assuming a condition which -suggests that the intestine is in a healthier and -more aseptic condition than is the case under -ordinary circumstances.</p> - -<p>Although the experiments hitherto made are, -as already stated, only preliminary in nature -and limited in scope, they establish beyond all -question that a full and careful study of the -matter is urgently called for.</p> - -<p>For this fuller study the Cambridge laboratories -do not possess at present either the -necessary equipment or the funds to provide it. -For the detailed study of the physical efficiency -of a man under varying conditions, elaborate -and expensive apparatus is required; and the -advantages claimed for the special treatment of -the food just discussed can only be fully tested -by prolonged and laborious experiments calling -for a considerable staff of workers.</p> - -<p>It is of great importance that the mind of the<span class="pagenum" id="Page_52">[Pg 52]</span> -lay public should be disabused of the idea that -medical science is possessed of final information -concerning questions of nutrition. This is very -far indeed from being the case. Human nutrition -involves highly complex factors, and the -scientific basis for our knowledge of the subject -is but small; where questions of diet are -concerned, medical teaching, no less than -popular practice, is to a great extent based -upon empiricism.</p> - -<p>But the scientific and social importance of the -question is clearly immense, and it is greatly to -be desired that its study should be encouraged.</p> - -<p class="psig"> -<span class="smcap">M. Foster.</span></p> - -<p><small>April 26th, 1902.</small></p> - -<hr class="chap x-ebookmaker-drop" /> - -<p><span class="pagenum" id="Page_53">[Pg 53]</span></p> - - - - -<h3 class="hang">REPORT OF A PLAN FOR THE INSTITUTION -OF AN INTERNATIONAL INQUIRY INTO -THE SUBJECT OF HUMAN NUTRITION</h3> -</div> - - -<div class="blockquot"> - -<p>[Sir Michael Foster’s “Note” (preceding) and Professor -Chittenden’s article in the <i>Popular Science Monthly</i> (following), -which form a part of this book, show a common want of -exact knowledge relative to human nutrition not at all creditable -to human intelligence at the beginning of the twentieth -century; but they both offer hope of relief from this discreditable -stigma in systematic study of the question. For this -purpose an international inquiry was proposed, a plan was -drawn up under advice of Sir Michael Foster, and the matter -was given to the writer to promote by the best means -available.</p> - -<p>The Carnegie Institution seemed, at the time, the most -likely supporter of such a scheme; but owing to an embarrassment -of applications for support of American science needs, it -was considered best not to attempt any foreign or even international -benefaction, for the present at least, and hence other -means of furthering the inquiry were sought.</p> - -<p>The invitation of Professor Chittenden to repeat the demonstration -of food-economy made by the author and Dr. Van -Someren at Cambridge, England, of which Sir Michael Foster’s -“Note” treats, at the laboratories of the Sheffield Scientific -School of Yale University, led to the discovery that New -Haven already possessed an equipment suitable for the inquiry -much more complete than the plan Professor Foster had -outlined as being desirable.</p> - -<p>At Yale were found not only a very well-adapted chemico-physiological -laboratory with some of the most active and -scientifically respected research talent of the world in charge, -but the laboratory stood only three minutes away from one of -the best furnished gymnasiums in the world, under a director -who is an M. D. of twenty years’ experience, as well as a -famous athlete and author of an athletic manual. It so hap<span class="pagenum" id="Page_54">[Pg 54]</span>pened -that this gymnasium was especially suited for assisting -in a research into the very causes of human efficiency, or lack -of it, which nutrition is supposed to affect.</p> - -<p>Only forty minutes from New Haven by rail,—a distance -not greater, as measured by time separation, than from one -side of London to the other,—at Middletown, Conn., stood -also the recently completed calorimeter of Professors Atwater -and Benedict ready for making a calorimetric trial-balance -measurement of metabolism attained and chemically estimated -in the tests at New Haven.</p> - -<p>After the Yale demonstration, of which Professor Chittenden’s -article, previously mentioned, treats, the author responded -to an invitation from Professor Atwater and submitted himself -to a 32-hour confinement in the calorimeter for confirmation -of the results obtained at New Haven.</p> - -<p>This experience in the calorimeter at Middletown was very -significant and instructive. The author was the first test-subject -used in the newly completed calorimeter. The oxygen-measuring -attachment of Dr. Benedict that completed the -apparatus and gave a complete trial balance of the metabolism -of the subject under examination was as yet untried, but it -proved its integrity within the fraction of one per cent and -registered as accurately as necessary for all practical purposes. -So much for the machine; but it measured a result which is -of the greatest importance to the human race. The author -had just demonstrated the possibility of running the human -machine on half the heat, on one-third of the fuel, and with -only one-tenth of the waste, as represented by the waste, or -ashes of digestion. Not only was this done while in pursuit -of the ordinary activity of present-day life, but under stress of -’Varsity-Crew exercise, as reported by Professor Chittenden -and Dr. Anderson. Had this demonstration been made relative -to steam engines or electrical motors, the information -would have been revolutionary in establishing new values for -things industrial and commercial.</p> - -<p>Its significance relative to human profitable possibilities -is even more important than if related to steam or electrical -power. The possibility of economy in the human machine -gives also a hope of immunity from the common diseases -which now afflict mankind.</p> - -<p>The trial of the calorimeter as a measuring machine and<span class="pagenum" id="Page_55">[Pg 55]</span> -the trial balance of the economic metabolism which the author -had attained by five years of careful attention to the natural -requirements of nutrition were epoch-making events coincidently -related, and for them the author here makes this distinguished -claim—not on account of any accomplishment of -himself, but as a promise of great possibilities for human -betterment.</p> - -<p>Here follows a reproduction of the plan just referred to, -with <i>fac-simile</i> of the signatures of the distinguished physiologists -who approved the plan and consented to serve as “Assessors.” -To this list should have been added the name of -Professor Ozawa, professor of physiology at the University of -Tokio, Japan; but time and distance did not permit gaining -the required understanding and assent. Professor Ozawa’s -connection with the inquiry would make it not only international -but interhemispherical and interracial as well, and -this possibility of scientific coördination and coöperation is -typical of the harmonising wave that is fast enveloping the -earth for the benefit of mankind.</p> - -<p>I give a copy of the document entire, with estimates of -cost, etc., just as it was originally drawn and intended only as -a trial suggestion, to be modified by circumstances.—<span class="smcap">Horace -Fletcher.</span>]</p> -</div> - - -<h3 class="hang">PROPOSAL TO FOUND AN INTERNATIONAL -LABORATORY OF -RESEARCH FOR THE STUDY OF -NUTRITION IN ALL ITS ASPECTS</h3> - - -<p>Notwithstanding the enormous development -which the study of Experimental Physiology has -undergone during the last half-century, and the -constant multiplication of physiological laboratories -fitted in a manner which enables them to -be used as places of research as well as of -instruction in the methods of physiological in<span class="pagenum" id="Page_56">[Pg 56]</span>quiry, -it has appeared to many physiologists -that a great need remains to be supplied by the -establishment of an International Laboratory of -Research, devoted primarily, if not exclusively, -to the investigation of problems connected with -the Nutrition of the Animal, and particularly of -Human Organisms,—studies particularly, and -in the first instance, from the point of view of the -relation of the food consumed by the animal -body to its output of energy, either in the form -of heat or mechanical work.</p> - -<p>The reason for establishing such a laboratory, -available for the use of investigations of all -nations, is to be found in the fact that the researches -which are now called for, in order to -place upon a firm foundation our knowledge of -food and its relations to the activity of the organism, -necessitates an assemblage of apparatus and -machinery so specialised and so costly that they -are not to be found collected together even in the -best equipped of the physiological laboratories -of Europe or America, which all subserve in the -first instance the purposes of systematic instruction. -Undoubtedly, unquestionably, certain of -the great and costly appliances of research are -to be found in particular laboratories, as, for instance, -in those of Berlin, Munich, Paris, and -Turin, but there certainly exists no laboratory -in which the investigator can find assembled<span class="pagenum" id="Page_57">[Pg 57]</span> -under one roof all the specially fitted chemical, -physical, and even bacteriological appliances -which he may need to employ in the investigation -of the Phenomena of Nutrition.</p> - -<p>A more precise conception of the nature of -the proposed laboratory may be formed if reference -is made to certain groups of appliances -which such a laboratory should possess and be -able to place at the disposal of the scientific -men coming to it for facilities which may be -denied them at home. It should possess a -complete set of respiration chambers of various -types, and especially should be provided with -the “Atwater Respiration Apparatus;” the -most perfect appliances for the analyses of gases -should be available; it should be provided with -the most perfect calorimeters of various types, -both for the investigation of the calorimetric -value of the foods experimented on, and for the -determination of the heat produced by man or -by the lower animals,—the subjects of observation. -The laboratory should possess, besides, -the most perfect appliances for the measurement -of work done by man and by animals -(“ergostat,” “ergograph”), and a set of balances -of the highest perfection capable of weighing -with accuracy very heavy loads. These -characteristic appliances of a laboratory specially -designed for placing our knowledge of<span class="pagenum" id="Page_58">[Pg 58]</span> -Animal Nutrition on a thoroughly sound basis -must be superadded to the ordinary means for -pursuing with success researches in Pure Organic, -Physiological, and Physical Chemistry, as -well as in Bacteriology.</p> - - -<h4><span class="smcap">Outline of the Proposed Subjects Of -Research to be Undertaken in the -Proposed International -Laboratory</span></h4> - -<p>1. To determine with greater precision than -has yet been possible the efficiency of the animal -organism considered as a machine in which -potential energy of the organic constituents of -food is converted into mechanical work. The -knowledge that we already possess has shown -that in the animal we have an engine infinitely -more efficient as a utiliser of the potential energy -supplied to it than any appliance yet constructed, -or which we can, in the present state -of physical science, construct. A still more precise -study of the actual efficiency of the animal -as a whole, as well as of certain of the vital organs -which are mainly concerned in mechanical -work, and a more thorough investigation of the -processes whereby—for instance, in the muscles—the -potential energy of stored-up chemical -compounds is, as appears certain, directly converted -into mechanical work, is not only desira<span class="pagenum" id="Page_59">[Pg 59]</span>ble -in the interest of the ultimate object of the -work of the Laboratory, but possesses a high -degree of theoretical interest, even from the -point of view of Pure Physics. To sum up: -One of the first objects of the investigations to -be carried out in the projected Laboratory -should be “the more precise determination of -the minimum transformation of energy which -corresponds to mean and accurately determined -conditions of the animal body, and of that of -man in particular.”</p> - -<p>2. We are acquainted with the fact that the -potential energy which is utilised by the animal -is supplied to it with the least wear and tear to, -or strain upon, its mechanism by non-nitrogenous -organic constituents of food which must -belong to the groups of starches and sugars or -fats, but that the continued existence of the -organism demands, as an essential condition, -the introduction of a certain proportion of albuminous -matter. In spite of numerous very fine -investigations on this subject, the yet more -precise determination of the minimum quantity -of the albuminous constituents which are absolutely -necessary or desirable, under the most -varying conditions, is eminently desirable, especially -in the light of recently recorded facts, -amongst which are those to be referred to -under 3 (following):—</p> - -<p><span class="pagenum" id="Page_60">[Pg 60]</span></p> - -<p>3. Certain very noteworthy observations -made by Messrs. Horace Fletcher and Ernest -H. Van Someren have shown that an excessively -prolonged mastication and insalivation of food -leads to remarkable results in respect to the -diminution of the total quantity of food necessary -to keep the body in a state of health, and -to, as is alleged, a remarkable improvement in -the digestive functions as well as of the general -health of the individual. It appears highly important -thoroughly to investigate the remarkable -phenomena discovered by Messrs. Fletcher and -Van Someren, and to determine how far they -may lead to a modification of or improvement -in the dietary of healthy individuals and of persons -in a state of disease.</p> - -<p>4. Indeed, it may truly be said that the average -diet of man, that is to say, the absolute and -relative amount of certain food-stuffs on which -an average man should live, is at present, to a -large extent, determined in an empirical manner. -It is most necessary that this should be determined -in an exact manner, since it is at least -possible that a more complete knowledge may -reveal that the good results thus obtained empirically -are only reached by means of an excess -of one element being counterbalanced by excess -of another element, and thus open up a way to -considerable economy. The changes needed<span class="pagenum" id="Page_61">[Pg 61]</span> -for variations from the average, to meet certain -conditions, are also at present, to a very large -extent, determined empirically, and these also -most certainly ought to be determined in an absolutely -exact manner.</p> - -<p>5. The researches of Pawlow on the conditions -which influence the activity of the secreting -glands of the organs of digestion, upon the -relation of their activity to the nature of the food -ingested, upon the influence exerted by the secretion -of the glands situated in one part of the -alimentary canal, upon the activity of glands -situated lower down, indicate lines of research -only recently opened out, but the importance -of which in reference to the problems of nutrition -is probably great.</p> - -<p>6. Similarly, the facts which have in recent -times been ascertained in reference to the remarkable -influence exerted by the so-called -“internal secretion” of certain ductless glands -on the general metabolism, the part played by -the pancreas in reference to the transformations -of sugar in the body indicate yet other lines of -research to be carried out in connection with -the main inquiry.</p> - -<p>In conclusion: The final problem of the -work of the proposed Laboratory will be to ascertain -the conditions which will “render it possible -to obtain from the human machine, under<span class="pagenum" id="Page_62">[Pg 62]</span> -varying conditions, the highest efficiency at the -least cost.”</p> - -<p>The value of results which may be thus -obtained, considered from the point of view of -social, political, and administrative economy, is -hardly to be exaggerated.</p> - - -<p><span class="smcap">Suggestions as to Staff and Personnel -of the Proposed International -Laboratory</span></p> - -<p>For the coördination and general direction -of the several investigations, the services of an -eminent physiological chemist (preferably one -having the principal European languages at his -command) is essential.</p> - -<p>Such a director would need at least two efficient -permanent technical assistants, as for instance, -one to deal with the problems of Organic -Chemistry, and another competent to deal with -the problems of Physical Chemistry. Other -assistants might be necessary, but it would -probably be desirable that the Institute should -have the power of subsidising, for a longer or -shorter period, men who would undertake special -investigations in coördination with the general -work, and who would thus be, as it were, temporary -assistants. This would be quite apart -from the general hospitality of the Laboratory -offered by the Institute to other investigators.</p> - -<p><span class="pagenum" id="Page_63">[Pg 63]</span></p> - - -<h4><span class="smcap">Estimates for the Proposed Laboratory</span></h4> - - -<table class="standard" summary=""> -<tr> -<th class="nb tdc" colspan="3">INITIAL OUTLAY</th> -</tr> -<tr> -<td class="tdl">Director</td> -<td class="tdr">$5,000</td> -<td class="tdr">$5,000</td> -</tr> -<tr> -<td class="tdl">Permanent and Temporary Assistants</td> -<td class="tdr">7,500</td> -<td class="tdr">to 10,000</td> -</tr> -<tr> -<td class="tdl">Other General Maintenance</td> -<td class="tdr">5,000</td> -<td class="tdr">to 7,500</td> -</tr> -<tr> -<td class="tdr"></td> -<td class="tdr_bt">$17,500</td> -<td class="tdr_bt">$22,500</td> -</tr> -</table> - - -<p>With regard to the second item, the permanent -assistants would be required at the outset, -but the temporary assistants would be taken -on as opportunity offered. Less than even the -lower estimate might suffice at first.</p> - -<p>Regarding the third item, also, the maximum -might not be required in the beginning.</p> - - -<h4><span class="smcap">Suggestions as to Desirability of Location</span></h4> - -<p>The place fitted for the establishment of an -International Institute should be one which can -be reached with comparative facility by investigators -of the different nationalities. It must be -one free from the objections due to national susceptibilities. -It should also be, if possible, a -place agreeable to live in; a place where work -can be carried on through the year; and a place -where expenses, both the personal expenses of -the investigators, and the general expenses of the -Institute, are not excessive. Venice has been -suggested as a place fulfilling the above require<span class="pagenum" id="Page_64">[Pg 64]</span>ments. -It can be reached readily from all parts -of Europe, and is as accessible to Americans as -any other European city. Living is very cheap, -and, indeed, all expenses are very moderate.</p> - -<p>On sea level itself, Venice is within near distance -of very high altitude, and hence offers -facilities for the study of the effects of climatic -influence on nutrition. It is also sufficiently -near the Regina Margherita Laboratory, on -Monte Rosa, to enable the observations made -at the two places to be coördinated. Venice is, -moreover, a cosmopolitan centre; and persons -of many different nations and races might readily -be obtained as subjects for observation and -experiment.</p> - -<p>On the other hand, it may be regarded as -essential to the complete success of the proposed -Institute that both the director and those -engaged in investigation should have ample opportunities -of ready and frequent intercourse -with eminent men engaged in investigation in -Physics, Chemistry, and the allied sciences. The -help which is thus gained by intercourse -with men at the very head of various scientific inquiry -cannot be supplied in any other way. There is -also an urgent reason for ready access to a most -thoroughly equipped scientific library. It is -also essential that the Institute should have -facility of obtaining, or of getting constructed,<span class="pagenum" id="Page_65">[Pg 65]</span> -with the least possible delay such apparatus as -it might need. These essentials cannot be supplied -otherwhere than in great centres of scientific -activity. A small university cannot supply -them. If they are insisted on, the Institute -must be located in a place which has metropolitan -distinction and holds not only a large -but an active university. The choice of a situation, -from this point of view, in Europe, is thus -almost limited to such places as Paris, Berlin, -Vienna, or London. Of these London probably -best recommends itself for international -purposes.</p> - -<p>But, on the other hand, London is distinctly -an expensive place to live in. Indeed, all expenses -there are great, and the same may be -said of any great metropolitan centre. Moreover, -London cannot be reached from the countries -of Europe without sea transit.</p> - -<p>The choice between such a place as London -and such a place as Venice must depend upon -the relative weight attached, on the one hand, to -the scientific advantages dwelt on above, and, -on the other hand, to the advantages other than -scientific.</p> - -<p><span class="pagenum" id="Page_66">[Pg 66]</span></p> - - -<h4><span class="smcap">Suggestions as to Management of the -Proposed International Institute</span></h4> - -<p>It is proposed that: First, there should be a -small body of trustees who should undertake the -financial responsibility; and, Second, a board -of scientific assessors, representing several nations, -who, in conjunction with the director, -should exercise general supervision of the work -of the Institute. Such a board need meet only -at rare intervals, much being done by way of -correspondence. The expenses which the members -incur in the exercise of their functions ought -to be met out of the funds of the Institute.</p> - -<p><span class="pagenum" id="Page_67">[Pg 67]</span></p> - - -<p>The following have expressed willingness to -act as scientific assessors:—</p> - - -<div class="figcenter illowp100" id="illus-105" style="max-width: 62.5em;"> - <img src="images/illus-105.jpg" alt="Signatures" /> -</div> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_68">[Pg 68]</span></p> - -<h3 class="nobreak" id="NATIONALITY_AND_SCIENTIFIC_TITLES_OF_OUR">NATIONALITY AND SCIENTIFIC TITLES OF OUR -BOARD OF SCIENTIFIC ASSESSORS</h3> -</div> - - -<div class="hangsection"> - -<p><span class="smcap">Sir Michael Foster</span>, M.D., K.C.B., F.R.S., M.P., etc. -Late Professor of Physiology, University of Cambridge, -England; Secretary of the Royal Society; Permanent -Honorary President of the International Congress of -Physiologists, etc.</p> - -<p><span class="smcap">Dr. Professor Angelo Mosso.</span> Professor of Physiology, -University of Turin, Italy; Director of the Regina Margherita -Biological Station on the summit of Monte Rosa, -etc.</p> - -<p><span class="smcap">Dr. Professor Hugo Kronecker.</span> Professor of Physiology, -University of Berne, Berne, Switzerland, etc.</p> - -<p><span class="smcap">Dr. Professor N. Zuntz.</span> Professor of Physiology, Berlin, -Germany, etc.</p> - -<p><span class="smcap">Dr. Professor Paul Heger.</span> Professor of Physiology, -Brussels, Belgium; Director of the Solvay Sociological -Institute, Brussels.</p> - -<p><span class="smcap">Dr. Professor A. Dastre.</span> Professor of Physiology, Universitie -de la Sorbonne, Paris, France, etc.</p> - -<p><span class="smcap">Dr. Professor Henry Pickering Bowditch</span>, Professor -of Physiology, Harvard Medical School; Second President -American Physiological Society; President of the -Children’s Aid Society, Boston, Mass., etc.</p> - -<p><span class="smcap">Professor Russell H. Chittenden.</span> Director Sheffield -Scientific School of Yale University; Professor of Physiological -Chemistry in Yale; Present President of the -American Physiological Society, etc.</p> - -<p><span class="smcap">Dr. Professor William H. Welch.</span> Professor of Pathology -in Johns Hopkins University, Baltimore, Maryland; -President of the Rockefeller Institute of Preventive Medicine, -etc.</p> - -<p><span class="smcap">Dr. Professor J. P. Pawlow.</span> Director of the Department -of Experimental Physiology in the Russian Imperial -Military School of Medicine, etc.</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_69">[Pg 69]</span></p> - -<h3 class="nobreak" id="PERSISTENT_SCIENTIFIC_DOUBTS">PERSISTENT SCIENTIFIC DOUBTS</h3> -</div> - - -<div class="blockquot"> - -<p>[Notwithstanding the report of the Cambridge examination -of the claims for an economic nutrition advanced by the -authors, American physiologists were still doubtful if a nitrogenous -economy like that reported could be maintained, and -the writer was invited to submit to further tests at the Physiological -Laboratory of Yale University, under direction of -Professor Russell H. Chittenden, Director of the Sheffield -Scientific School, and President of the American Physiological -Society, and Dr. Lafayette B. Mendel.</p> - -<p>The following article, first published in the <i>Popular -Science Monthly</i>, June, 1903, is a report of that test, and indicates -a desire to carry the investigation further to include -a variety of test-subjects.</p> - -<p>In response to Professor Chittenden’s request, the Trustees -of the Bache Fund of the National Academy of Sciences -appropriated $1000 towards a more extended inquiry; and -other means having been assured, a project of experiments -was taken under consideration.</p> - -<p>One of the difficulties encountered was the control of -test-subjects for a sufficiently long time to make conclusive -estimates relative to the minimum needs of nitrogenous food -in relation to the common occupations of life. Few if any -volunteers, with the leisure and interest fortunately possessed -by the writer, were available outside the laboratory force -itself, and there were serious objections to using for test-subjects -the same persons who did the chemical analyses and -estimated the results.</p> - -<p>In this dilemma the good fortune of a meeting with Surgeon-General -O’Reilly of the United States Army and with -General Leonard Wood—the former on his way to Madrid to -attend a medical congress, and the latter <i>en route</i> to the -Philippines to take command there—happened to the writer -on the S. S. <i>Commonwealth</i>, on a voyage to Italy in April, -1903.</p> - -<p><span class="pagenum" id="Page_70">[Pg 70]</span></p> - -<p>Both these officers are medical men and research enthusiasts. -They had fought yellow fever together, in coöperation -with martyr Dr. Major Walter Reed, in Cuba, and the fame -of their success was being talked of as one of the great -triumphs of pathologic, or hygienic, science at the time of -the meeting.</p> - -<p>There was ample time on the steamer to discuss a subject -of such mutual and general interest, and both officers had -had, in service, experiences that led them to believe that the -results obtained by the writer and his colleagues were the -common possibilities of all persons under right conditions of -alimentation.</p> - -<p>General O’Reilly was of the opinion that the corps he commanded -could furnish intelligent and earnest test-subjects for -nutrition investigation, as it did in the yellow fever case. In -the yellow fever investigation privates and officers alike had -volunteered to act as test-subjects, even though their lives -were at stake and many had already been sacrificed. It is -to their great honour, also, that they refused to receive the -bounty that was offered for test-subjects, preferring to serve -science and humanity freely as volunteers rather than sell -themselves as experimental risks. From such material General -O’Reilly was sure that capable assistants could be secured -to test the not at all dangerous or disagreeable economies of -nutrition that the projected inquiry wished to solve.</p> - -<p>Armed with letters of recommendation to the President -and to the Secretary of War from General Wood, and an -invitation from Surgeon-General O’Reilly to call on him if -coöperation on his part were desired, the writer returned to -the United States and consulted with Professors Chittenden -and Bowditch relative to the desirability of army coöperation. -It was believed to be just the thing wanted to facilitate the -inquiry, and the writer proceeded to Washington to effect the -combination.</p> - -<p>General O’Reilly had already had the matter under consideration -and was quite ready to draw up a project for presentation -to the Secretary of War when Mr. Root should -return to Washington from his summer vacation.</p> - -<p>Twenty privates and three non-commissioned officers of -the Hospital Corps of the United States Army under command -of Dr. Lieutenant Wallace DeWitt are now quartered at<span class="pagenum" id="Page_71">[Pg 71]</span> -New Haven in coöperation with the staff of the Sheffield -Scientific School. It is the intention to learn, if possible, how -little nitrogen is necessary to secure the best human efficiency; -and also, if possible, to ascertain some measure of the evil -effects of an excess of nitrogenous food as well as excess of -food in general upon human efficiency.</p> - -<p>The writer is grateful for the good fortune of being able to -be of service in a development of interest in a subject which -is of vital importance to the human race. He has enjoyed -the benefits of an economic nutrition and knows its value.</p> - -<p>The practical proof of a subject of personal application must -come from such personal application. Each person must be -his own doctor and his own scientist in the matter of his alimentation -or he runs the risk of running amuck in his health -economy. There is not so much to learn, neither is there very -much to do to insure right alimentation, perfect digestion, -and continuous good health; but the little required of us -must be attended to with no lapses of attention.—<span class="smcap">Horace -Fletcher.</span>]</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_72">[Pg 72]</span></p> - -<h3 class="nobreak" id="PHYSIOLOGICAL_ECONOMY_IN">PHYSIOLOGICAL ECONOMY IN -NUTRITION<br /> - -<small><span class="smcap">By Russell H. Chittenden</span><br /> - -<i>Director of the Sheffield Scientific School of Yale University</i></small></h3> -</div> - - -<p>Among the many problems awaiting solution, -none is of greater importance for the -welfare of the individual and of the race than -that which relates to the proper nutrition of the -body. Man eats to live and to gain strength -for his daily work, and without sufficient nutriment -the machinery of the body cannot be run -smoothly or with proper efficiency. The taking -of an excess of food, on the other hand, is just -as harmful as insufficient nourishment, involving, -as it does, not only wasteful expenditure but, -what is even of greater moment, an expenditure -of energy on the part of the body, which may in -the long run prove disastrous. While it is the -function of food to supply the material from -which the body can derive the necessary energy -for its varied activities, any excess of food over -and above what is needed to make good the -loss incidental to life and daily activity is just so<span class="pagenum" id="Page_73">[Pg 73]</span> -much of an incubus, which is bound to detract -from the smooth running of the machinery and -to diminish the fitness of the body for performing -its normal functions.</p> - -<p>A proper physiological condition begets a -moral, mental, and physical fitness which cannot -be attained in any other way. Further, it must -be remembered that lack of a proper physiological -condition of the body is more broadly -responsible for moral, social, mental, and physical -ills than any other factor that can be named. -Poverty and vice on ultimate analysis may often -be traced to a perversion of nutrition. A -healthy state of the body is a necessary concomitant -of mental and moral vigour, as well as -of physical strength. Abnormal methods of -living are often the accompaniment or forerunner -of vicious tastes that might never have -been developed under more strictly physiological -conditions. Health, strength (mental and -physical), and moral tone alike depend upon -the proper fulfilment of the laws of nature, and -it is the manifest duty of a people hoping for -the fullest development of physical, mental, and -moral strength to ascertain the character of -these laws with a view to their proper observance. -Poverty, crime, physical ills, and a blunted -or perverted moral sense are the penalties we -may be called upon to pay for the disobedience<span class="pagenum" id="Page_74">[Pg 74]</span> -to Nature’s laws; penalties which not only <i>we</i> -may have to pay, but which may be passed -down to succeeding generations, thereby influencing -the lives of those yet unborn.</p> - -<p>There is to-day great need for a thorough -physiological study of those laws of nutrition -which constitute the foundation of good living. -It is a subject full of interest and promise for -the sociologist and economist, as well as for the -physiologist. We need a far more complete -knowledge than we possess at present of the -laws governing nutrition; we need fuller knowledge -of the methods by which the most complete, -satisfactory, and economical utilisation of -the diet can be obtained; we need to know -more concerning the minimum diet and the -minimum amount of proteid or albuminous foods -on which health, mental and physical vigour can -be permanently maintained; we need to know -more fully concerning the influence of various -forms of food on growth and recuperative -power; we need more complete knowledge regarding -the rôle of various dietetic and digestive -habits, fixed or acquired; the effects of thorough -mastication, insalivation, and the influence -of two versus three meals a day upon the -utilisation of food and hence upon the bodily -health. Further, we need more concise information -as to the effect of the mental state upon<span class="pagenum" id="Page_75">[Pg 75]</span> -digestion and nutrition. These and many other -problems of a like nature confront us when we -attempt to trace the influence of a proper nutrition -upon the condition of the body. These -problems, however, all admit of solution, and -in their solution undoubtedly lies the remedy -for many of the personal ills of mankind.</p> - -<p>The foregoing thoughts have been suggested -by observations recently made in the writer’s -laboratory on the amount and character of the -food actually required by a healthy man in the -maintenance of bodily equilibrium in periods -of rest and physical work. Our ideas at present -are based primarily upon observations as to -what civilised peoples are accustomed to do, -and not upon what they need to do in order to -meet the demands made upon the body. Sir -William Roberts has well said that the palate is -the dietetic conscience, but he adds that there -are many misfit palates, and we may well query -whether our dietetic consciences have not become -generally perverted through a false mode -of living. The well-nigh universal habit of -catering to our appetite on all occasions, of bowing -to the fancied dictates of our palates even -to the extent of satiety, and without regard to -the physiological needs of the body, may quite -naturally have resulted in a false standard of -living, in which we have departed widely from<span class="pagenum" id="Page_76">[Pg 76]</span> -the proper laws of nutrition. Statistical studies -carried out on large groups of individuals by -various physiologists have led to the general -acceptance of dietary standards, such as those -proposed by Voit, of Munich, and Atwater in -this country. Thus the Voit diet for a man -doing moderate work is 118 grams of proteid or -albuminous food, 56 grams of fat, and 500 grams -of carbohydrates, such as sugar and starch, with -a total fuel value of 3,055 large calories or heat -units per day. With hard work, Voit increases -the daily requirement to 145 grams of proteid, -160 grams of fat, and 450 grams of carbohydrates, -with a total fuel value of 3,370 large -calories. Atwater, on the other hand, from his -large number of observations, is inclined to -place the daily proteid requirement at 125 -grams, with sufficient fat and carbohydrate to -equal a total fuel value of 3,500 large calories -for a man doing a moderate amount of work; -while for a man at hard work the daily diet is -increased to 150 grams of proteid, and with fats -and carbohydrates to yield a total fuel value of -4,500 large calories. These standards are very -generally accepted as being the requirement for -the average individual under the given conditions -of work, and it may be that these figures -actually represent the daily needs of the body. -Suppose, on the other hand, that we have in<span class="pagenum" id="Page_77">[Pg 77]</span> -these figures false standards, or, in other words, -that the quantities of food-stuffs called for are -altogether larger than the actual demands of -the body require. In this case there is a positive -waste of valuable food material which we -may calculate in dollars and cents; a loss of income -incurred daily which might be expended -more profitably in other directions. To the -wage-earner with a large family, who must of -necessity husband his resources, there is in our -hypothesis a suggestion of material gain not to -be disregarded. The money thus saved might -be expended for the education of the children, -for the purchase of household treasures tending -to elevate the moral and mental state of the -occupants, or in many other ways that the imagination -can easily supply. This kind of saving, -however, is purely a question of economy, and -in some strata of society would be objected to -as indicative of a condition of sordidness. It -has come to be a part of our personal pride to -have a well-supplied table, and to eat largely -and freely of the good things provided. The -poorer man takes pride in furnishing his family -with a diet rich in expensive articles of food, and -imagines that by so doing he is inciting them to -heartier consumption and to increased health and -strength. He would be ashamed to save in this -way, under the honest belief that by so doing he<span class="pagenum" id="Page_78">[Pg 78]</span> -might endanger the health of his dear ones. But -let us suppose that this hypothetical waste of food -is not merely uneconomical, that it is undesirable -for other and weightier reasons. Indeed, let us -suppose that this unnecessary consumption of -food is distinctly harmful to the body, that it is -physiologically uneconomical, and that in our -efforts to maintain a high degree of efficiency -we are in reality putting upon the machinery of -the body a heavy and entirely uncalled-for strain, -which is bound to prove more or less detrimental. -If there is truth in this assumption, our hypothesis -takes on a deeper significance, and we -may well inquire whether there are any reasonable -grounds for doubting the accuracy of our -present dietary standards.</p> - -<p>In this connection it is to be remembered -that the food of mankind may be classified under -three heads, viz., <i>proteid or albuminous</i>, such as -meat, eggs, casein of milk, gluten of bread, and -various vegetable proteids; <i>carbohydrates</i>, as -sugar and the starches of our cereals, and <i>fats</i>, -including those of both animal and vegetable -origin. The proteids are characterised by containing -nitrogen (about 16 per cent), while the -fats and carbohydrates contain only carbon, hydrogen, -and oxygen. The two latter classes of -food-stuffs are burned up in the body, when -completely utilised, to carbonic acid (a gas) and<span class="pagenum" id="Page_79">[Pg 79]</span> -water, while the proteid foods, beside yielding -carbonic acid and water, give off practically all -of their nitrogen in the form of crystalline nitrogenous -products in the excreta of the body. -Proteid foods have a particular function to -perform, viz., to supply the waste of proteid -matter from the active tissues of the body, and -this function can be performed only by the -proteid foods; hence the latter are essential -food-stuffs without which the body cannot long -survive. Fats and carbohydrates, on the other -hand, are mainly of value for the energy they -yield on oxidation, and in this connection it is -to be remembered that the fuel value of fats per -gram is much larger than that of carbohydrates, -viz., 9.3: 4.1, or more than twice as great. Further, -it is to be noted that the various food-stuffs -cannot be utilised directly by the body, but they -must first be digested, then absorbed and assimilated, -after which they gradually, in their -changed form, undergo decomposition with liberation -of their contained energy, which may -manifest itself in the form of heat or of mechanical -work. The thoroughness with which foods are -digested and utilised in the body must therefore -count for a great deal in determining their dietetic -or nutritive value. Moreover, it is easy to see -how an excess of proteid food will give rise to -a large proportion of nitrogenous waste matter,<span class="pagenum" id="Page_80">[Pg 80]</span> -which, floating through the system prior to -excretion, may, by acting on the nervous system -and other parts of the body, produce disagreeable -results. A mere excess of food, even of -the non-nitrogenous variety, must entail a large -amount of unnecessary work, thereby using up -a proportional amount of energy for its own disposal, -since once introduced into the body it must -be digested and absorbed, otherwise it undergoes -fermentation and putrefaction in the stomach -and intestines, causing countless troubles. -When absorbed in quantities beyond the real -needs of the body, it may be temporarily deposited -as fat; but why load up the system with -unnecessary material, thereby interfering with -the free running of the machinery? In other -words, it is very evident that the taking in of -food in quantities beyond the physiological requirements -is undesirable, and may prove exceedingly -injurious. It is truly uneconomical, -and defeats the very ends we aim to attain. -Instead of adding to the bodily vigour and -increasing the fitness of the organism to do its -daily work, we are really hampering the delicate -mechanism, upon the smooth running of which -so much depends.</p> - -<p>Why, now, should we assume that a daily -diet of over 100 grams of proteid, with fats and -carbohydrates sufficient to make up a fuel value<span class="pagenum" id="Page_81">[Pg 81]</span> -of over 3,000 large calories, is a necessary requisite -for bodily vigour and physical and mental -fitness? Mainly because of the supposition that -true dietary standards may be learned by observing -the relative amounts of nutrients actually -consumed by a large number of individuals so -situated that the choice of food is unrestricted. -But this does not constitute very sound evidence. -It certainly is not above criticism. We may -well ask ourselves whether man has yet learned -wisdom with regard to himself, and whether his -instincts or appetites are to be entirely trusted -as safe guides to follow in the matter of his -own nutrition. The experiments of Kumagawa, -Sivén, and other physiologists, have certainly -shown that men may live and thrive, for a time -at least, on amounts of proteid per day equal -to only one-half and one-quarter the amount -called for in the Voit standard. Sivén’s experiments, -in particular, certainly indicate that the -human organism can maintain itself in nitrogenous -equilibrium with far smaller amounts of -proteid in the diet than is ordinarily taught, and, -further, that this condition can be attained without -unduly increasing the total calories of the -food intake. Such investigations, however, have -always called forth critical comment from writers -on nutrition, indicating a reluctance to depart -from the current doctrines of the Voit or Munich<span class="pagenum" id="Page_82">[Pg 82]</span> -school; and, indeed, it may justly be claimed -that the ordinary nutrition experiments, extending -over short periods of time, are not entirely -adequate to prove the effect of a given set of -conditions when the latter are continued for -months or years. Thus, Schäfer writes: “It -may be doubted whether a diet which includes -considerably less proteid than 100 grams for the -twenty-four hours could maintain a man of -average size and weight for an indefinite time. -It has frequently been asserted that many Asiatics -consume a very much smaller proportion -of proteid than is the case with Europeans. -The inhabitants of India, Japan, and China -chiefly consume rice as the normal constituent -of their diet, which contains relatively little proteid; -and this has been advanced as an argument -in favour of the view that the minimal -amount of proteid is much less than that ordinarily -given as essential to the maintenance of -nutritive equilibrium. It must, however, be -stated that we have no definite statistics to -show that, in proportion to their body-weight, -Asiatics doing the same amount of work as -Europeans require a less amount of proteids; -indeed such evidence as is forthcoming is rather -in favor of the opposite view.” This statement -is typical of the attitude of physiologists in -general on this important subject. Why not<span class="pagenum" id="Page_83">[Pg 83]</span> -candidly admit that the matter is in doubt, and, -with a due recognition of the importance of the -subject, attempt to ascertain the real truth of -the matter?</p> - -<p>The writer has had in his laboratory for -several months past a gentleman (H. F.) who -has for some five years, in pursuit of a study of -the subject of human nutrition, practised a certain -degree of abstinence in the taking of food -and attained important economy with, as he believes, -great gain in bodily and mental vigour, -and with marked improvement in his general -health. Under his new method of living he finds -himself possessed of a peculiar fitness for work -of all kinds, and with freedom from the ordinary -fatigue incidental to extra physical exertion. -In using the word abstinence possibly a wrong -impression is given, for the habits of life now -followed have resulted in the disappearance of -the ordinary craving for food. In other words, -the gentleman in question fully satisfies his appetite, -but no longer desires the amount of food -consumed by most individuals.</p> - -<p>For a period of thirteen days, in January, -he was under observation in the writer’s laboratory, -his excretions being analysed daily with a -view to ascertaining the exact amount of proteid -consumed. The results showed that the average -daily amount of proteid metabolised was 41.25<span class="pagenum" id="Page_84">[Pg 84]</span> -grams, the body-weight (165 pounds) remaining -practically constant. Especially noteworthy, -also, was the very complete utilisation of the -proteid food during this period of observation. -It will be observed here that the daily amount -of proteid food taken was less than one half that -of the minimum Voit standard, and it should also -be mentioned that this apparent deficiency in -proteid food was not made good by any large -consumption of fats or carbohydrates. Further, -there was no restriction in diet. On the contrary, -there was perfect freedom of choice, and -the instructions given were to follow his usual -dietetic habits. Analysis of the excretions -showed an output of nitrogen equal to the -breaking down of 41.25 grams of proteid per -day as an average, the extremes being 33.06 -grams and 47.05 grams of proteid.</p> - -<p>In February a more thorough series of observations -was made, involving a careful analysis -of the daily diet, together with analysis of -the excreta, so that not alone the proteid consumption -might be ascertained, but likewise the -total intake of fats and carbohydrates. The -diet consumed was quite simple, and consisted -merely of a prepared cereal food, milk, and -maple sugar. This diet was taken twice a day -for seven days, and was selected by the subject -as giving sufficient variety for his needs and<span class="pagenum" id="Page_85">[Pg 85]</span> -quite in accord with his taste. No attempt was -made to conform to any given standard of quantity, -but the subject took each day such amounts -of the above foods as his appetite craved. Each -portion taken, however, was carefully weighed -in the laboratory, the chemical composition of -the food determined, and the fuel value calculated -by the usual methods.</p> - -<p>The following table gives the daily intake of -proteids, fats, and carbohydrates for six days, -together with the calculated fuel value, and also -the nitrogen intake, together with the nitrogen -output through the excreta. Many other data -were obtained showing diminished excretion of -uric acid, ethereal sulphates, phosphoric acid, -etc., but they need not be discussed here.</p> - -<table class="standard" summary=""> -<tr> -<th class="td" rowspan="2"></th> -<th class="tdc" colspan="5">Intake</th> -<th class="tdc" colspan="3">Output of Nitrogen</th> -</tr> -<tr> -<th class="tdc">Proteids</th> -<th class="tdc">Fats</th> -<th class="tdc">Carbohy</th> -<th class="tdc">Calories</th> -<th class="tdc">Nitrogen</th> -<th class="tdc">Urine</th> -<th class="tdc">Fæces</th> -<th class="tdc">Total</th> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br">Grams</td> -<td class="tdc_br">Grams</td> -<td class="tdc_br">Grams</td> -<td class="tdc_br"></td> -<td class="tdc_br">Grams</td> -<td class="tdc_br">Grams</td> -<td class="tdc_br">Grams</td> -<td class="tdc">Grams</td> -</tr> -<tr> -<td class="tdr_br">Feb. 2</td> -<td class="tdr_br">31.3</td> -<td class="tdr_br">25.3</td> -<td class="tdr_br">125.4</td> -<td class="tdr_br">900</td> -<td class="tdr_br">5.02</td> -<td class="tdr_br">5.27</td> -<td class="tdr_br">0.18</td> -<td class="tdr">5.45</td> -</tr> -<tr> -<td class="tdr_br">3</td> -<td class="tdr_br">46.8</td> -<td class="tdr_br">40.4</td> -<td class="tdr_br">266.2</td> -<td class="tdr_br">1690</td> -<td class="tdr_br">7.50</td> -<td class="tdr_br">6.24</td> -<td class="tdr_br">0.81*</td> -<td class="tdr">7.05</td> -</tr> -<tr> -<td class="tdr_br">4</td> -<td class="tdr_br">48.0</td> -<td class="tdr_br">38.1</td> -<td class="tdr_br">283.0</td> -<td class="tdr_br">1747</td> -<td class="tdr_br">7.70</td> -<td class="tdr_br">5.53</td> -<td class="tdr_br">0.81*</td> -<td class="tdr">6.34</td> -</tr> -<tr> -<td class="tdr_br">5</td> -<td class="tdr_br">50.0</td> -<td class="tdr_br">40.6</td> -<td class="tdr_br">269.0</td> -<td class="tdr_br">1711</td> -<td class="tdr_br">8.00</td> -<td class="tdr_br">6.44</td> -<td class="tdr_br">0.81*</td> -<td class="tdr">7.25</td> -</tr> -<tr> -<td class="tdr_br">6</td> -<td class="tdr_br">47.0</td> -<td class="tdr_br">41.5</td> -<td class="tdr_br">267.0</td> -<td class="tdr_br">1737</td> -<td class="tdr_br">7.49</td> -<td class="tdr_br">6.83</td> -<td class="tdr_br">0.81*</td> -<td class="tdr">7.64</td> -</tr> -<tr> -<td class="tdr_br">7</td> -<td class="tdr_br">46.5</td> -<td class="tdr_br">39.8</td> -<td class="tdr_br">307.3</td> -<td class="tdr_br">1852</td> -<td class="tdr_br">7.44</td> -<td class="tdr_br">7.50</td> -<td class="tdr_br">0.17</td> -<td class="tdr">7.67</td> -</tr> -<tr> -<td class="tdr_btbr">Daily Av.</td> -<td class="tdr_btbr">44.9</td> -<td class="tdr_btbr">38.0</td> -<td class="tdr_btbr">253.0</td> -<td class="tdr_btbr">1606</td> -<td class="tdr_btbr">7.19</td> -<td class="tdr_btbr">6.30</td> -<td class="tdr_btbr">0.60</td> -<td class="tdr_btb">6.90</td> -</tr> -<tr> -<td class="tdl" colspan="9">* Average of the four days.</td> -</tr> -</table> - - -<p>The main things to be noted in these results -are, first, that the total daily consumption of -proteid amounted on an average to only 45<span class="pagenum" id="Page_86">[Pg 86]</span> -grams, and that the fat and carbohydrate were -taken in quantities only sufficient to bring the -total fuel value of the daily food up to a little -more than 1,600 large calories. If, however, we -eliminate the first day, when for some reason -the subject took an unusually small amount of -food, these figures are increased somewhat, but -they are ridiculously low compared with the -ordinarily accepted dietary standards. When -we recall that the Voit standard demands at -least 118 grams of proteid and a total fuel value -of 3,000 large calories daily, we appreciate at -once the full significance of the above figures. -But it may be asked, was this diet at all adequate -for the needs of the body—sufficient for a man -weighing 165 pounds? In reply, it may be said -that the appetite was satisfied, and that the subject -had full freedom to take more food if he so -desired. To give a physiological answer, it -may be said that the body-weight remained -practically constant throughout the seven days’ -period, and further, it will be observed by comparing -the figures of the table that the nitrogen -of the intake and the total nitrogen of the output -were not far apart. In other words, there -was a close approach to what the physiologist -calls nitrogenous equilibrium. In fact, it will be -noted that on several days the nitrogen output -was slightly less than the nitrogen taken in. We<span class="pagenum" id="Page_87">[Pg 87]</span> -are, therefore, apparently justified in saying -that the above diet, simple though it was in -variety, and in quantity far below the usually -accepted requirement, was quite adequate for -the needs of the body. In this connection it -may be asked, what were the needs of the body -during this seven days’ period? This is obviously -a very important point. Can a man on -such a diet, even though it suffices to keep up -body-weight and apparently also physiological -equilibrium, do work to any extent? Will there -be under such condition a proper degree of fitness -for physical work of any kind? In order -to ascertain this point, the subject was invited -to do physical work at the Yale University -Gymnasium, and placed under the guidance of -the director of the gymnasium, Dr. William G. -Anderson. The results of the observations -there made are here given, taken verbatim from -Dr. Anderson’s report to the writer.</p> - -<div class="blockquot"> - -<p>On the 4th, 5th, 6th, and 7th of February, 1903, I gave -to Mr. Horace Fletcher the same kind of exercises we -give to the Varsity Crew. They are drastic and fatiguing -and cannot be done by beginners without soreness and -pain resulting. The exercises he was asked to take were -of a character to tax the heart and lungs, as well as to -try the muscles of the limbs and trunk. I should not -give these exercises to Freshmen on account of their -severity.</p> - -<p>Mr. Fletcher has taken these movements with an ease -that is unlooked for. He gives evidence of no soreness<span class="pagenum" id="Page_88">[Pg 88]</span> -or lameness, and the large groups of muscles respond -the second day without evidence of being poisoned by -Carbon dioxide. There is no evidence of distress after -or during the endurance test, <i>i. e.</i>, the long run. The -heart is fast but regular. It comes back to its normal -beat quicker than does the heart of other men of his -weight and age.</p> - -<p>The case is unusual, and I am surprised that Mr. -Fletcher can do the work of trained athletes and not give -marked evidences of over-exertion. As I am in almost -constant training I have gone over the same exercises, -and in about the same way, and have given the results -for a standard of comparison. [The figures are not -given here.]</p> - -<p>My conclusion, given in condensed form, is this: -Mr. Fletcher performs this work with greater ease and -with fewer noticeable bad results than any man of his -age and condition I have ever worked with.</p> -</div> - -<p>To appreciate the full significance of this -report, it must be remembered that Mr. Fletcher -had for several months past taken practically no -exercise other than that involved in daily walks -about town.</p> - -<p>In view of the strenuous work imposed during -the above four days, it is quite evident that -the body had need of a certain amount of nutritive -material. Yet the work was done without -apparently drawing upon any reserve the body -may have possessed. The diet, small though it -was, and with only half the accepted requirement -in fuel value, still sufficed to furnish the -requisite energy. The work was accomplished -with perfect ease, without strain, without the<span class="pagenum" id="Page_89">[Pg 89]</span> -usual resultant lameness, without taxing the -heart or lungs, and without loss of body-weight. -In other words, in Mr. Fletcher’s case -at least, the body machinery was kept in perfect -fitness without the consumption of any such -quantities of fuel as has generally been considered -necessary.</p> - -<p>Just here it may be instructive to observe -that the food consumed by Mr. Fletcher during -this seven days’ period—and which has been -shown to be entirely adequate for his bodily -needs during strenuous activity—cost eleven -cents daily, thus making the total cost for the -seven days seventy-seven cents! If we contrast -this figure with the amounts generally paid for -average nourishment for a like period of time, -there is certainly food for serious thought. Mr. -Fletcher avers that he has followed his present -plan of living for nearly five years; he usually -takes two meals a day; has been led to a strong -liking for sugar and carbohydrates in general -and away from a meat diet; is always in perfect -health, and is constantly in a condition of fitness -for work. He practises thorough mastication, -with more complete insalivation of the food -(liquid as well as solid) than is usual, thereby -insuring more complete and ready digestion and -a more thorough utilisation of the nutritive portions -of the food.</p> - -<p><span class="pagenum" id="Page_90">[Pg 90]</span></p> - -<p>In view of these results, are we not justified -in asking ourselves whether we have yet attained -a clear comprehension of the real requirements -of the body in the matter of daily nutriment? -Whether we fully comprehend the best -and most economical method of maintaining the -body in a state of physiological fitness? The -case of Mr. Fletcher, just described; the results -noted in connection with certain Asiatic peoples; -the fruitarians and <i>nut</i>arians in our own country -recently studied by Professor Jaffa, of the University -of California; all suggest the possibility -of much greater physiological economy than we -as a race are wont to practise. If these are -merely exceptional cases, we need to know it; -but if, on the other hand, it is possible for mankind -in general to maintain proper nutritive -conditions on dietary standards far below those -now accepted as necessary, it is time for us to -ascertain that fact. For, if our standards are -now unnecessarily high, then surely we are not -only practising an uneconomical method of sustaining -life, but we are subjecting ourselves to -conditions the reverse of physiological, and -which must of necessity be inimical to our well-being. -The possibility of more scientific knowledge -of the natural requirements of a healthy -nutrition is made brighter by the fact that the -economic results noted in connection with our<span class="pagenum" id="Page_91">[Pg 91]</span> -metabolism examination of Mr. Fletcher is confirmatory -of similar results obtained under the -direction and scrutiny of Sir Michael Foster at -the University of Cambridge, England, during -the autumn and winter of last year; and by Dr. -Ernest Van Someren, Mr. Fletcher’s <i>collaborateur</i>, -in Venice, on subjects of various ages and -of both sexes, some account of which has already -been presented to the British Medical Association -and to the International Congress of Physiologists -at its last meeting at Turin, Italy. At -the same time emphasis must be laid upon the -fact that no definite and positive conclusions -can be arrived at, except as the result of careful -experiments and observations on many individuals -covering long periods of time. This, however, -the writer hopes to do in the very near -future, with the coöperation of a corps of interested -observers.</p> - -<p>The problem is far-reaching. It involves not -alone the individual, but society as a whole, for -beyond the individual lies the broader field of -the community, and what proves helpful for the -one will eventually react for the betterment of -society, and for the improvement of mankind in -general.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_92">[Pg 92]</span></p> - -<h3 class="nobreak" id="INTRODUCTION_TO_DR_HARRY_CAMPBELLS">INTRODUCTION TO DR. HARRY CAMPBELL’S -CONTRIBUTION ON THE IMPORTANCE -OF MASTICATION</h3> -</div> - - -<div class="blockquot"> - -<p>[Since the publication of Van Someren’s paper, “Was Luigi -Cornaro Right?”, read before the British Medical Association, -and reprinted elsewhere in this volume, much more -attention has been given to the study of mastication than had -been previously reported. Mr. Gladstone’s advice to his children, -which was commonly current and was repeated whenever -mastication was mentioned, was usually accompanied and -met by an amused smile that showed that the full importance -of better mouth-treatment of food was not appreciated. <i>Glutton -or Epicure</i>, a little book by the present writer, published -in 1898, insisted on thorough use of the functions of the mouth -in alimentation but did not go into the anatomical, physiological -and dental details.</p> - -<p>Dr. Harry Campbell of Northwest London Hospital has performed -this latter service to science and humanity, with splendid -carefulness, and must have devoted much time and study -to the collection of evidence and suggestion which is given -here following in full, reprinted from the <i>London Lancet</i>.</p> - -<p>The authors acknowledge with much gratitude, the courteous -permission of both Dr. Campbell and of the editor of the -<i>Lancet</i>, to reprint all four articles which composed the series.</p> - -<p>In our own study of the subject of mouth-treatment of food -we have been led to give more credit to the chemical feature -of preparation than Dr. Campbell yet attributes to the chemical -side of the problem. Comminution of hard food is of -first importance, undoubtedly, but insalivation and neutralisation -or alkalinisation are, seemingly, much more easily and -quickly accomplished in the mouth than farther on in the -alimentary canal. The intestines <i>can</i> do all in the way of -digestion, even if the mouth and stomach are passed and their -assistance in the digestive process is entirely neglected, but it -is done at tremendous disadvantage in the supplementary -digestive tract of the intestines. We have proven the econ<span class="pagenum" id="Page_93">[Pg 93]</span>omy -of letting the mouth do <i>all it can</i>, by the insalivation -(sipping and tasting) of liquids that have taste up to the point -of compulsory swallowing (a sucking-up by the Swallowing -Impulse which naturally occurs in the course of treatment -in the mouth if not fought against too strongly). If Dr. -Campbell will extend his observations to liquids, say milk, -and for a sufficiently long time to measure results by continued -economy of assimilation and saving of solid excreta, he -will find that it pays to let the mouth do all it can do, and that -while it <i>cannot do too much</i> it <i>may do too little</i>. The natural -instincts of the mouth, or those that attach to the mouth, -become much more discriminating also if exercised on liquids -as well as on solids. This they do not learn to do so well -if sapid liquids are habitually rushed past their field of -discrimination.</p> - -<p>Taste enjoyed in the mouth is good, and a good part of the -pleasure of living comes from taste gratification, but taste that -returns from the stomach and is belched by eructation or is -lingeringly reminiscent in the mouth or nose is indicative of -indigestion.</p> - -<p>Hence it is better to dissipate taste in the mouth, which is -the sole region of taste. Spirits tasted into absorption in this -way leave no odour upon the breath, and asparagus munched -and tasted to the limit in the mouth, carries no odour to the -urine. Even the stale and disagreeable odour of onion or -garlic can be neutralised by saliva and killed in the mouth.</p> - -<p>It is extremely difficult to get observers to practise tasting -taste out of liquids as the wine tasters do, and as the tea -tasters <i>have to do or die</i>; or, at least, become useless in their -profession. Once the efficacy of the liquid-tasting precaution -in digestion is understood, however, to swallow anything but -pure water without tasting it into absorption produces a shock. -This care becomes instinctive quite easily and regulates itself -automatically. It is also a distinct gain to the gustatory possibilities, -which are very limited at best.</p> - -<p>When the body will tolerate spirits tasted into it—not -poured into it—at all, which is not often when the nutrition -is normal (only in damp or cold weather, as a general thing, -and then in the case of the writer only at rare intervals, say -two or three times a year), the spirit will mix quickly with the -saliva and become neutralised sufficiently to excite the Swal<span class="pagenum" id="Page_94">[Pg 94]</span>lowing -Impulse. Continue sipping the spirit for a time and -you will note that there comes a point where the saliva and -the spirit do not mix, do not neutralise; the mouth becomes -unduly full of liquid without any relaxation or invitation of -the Swallowing Impulse; and the really instinctive inclination -will be to <i>spit it out</i>. It is a clear indication that the -body-<i>toleration</i> has been fully taxed; there is no longer any -bodily need for alcohol—in fact, there is no longer natural -toleration—and the secretion sent down into the mouth is -evidently mucous for a washing-out process, and is not alkaline -saliva for assisting in a utilisation function.</p> - -<p>It is quite uncanny to observe the nicety of mouth-discrimination -and the consistency of it as related to similar substances -under similar conditions, if one learn to read it with precision -and intelligence.</p> - -<p>With increased ease of digestion, which comes with more -thorough attention to solid foods alone, the ordinary observer -will think that he has accomplished the whole of the possible -benefit. It is only when he gives sufficient time to liquids -also, to get the added delight and relief that salivary respect -of them brings, that the whole of the beneficence of mouth-service -is realised. Follow this discrimination and care to a -comparative measurement of the waste of digestion, the solid -excreta, and note the increased proportionate gain in assimilation -and the value of the economy will be appreciated. Try -the different treatments on milk for a month; fifteen days -with drinking and fifteen days insalivating (sipping and tasting) -the milk to the limit, and keep account of quantity of intake -required to satisfy appetite and maintain body-weight; and -also note carefully the condition and quantity of the fæces. -In the one case you will find the waste to be <i>fæces</i> indeed, and -unmistakably worthy of the name; but in the case of sipping, -tasting and insalivating the milk to the full satisfaction of the -appetite, the <i>digestion-ash</i> will assume quite a different amount -and character and deserve a change of name. The proportions -of the saving in our own experiments have approximated -the difference between three and ten; that is, on a reduction -of only one-third the quantity of food commonly ingested, -but fully satisfying the sipping and tasting appetite, the quantity -of solid excreta was only one-tenth of the other and of -quite a different character, æsthetically considered.</p> - -<p><span class="pagenum" id="Page_95">[Pg 95]</span></p> - -<p>While these suggestions do not discredit or affect the value -of the purely mechanical side of the treatment as given by Dr. -Campbell, and are not intended to be controversial, they are -ventured as an amendment to be worked out in regard to -liquids, which are, in fact, only an extreme of the pultaceous -foods against which Dr. Campbell warns us as being subtly -dangerous.</p> - -<p>There is another point in our experiences and observations -of the largest importance that may appropriately be introduced -here: The treatment of all liquids in the manner suggested -prevents intemperance of drinking as effectively as it -does intemperance of eating.</p> - -<p>When food is filtered into the body after having become -liquified and made alkaline, or, at least neutral, by saliva, the -appetite is given a chance to measure the needs of the body -and to discriminate against excess. As soon as the point of -complete saturation of any one deficiency is reached, the -appetite is cut off, as short as possible to imagine, with no -indication of stomach fullness. It will welcome a little of -proteid in beans, cheese, eggs, or in some other of its richer -forms, and then turn to sugar or fat in some of their numerous -forms. Thirst for water will assert itself for a moment, -sometimes asking but for a drop and again for a full glass, -and afterwards, when near the point of complete saturation, -appetite will hesitate for a moment, as if searching around -for some rare substance, and may find its final satisfaction in -a single spoonful of a sweet or a sip of something in sight.</p> - -<p>The appetite satisfied by the infiltering process is a sweetly -appeased appetite, calm, rested, contented, normal. There -is no danger from the flooding of intemperance, for there is -not even toleration of excess either of more food or of more -drink, and this contented appetite will remain in the condition -of contentment until another need has really been earned by -evaporation or destructive katabolism.</p> - -<p>In the teaching of this physiology and psychology of alimentation -to the children of England, lies the only true solution -of the drink question, which is now the curse of the -nation.</p> - -<p>Dr. Campbell has made such a splendid case for the mechanical -side of mouth work, that it is the hope of the writer that -he will give equally careful consideration to the chemical and<span class="pagenum" id="Page_96">[Pg 96]</span> -psychological sides, and in a completeness of observation -render inestimable service to his country, to science, and -humanity. A decade of trial on the inmates of an infant -orphan asylum will show the possibilities for the nation in a -single generation, if broadly applied. It might lead to an -effective intemperance, inhibition, or quarantine, and that is -all any nation needs of advantage to make it independent of -the world and truly great.—<span class="smcap">Horace Fletcher.</span>]</p> -</div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="OBSERVATIONS_ON_MASTICATION">OBSERVATIONS ON MASTICATION<br /> -<br /> - -<small><span class="smcap">By Harry Campbell, M.D., F.R.C.P.</span> (Lond.)<br /> - -<i>Physician to the Northwest London Hospital</i><br /> - -[London <i>Lancet</i>, July 11, 18, 25, and August 8, 1903]</small></h3> - - -<p class="center small"><span class="smcap">Section I.</span> From <i>London Lancet</i>, July 11, 1903</p> - -<h4><span class="smcap">The Effects of Mastication</span></h4> - -<p>The primary object of mastication is to -break up the food so as (1) to facilitate the -swallowing of it, and (2), still more important, -to insure its intimate admixture with the digestive -juices, not only within the mouth, but -throughout the entire digestive tract. Mastication -has, however, other important and far-reaching -effects. Thus it promotes the flow of -saliva and, when properly performed, secures a -due insalivation of the food; it increases the -quantity of alkaline saliva passing into the stomach; -it stimulates the heart and circulation; -and it finally influences the nutrition of the jaws -and their appendages by stimulating the local<span class="pagenum" id="Page_97">[Pg 97]</span> -blood and lymph circulation. Now to consider -these various objects and effects of mastication.</p> - -<p><i>Mastication facilitates swallowing.</i>—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. Dry food needs first to be well -moistened; and it is not surprising that it promotes -a more abundant flow of saliva than moist -food, though the secretion thus excited may be -poor in ferment. Hence it follows that if we -desire to give foods which compel mastication, -they should be tough or dry. On the whole, -vegetable foods necessitate more thorough mastication -than animal. The carnivora can scarcely -be said to masticate at all the flesh which they -consume; they simply tear off portions, and -forthwith swallow them whole. Cooked flesh, -however, does require mastication, owing to the -coagulation of its proteids. The herbivora, on -the other hand, unlike the carnivora, have to -subject their food to considerable mastication -before it can be swallowed; but they generally -masticate it far more than is needful to render<span class="pagenum" id="Page_98">[Pg 98]</span> -swallowing mechanically possible, as is exemplified -in the act of rumination, the object here -being to facilitate the admixture of the digestive -juices with the food.</p> - -<p>According to Van Someren, if the habit of -masticating efficiently is once acquired, the food -is not swallowed before it is converted into the -liquid state, the swallowing of unmasticated -lumps being effectually prevented by a pharyngeal -reflex.</p> - -<p><i>Mastication, by breaking the food up into small -particles, enables it to be brought into intimate contact -with the digestive juices.</i>—Such comminution -is especially needful in the case of raw -vegetable foods of the tougher kind, in order to -break up their cellulose framework, and to set -free the contained starch, proteids, and fats. -Foods of this kind, unless masticated, yield practically -no nutriment to the organism. I cannot -too strongly emphasise the fact that before man -learned to break up the cellulose framework of -his vegetable food by cooking he was compelled -to subject it to laborious mastication. But, while -thorough comminution is especially needed for -vegetable food when raw, it is also needed for -many cooked forms of it also,—as, for example, -solid batter pudding and new underbaked -bread, heavy lumps of which, passing into the -stomach, may seriously hamper the work of that<span class="pagenum" id="Page_99">[Pg 99]</span> -organ. Such substances are indigestible essentially -by virtue of their impermeability to the -digestive juices, and they gain in digestibility in -proportion as they are comminuted. The indigestibility -of new bread would appear to be -wholly due, not to any peculiarity of chemical -composition, but to its tendency to elude the -teeth and form a sodden mass impermeable to -the digestive juices, while the more powdery -stale bread is more easily broken up both in -the mouth and within the stomach. Cabbage, -again, owes its indigestibility to the fact that it -is allowed to pass into the stomach in large -masses, while the well-known digestibility of -cauliflower and minced spinach is due to the fineness -of their division; were cabbage as finely -minced as spinach usually is it would be equally -digestible.</p> - -<p>Turning now to animal food it has to be remarked -that while in the raw state it may be -readily digestible with little or no previous mastication, -since massive pieces of it are readily -attacked by the digestive juices, the like is -much less true of animal food the proteids of -which have been coagulated and rendered less -permeable by cooking. Large lumps of hard-boiled -egg or overdone meat, for instance, may -obstinately resist gastric digestion; indeed, as -with vegetable so with animal foods, their rela<span class="pagenum" id="Page_100">[Pg 100]</span>tive -digestibility depends more upon physical -consistence than chemical composition; beef is -generally more indigestible than mutton and -pork or veal than either, not so much by virtue -of chemical composition as of physical consistence; -the indigestibility of cheese illustrates -the same truth; the individual nutritive ingredients -of this substance—the proteids and fats—are -not in themselves indigestible; casein in -the form of protein or plasmon is known to be -easy of digestion, and butter is one of the most -digestible of fats; but in cheese the two are -welded together into a comparatively impermeable -mass, which is apt to escape comminution -by the teeth and to pass down into the stomach -in the form of solid lumps. A plain, wholesome -cheese well masticated or intimately mixed with -other foods, as in macaroni cheese, is quite -easily digested by the majority.</p> - -<p>I do not, of course, deny the influence of -the chemical factor. Undoubtedly food may -disturb digestion by virtue of its chemical composition, -apart altogether from its physical characters; -thus, while cooked goose-fat sets up -violent irritation in some, others cannot tolerate -eggs in any shape or form, and innumerable -idiosyncrasies in respect of special articles of -diet are met with which are essentially referable -to chemical composition; but making due al<span class="pagenum" id="Page_101">[Pg 101]</span>lowance -for this chemical influence there can, I -think, be little doubt that the digestibility of the -more common articles of diet, both animal and -vegetable, depends in the main upon their physical -constitution, <i>all of them tending to be -equally digestible when reduced to the same degree -of comminution</i>. This, if true, is, I need -scarcely say, a fact of the greatest practical importance, -for it amounts to this: that we may -often allow to those with very weak digestions -foods which are generally considered indigestible, -provided that they be thoroughly comminuted, -whether by mastication or artificial means.</p> - -<p><i>Mastication promotes the flow of saliva and the -insalivation of the food.</i>—The more efficiently -food is masticated the greater is the salivary flow, -and the more intimately is it mixed with the -saliva, or, as we say, insalivated. The saliva -has apparently no effect on fats; whether it acts -on proteids seems more doubtful, though by -some authorities the penetration of these by the -alkali of this fluid is said to aid in their subsequent -digestion; on starch, however, the saliva -acts very potently, and hence mastication plays -a special part in promoting the digestion of -starchy foods. Indeed, if only mastication be -persisted in long enough, starch may be wholly -converted into maltose within the mouth, and it -need scarcely be said that it is better for the<span class="pagenum" id="Page_102">[Pg 102]</span> -individual himself to manufacture his maltose in -this way than that he should take it ready made -for him in the form of one of the many “malt -extracts” on the market. Patients are often -forbidden starchy food, while they are allowed -the maltose which they can quite well manufacture -in their own mouths. Provided they be -sufficiently insalivated, there are few starchy -foods which are indigestible, not even excepting -the proverbially indigestible new potato. These -remarks are especially applicable to children, as -will be more particularly insisted on later.</p> - -<p><i>Mastication increases the amount of alkaline -saliva passing into the stomach</i>, and this not only -prolongs the period of starch digestion within -this organ but, by its influence upon the reaction -of the gastric contents, influences all the digestive -processes taking place there. I shall have -occasion to point out later that a deficient supply -of alkaline saliva in the stomach predisposes to -certain forms of indigestion.</p> - -<p><i>Mastication acts reflexly upon the stomach.</i>—It -is now known that the act of mastication -influences the stomach reflexly, promoting the -flow of gastric juice and thus preparing the stomach -for the entrance of food into it. If the -œsophagus of a dog is cut so as to allow the -swallowed food to escape instead of passing into -the stomach, it is found that the mastication of<span class="pagenum" id="Page_103">[Pg 103]</span> -food causes a considerable flow of gastric juice. -Food introduced into the stomach unaccompanied -by mastication is less effective in promoting -the gastric flow. It is probable that the -influence of mastication on the flow of gastric -juice is largely produced through the medium -of psychic influences, for the more efficient -the mastication the more is the sense of taste -affected.</p> - -<p><i>Mastication stimulates the heart and so promotes -the general circulation.</i>—This stimulating -action may be partly due to its local action on -the flow of blood and lymph in the jaws and -accessory parts, and partly to a reflex influence, -but whatever the explanation there can be no -doubt of the fact. Hence the mere chewing of -a non-nutritive substance, such as gum arabic, -is stimulating, and, doubtless, the stimulating -effects induced by the chewing of such articles -as tobacco and betel are largely to be explained -in this way.</p> - - -<h4><span class="smcap">The Influence of Mastication on the -Jaws and Adjacent Structures</span></h4> - -<p>This subject is of such importance that it -needs to be dealt with in some detail. By -“adjacent structures” I mean the masticatory -muscles, tongue, teeth, salivary glands, the nasal<span class="pagenum" id="Page_104">[Pg 104]</span> -passages and sinuses pertaining thereto, the -naso-pharynx, soft palate, and tonsils.</p> - -<p><i>The muscles of mastication.</i>—Let me at -the outset draw attention to certain anatomical -points, in connection with the muscles of mastication. -These are (<i>a</i>) their massiveness; (<i>b</i>) -the very close relation of the pterygoids to the -naso-pharynx; and (<i>c</i>) the outward direction of -the pterygoids.</p> - -<p>(<i>a</i>) It is not until one studies the muscles -of mastication closely that one comes to realise -their massiveness. Their large size, in relation -to the bony structures in connection with them, -is well shown in a vertical transverse section of -the head carried through the ascending ramus -of the mandible<a id="FNanchor_7" href="#Footnote_7" class="fnanchor">[7]</a> (see Fig. 1). It is evident -that the functional activity of so large a mass -of muscle tissue cannot but exercise considerable -influence on the nutrition of the neighbouring -parts.</p> - - -<div class="figcenter illowp100" id="illus-143" style="max-width: 62.5em;"> - <img src="images/illus-143.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 1.</span>—Vertical transverse (slightly oblique) section through -the head on a level with the epiglottis. The massiveness of the -system of masticatory muscles is apparent.</div> -</div> - - -<p>(<i>b</i>) The pterygoid muscles, springing as -they do from the internal pterygoid plates, must -necessarily be in close relation with the naso-pharynx, -especially the internal pair, which -take their origin from the internal aspect of the -internal plates. I would further point out that -the external pair, although they diverge from<span class="pagenum" id="Page_106">[Pg 106]</span> -the naso-pharynx on their way to the mandibular -condyles, yet remain on a level with that -cavity. This close relation of the pterygoids -to the naso-pharynx is, if I mistake not, of -great importance in relation to the etiology -of “adenoids.”</p> - -<p>(<i>c</i>) Of the two pairs of pterygoids the external -pair pass in the more outward direction, -forming with the sagittal plane of the head -an angle of 45° (see Figs. 1 and 2). In consequence -of this direction they tend by their -contraction to pull the pterygoid plates and -posterior parts of the maxilla away from the -sagittal plane of the head, and thus to secure -the normal width of the posterior nares. It -is these muscles which bring about the lateral -movements of the mandible, causing the lower -teeth to move laterally and sagittally across the -upper, the food being in this way far more effectually -ground than by a mere vertical pressure -of the teeth against one another. These -lateral movements are, as we shall see, less -pronounced among the moderns than among -primitive peoples.</p> - -<span class="pagenum" id="Page_107">[Pg 107]</span> -<div class="figcenter illowp100" id="illus-145" style="max-width: 62.5em;"> - <img src="images/illus-145.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 2.</span>—Portion of horizontal section of head about an inch -below the condyles of the lower jaw. The outward direction of -the external pterygoids is well shown; also the close relation of -the levatores and tensores palati with the internal pterygoids.</div> -</div> - -<p><i>The influence of the contraction of the masticatory -muscles on the local circulation of blood and -lymph.</i>—When a muscle is at rest the blood<span class="pagenum" id="Page_108">[Pg 108]</span> -flows sluggishly through it, while there is a complete, -or all but complete, stagnation of the lymph -current; if a lymphatic trunk of a limb at rest -be cut no lymph escapes from it. Rhythmic -muscle contractions, however, stimulate the flow -both of blood and lymph (<i>a</i>), in the contracting -muscles themselves and (<i>b</i>) in the neighbouring -parts. (<i>a</i>) Not only are the muscle arteries -dilated during rhythmic contractions, but the -blood is vigorously squirted out of the muscle -veins, so that much more blood flows through -a muscle during its rhythmic contraction than -during rest. The flow of lymph is even more -markedly stimulated,—this fluid, which, while the -muscle is at rest, is stagnant or all but so, being -during contraction driven actively along the -lymphatic trunks. (<i>b</i>) How greatly rhythmic -muscle contractions influence the circulation of -fluids in the neighbouring parts is shown by the -flushing of the skin and the swelling of the soft -parts generally of a limb which is being exercised. -We thus see how profoundly the exercise -of the masticatory muscles—and among -these we must not forget to include the tongue—influences -not only their own nutrition but -that of the important structures adjacent to -them—that is to say, of the jaw-bones, salivary -glands, buccal mucous membrane, soft palate, -faucial tonsils, pharynx, and naso-pharynx, as<span class="pagenum" id="Page_109">[Pg 109]</span> -well as of the nasal cavities and their accessory -sinuses. All these parts are during mastication -copiously flushed with blood and lymph, from -which it is evident that efficient mastication -must stimulate their nutrition and favour their -proper development. Hence, in one who has -from childhood upwards been accustomed to -masticate efficiently, we generally find these parts -well developed, the jaws large and shapely, the -teeth regular and straight, the tongue and salivary -glands large, the nasal and naso-pharyngeal -passages spacious, and the mucous membrane -of the buccal and adjoining cavities healthy.</p> - -<p><i>Influence of mastication on the jaw-bones.</i>—It -is well known that the size of a bone is largely -determined by the degree to which the muscles -attached to it are exercised. That the jaws do -not grow to their normal size, if not adequately -exercised during their period of growth, is strikingly -shown by the overcrowding of the teeth, -which takes place in those brought up on soft -foods, and this even though there be no contraction -of the jaws resulting from mouth-breathing. -The dependence of the size of the jaws upon -the degree to which they are exercised is also -shown by the smallness of the modern jaw, as -compared with that of primitive peoples, a difference -which, as we shall see, is in part congenital -and in part due to the comparative<span class="pagenum" id="Page_110">[Pg 110]</span> -disuse of the former. Mastication influences not -only the size but also the shape of the jaws (<i>a</i>), -through its influence on the size of the tongue, -which by pressing against the teeth tends, as -Sim Wallace has shown, to expand the jaws; -(<i>b</i>) by the pressure of opposing teeth against -one another, which has a similar effect; and -(<i>c</i>) by the outward pull of the pterygoids, which -tends to widen the maxilla posteriorly and to -broaden the posterior nares.</p> - -<p><i>Influence of mastication on the teeth.</i>—The -teeth being developed within the jaw-bones and -remaining, even after eruption, in close anatomical -and physiological association with them, -must necessarily share in their nutritive tendencies. -If these bones are efficiently exercised -during the formation of the teeth—and my remarks -apply especially to the permanent set—the -tooth-germs will be abundantly flushed with -blood, while the ample growth of the jaws themselves -will provide the germs with plenty of room -in which to grow and to develop, and the more -perfect their growth and development the more -resistant should we expect them to be to the -ravages of caries. Who can contemplate the -jaw-bones of a six-years-old child, dissected so -as to display all the imbedded teeth, without -being assured of the effect of mastication upon -dental development? Fifty-two teeth meet the<span class="pagenum" id="Page_111">[Pg 111]</span> -view: the whole region from the orbital rims to -the inferior border of the mandible is literally -paved with them, and I can hardly doubt that -they collectively weigh more than the bone in -which they are imbedded. Surely no one can -examine such a dissection without being convinced -of the urgent necessity, if the teeth are -to grow and to develop normally, of giving the -child’s jaws from infancy onwards plenty of -work to do.</p> - -<p>The ample development of the jaws, which -efficient mastication brings about, has a further -beneficial effect as regards the teeth, in that it -enables them to take up their proper places in -the alveolar ridges, thus securing all the advantages -of a good “bite.” These I now proceed -to consider. The teeth during mastication, and -especially when the bite is good and the food -of a kind necessitating vigorous and sustained -mastication, are made to move in their sockets -both vertically and horizontally; the effect of -this is to stimulate the circulation in the tooth-pulp, -the alveolar periosteum (and hence also -in the cementum and alveolar walls which are -supplied by it), and the circumjacent mucous -membrane of the gum. All this makes for the -health of the teeth; not only does it promote -the nutrition of the tooth itself and of its bony -socket, thus maintaining a firm dental setting,<span class="pagenum" id="Page_112">[Pg 112]</span> -but it also tends to secure a healthy environment -for the exposed part of the tooth—that -part, namely, wherein caries begins—by maintaining -a healthy state of the surrounding and, -indeed, of the entire buccal mucous membrane, -as well as of the various secretions which bathe -the mouth. Wherefore it is not surprising to -find that those who masticate efficiently suffer -much less from dental caries and its complications -(such as abscess at the root) and disease -of the periodontal membrane (<i>e.g.</i>, pyorrhœa -alveolaris and loosening of the teeth) than those -who are accustomed to bolt their food.</p> - -<p>A few words as to the influence of mastication -in wearing down the teeth. In those races -which masticate vigorously the teeth in quite -early adult life show signs of wearing away, -while in later life it is quite common for the -biting surfaces to be worn flat; sometimes the -crown of the molars is worn away so that its -surface shelves downwards and inwards and not -infrequently it is concave, having a scooped-out -appearance; often the dentine is exposed in -this way; and yet among many hundreds of -skulls examined I do not remember to have -seen one single case where caries has started -on the biting surface thus worn down.</p> - -<p>I had always attributed this wearing down of -the teeth to the friction of coarse food against<span class="pagenum" id="Page_113">[Pg 113]</span> -them. Primitive races eat coarse vegetable food, -which frequently contains grit, and this doubtless -helps to grind the teeth down, but they -may be markedly ground down even in those -living on soft food, and in such cases the grinding -away can obviously only be due to the friction -of opposing teeth against one another. I, -indeed, believe this to be the essential cause of -the phenomenon, both in civilised races living -on soft food and in primitive races whose coarse -food necessitates prolonged and vigorous mastication -and a corresponding amount of attrition -between the biting surfaces of opposing teeth. -In order that this attrition may occur two things -are requisite: the upper and lower teeth must -be well opposed—there must be a good bite—and -mastication must be vigorous and of the -right kind. Mere vertical pressure of the teeth -against one another will not wear away the opposing -surfaces; there must be friction of these -surfaces against one another—a transverse and -sagittal movement of the lower teeth against the -upper by means of the pterygoids. Mainly to -this do I attribute the marked wearing down of -the teeth observed in primitive peoples, and I -am gratified to know that so competent an -authority on dental pathology as Sim Wallace -is a convert to this view.</p> - -<p>That all the teeth may be worn down just as<span class="pagenum" id="Page_114">[Pg 114]</span> -we observe in primitive people, even in those -who have lived all their lives on the ordinary -fare of the moderns, is proved by a case I have -under observation. It is that of a man in his -fiftieth year, who was brought up in Belgium -but who has resided in London for the last -thirty years. When he came to my out-patient -room I was not a little surprised to find that all -his teeth were sound—a very unusual occurrence, -I need hardly say, among the London -poor at his age. In seeking for an explanation -I elicited the fact that he was unable to swallow -his food without chewing it very thoroughly, -and on giving him a moderate-sized piece of -bread, with the request that he should chew it -in the ordinary way, I found that he subjected -it to one hundred and twenty separate bites before -swallowing it, and in the steady, deliberate -way he went to work and in his extensive lateral -movements of the mandible he reminded one -for all the world of a cow chewing its cud. The -temporals and masseters of this man are enormous, -and the like is no doubt true of the pterygoids; -he has well-developed nasal passages, has -never suffered from nasal obstruction, while his -buccal mucous membrane is unusually healthy -for one of his years and circumstances. May -we not attribute this healthy state of the mouth, -teeth, and nose to the good effects upon them<span class="pagenum" id="Page_115">[Pg 115]</span> -of efficient chewing? Here is a man who has -lived for thirty years in London on the same -kind of food as the average poor Londoner, but -instead of finding his mouth full of carious, tartar-coated -teeth, and spongy, receding, pus-exuding -gums, we find thirty-two sound teeth -firmly set in healthy gums and all but devoid -of tartar.</p> - -<p>A word as to the wearing down of the teeth -in the anthropoid apes. In this respect the -gorilla differs markedly from the orang and the -chimpanzee. In all the skulls of these latter -which I have examined the teeth show signs of -wearing away, while I have found the teeth of -the gorilla, with the exception of the tusk-like -canines, but little worn. From this we should -expect the latter animal to be mainly carnivorous, -and the orang and chimpanzee to be largely -herbivorous.</p> - - -<p class="center small"><span class="allsmcap">SECTION II.</span> From <i>London Lancet</i>, July 18, 1903</p> - -<h4><span class="smcap">Changes which the Jaws and Teeth of -Man have undergone during Man’s -Evolution from his Anthropoid -Ancestors</span></h4> - -<p>During man’s progress upwards from the -anthropoid his diet has undergone a progressive -change, and a parallel adaptation has taken place<span class="pagenum" id="Page_116">[Pg 116]</span> -in his jaws and teeth. Dietetically considered, -we may divide his evolutionary career into the -following epochs<a id="FNanchor_8" href="#Footnote_8" class="fnanchor">[8]</a>: (1) the anthropoid stage; -(2) the pre-cooking human stage; (3) the cooking -pre-agricultural stage; (4) the early agricultural -stage; and (5) the late agricultural -stage.</p> - -<p>1. <i>The anthropoid stage.</i>—The diet of man’s -anthropoid ancestors was probably much the -same as is that of existing anthropoid apes; it -consisted, namely, of raw vegetable and animal -food, necessitating a vigorous use of the maxillary -apparatus. This latter, we may assume, -was of the type belonging to the anthropoids—<i>i. e.</i>, -the jaws were massive and markedly prognathic; -the denture was the same as it is in existing -man, but the teeth were larger, especially -the upper canines, which served as weapons of -offence and defence; the third molars (the wisdom -teeth) were as large as the other molars -and were provided with three fangs, and there -was an ample portion of alveolar ridge behind -them; there was no chin. No doubt the massiveness -and the marked prognathism, which -characterised the jaws at this stage, served other -ends than that of mastication; it is obvious that -projecting jaws and teeth are much more effec<span class="pagenum" id="Page_117">[Pg 117]</span>tual -for seizing and lacerating prey than are the -orthognathic jaws of modern man.</p> - -<p>2. <i>The pre-cooking human stage</i> extends from -the time man’s ancestors first assumed the human -form till they learned to apply fire in the -preparation of their food. During all this period -the jaws and teeth were probably used as much, -or almost as much, for mastication as during the -anthropoid stage; raw animal food had to be torn -from the bones, the latter had to be crunched, -while the bulk of the raw vegetable food needed -then no less than it needs now prolonged and -vigorous mastication in order to liberate the -starch and other nutritive ingredients from their -undigestible cellulose envelopes.<a id="FNanchor_9" href="#Footnote_9" class="fnanchor">[9]</a> Nevertheless, -the jaws and teeth underwent considerable -change during this period, for not only were -they with every advance in intelligence called -less and less into requisition for purposes of -offence and defence, but the jaws, at least, -became materially modified in correlation with -the expanding cranial cavity and in connection -with the assumption of the erect posture. It is, -I think, rather for these reasons than in consequence -of alterations in the nature of the food -that the masticatory apparatus now gradually<span class="pagenum" id="Page_118">[Pg 118]</span> -lost its more bestial aspect and assumed an -essentially human type, becoming towards the -close of the period much the same as may -be observed among the most primitive peoples -now living.</p> - -<p>3. <i>The pre-agricultural cooking period.</i>—The -characters of the maxillary apparatus belonging -to this period are still available for study, the -aboriginal Australians, the Bushmen, Negritos, -and many Esquimaux not having yet emerged -from it. So far as mastication is concerned, -cooking influences vegetable far more than -animal food, for it not only softens it but by -rupturing the undigestible cellulose chambers -and liberating their contents relieves mastication -of one of its essential functions. Wherefore, -with the advent of cooking, man’s jaws and teeth -began to get smaller, and they have continued -to diminish in size up to the present time. No -great diminution, however, took place at first, -inasmuch as the diet still continued to be largely -animal (and prior to the use of knives and forks -such food had to be torn by the teeth), while -the coarse vegetable food of this date, even -when cooked, still needed laborious mastication. -The chief differences between the maxillary apparatus -of this early cooking age as compared -with that of the present day are as follows: the -jaws of the earlier period—<i>e. g.</i>, in the abo<span class="pagenum" id="Page_119">[Pg 119]</span>riginal -Australian—are more massive, and their -sagittal diameter is greater, giving rise to decided -prognathism, the teeth for the most part -are larger and stronger, the third molars being -nearly, if not quite, as big as the other molars, -and provided with three fangs, while there is -a considerable portion of alveolar ridge behind -them. The third molars, however, show a decided -tendency to be smaller than the rest, and -the alveolar ridge behind them is less marked -than in the previous period, features, I doubt -not, attributable to the influence of cooking in -diminishing mastication. Dental caries is rare -and is chiefly met with in the third molars.</p> - -<p>4. <i>The early agricultural age.</i>—All the existing -primitive races which have attained to the -cultivation of the soil may be regarded as belonging -to this period. Previously to it man -was mainly carnivorous, owing to the comparatively -limited quantity of vegetable food available, -so long as the supply was left to nature -alone; but when by cultivation this supply was -increased and, at the same time, rendered more -constant and certain, he gradually became less -carnivorous and more vegetarian in his diet. -The result of agriculture, however, is not only -to increase the supply of vegetable food, but to -diminish its fibrous, cellulosic ingredients, and -thus to render it more easily masticated. Hence<span class="pagenum" id="Page_120">[Pg 120]</span> -at this stage we find the maxillary apparatus -becoming smaller than in the previous period, -although the difference as shown—<i>e. g.</i>, by the -examinations of the skulls of the African negroes -and the Melanesians—is less pronounced than -we might perhaps have anticipated; prognathism -is not so decided, the jaws are smaller, also the -teeth, especially the third molars, which now -for the first time show a tendency to be furnished -with two instead of three fangs, while -the alveolar ridge behind them is distinctly -shorter than in the preceding period. Dental caries, -hitherto rare, now becomes more frequent.</p> - -<p>5. <i>The late agricultural period.</i>—A mid-agricultural -period might be described, but I shall -take no account of it here, but pass on to a consideration -of the late agricultural period—that, -namely, in which we ourselves live. The chief -characteristic of the food of this period is its -softness. Cooked animal food requires, indeed, -more mastication than raw, but the vegetable -food of to-day, owing to the combined effects of -improved agriculture, and skilful milling and -cooking, is so soft as to excite comparatively -little mastication. The present may, in fact, be -described as the <i>age of pap</i>. Hence the jaws -and teeth are now called upon to perform far -less work than in any earlier stage of our evolution, -and there has taken place in consequence<span class="pagenum" id="Page_121">[Pg 121]</span> -a great diminution in their size, more especially -in the size of the jaws, so that there is now often -no room for the teeth to take up their normal -positions, and there is generally a complete absence -of alveolar ridge behind the last molars. -The latter are, moreover, apt to be very small -or even absent, while dental caries is alarmingly -frequent.</p> - -<p>It will thus be seen that from the period of -the anthropoids to the present time, a progressive -change in the size and shape of the jaws and -teeth has been taking place, a change which is -to be explained by (1) the cessation of the need -for using them for offensive and defensive purposes; -(2) the growing capacity of the cranium -and the assumption of the erect position; (3) -the progressive alteration in man’s diet; and -probably also (4) considerations of beauty. -The first three factors have operated through -natural selection, the last through sexual selection, -which has come into play, I would suggest, -chiefly within recent times. Probably the -most pronounced change which has taken place -in the jaws during the agricultural periods has -been the suppression of prognathism which, in -the woman especially, is very unsightly, and -tends to diminish the likelihood of marriage.</p> - -<p><span class="pagenum" id="Page_122">[Pg 122]</span></p> - - -<h4><span class="smcap">Instances of the Vigorous Use to which -the Jaws and Teeth are put among -Existing Primitive Peoples</span></h4> - -<p>A study of existing primitive peoples brings -forcibly home to the mind how laboriously the -jaws and teeth of our primitive ancestors were -used. I have already shown how in pre-agricultural -and early agricultural times the nature -of the food compelled a sustained and vigorous -exercise of these structures, and I wish here -only to refer to a few specific and peculiar instances -of laborious mastication exercised by -primitive races now or recently living.<a id="FNanchor_10" href="#Footnote_10" class="fnanchor">[10]</a> Among -some of these mastication has been promoted -almost to the position of an industrial art.</p> - -<p><i>The chewing of very tough substances in order -to extract therefrom liquid or nourishment.</i>—The -recently extinct Tasmanians included among -their articles of diet a species of sea-weed which, -even when cooked, was so tough as to require -long-sustained mastication in order to extract -its nutrient elements. The Indians of North -California chew kelp, which is “as tough as -white leather” (<i>i. e.</i>, leather dressed with alum). -“A young fellow with good teeth will masticate<span class="pagenum" id="Page_123">[Pg 123]</span> -a piece of it a whole day.” Again Featherman<a id="FNanchor_11" href="#Footnote_11" class="fnanchor">[11]</a> -tells how when the Bushmen are short of food -in the winter they steep an old dried gnu-skin in -water and, having rubbed off the hair, boil it, -and proceed to gnaw the tough morsel until -their very jaws ache. The Modoc Indians are -said to munch the raw kais root all day long.<a id="FNanchor_12" href="#Footnote_12" class="fnanchor">[12]</a> -Among the Esquimaux it is a universal custom -to chew the raw skin of the whale, the porpoise, -and the seal for the blubber it contains, and the -skin being as tough as india-rubber, it requires, -as may be imagined, a good deal of chewing. -The Lower Californians also chew deer-skin and -ox-skin (Bayert). The more southern Esquimaux, -according to Nansen, preserve the stalks of -<i>angelica</i> by steeping them in a mixture of chewed -blubber and saliva. Finally, I may refer to the -habit of chewing the sugar-cane, a practice -which is prevalent among the natives in all -countries where the cane grows, and affords, it -need scarcely be said, abundant exercise for -the jaws and teeth.</p> - -<p><i>Mastication in the preparation of beverages.</i>—I -find that among widely separated aboriginal -peoples chewing is resorted to in the preparation -of beverages, both intoxicating and non-intoxicating. -The Gran Chaco Indians make an in<span class="pagenum" id="Page_124">[Pg 124]</span>toxicating -drink by chewing the algarroba bean -and then spitting into a receptacle. In other -parts of South America berries are chewed with -the same object. In some of the Pacific Islands -boys and girls with good teeth are selected to -chew a root (kava), from which they then prepare -a drink. In New Guinea drinks are similarly -prepared from roots. Boiled cassava root -is chewed by the Indians of Nicaragua for the -same purpose. In British Guiana the natives -make a drink by adding chewed maize and -saliva to sweet potato, maize, and sugar-cane. -The Indians in Honduras, after steeping cassava -cake or carbonised bread in hot water, chew a -portion and mix it with the rest.</p> - -<p><i>Mastication in the industries.</i>—Even among -moderns teeth are used for many purposes -other than mastication—<i>e. g.</i>, for holding pins -and needles and for severing cotton; also in some -industries—<i>e. g.</i>, among diamond workers—where -it is the custom for girls to hold the -diamond between their front teeth, which in -consequence get much worn away, as I have -myself seen. It is only among primitive peoples, -however, that the jaws and teeth actually play -the part of implements for use in the arts. The -Australian women make lines, nets, and bags -by chewing various kinds of fibre, a process -which wears down their teeth considerably and<span class="pagenum" id="Page_125">[Pg 125]</span> -may cause them to be tender.<a id="FNanchor_13" href="#Footnote_13" class="fnanchor">[13]</a> The Esquimaux -are still more dependent upon the use of -their teeth as implements, especially in the -preparation of skins for their clothing, boats, -and lines. The teeth are used to hold the skins, -while the latter are being scraped, the mouth -constituting, in fact, “a third hand;” and the -front teeth of Esquimaux women are often by -this means worn away to the merest stumps.<a id="FNanchor_14" href="#Footnote_14" class="fnanchor">[14]</a> -The garments of the Esquimaux, even to the -boots, are made up of skins which have been -laboriously chewed for this purpose by the -women “inch by inch,” till they acquire a beautiful -softness and flexibility, and are often, indeed, -chewed again after having been dried. -And we are told that the women have no objection -to the task, while the children are eager to -help in it on account of the blubber the skin -contains; also, that in bad times the men do not -object to join in the work. The lines for harpooning -are prepared in a similar way from -the skin of the bearded seal, and in very large -quantities.<a id="FNanchor_15" href="#Footnote_15" class="fnanchor">[15]</a> When we think of the quantity of -skins needed for these lines, for their dress, -including boots and gloves, and for their boats<span class="pagenum" id="Page_126">[Pg 126]</span> -(although for the latter some skins are used -without having first undergone chewing), it is -clear that enormous quantities must be chewed. -The Esquimaux men also use their teeth considerably -in other work—<i>e. g.</i>, in lashing the -sledges together.<a id="FNanchor_16" href="#Footnote_16" class="fnanchor">[16]</a> The Indians of North California -use their teeth for stripping the bark -from the fresh shoots employed in making their -wickerwork utensils, and they also employ their -teeth in making strings, cords, and nets.</p> - - -<h4><span class="smcap">The Instinct to Masticate</span></h4> - -<p>Seeing that the maxillary apparatus of man -has for long ages past been put to vigorous use, -it is not surprising that the need to exercise it -should express itself as a powerful instinct. -This instinct manifests itself in many and curious -ways, some of which I will now consider. During -the early months of life the natural function -of feeding at the breast provides the infant’s -jaws, tongue, and lips with all the needful exercise. -This bottle-feeding fails to do, and we -frequently find bottle-fed children seeking to -satisfy the natural instinct by sucking their -thumb, fingers, or any convenient object to -hand. The teeth are a provision for biting hard -foods, but even before they actually appear we -find the child seeking to exercise his toothless<span class="pagenum" id="Page_127">[Pg 127]</span> -gums on any hard substance he can lay hold of, -and there can be no doubt that exercise of this -kind tends to facilitate the eruption of the teeth, -a truth, indeed, recognised universally, whether -by the primitive mother who strings the tooth -of some wild animal round the neck of her infant, -or the up-to-date parent who provides her -child with a bejewelled ivory or coral bauble. -When the teeth have erupted, the masticatory -instinct finds among primitive peoples abundant -satisfaction in the chewing of the coarse, hard -foods which constitute their dietary; but among -us moderns, subsisting as we do mainly on soft -foods, affording but little exercise for the masticatory -apparatus, it does not find its proper -expression, and thus tends to die out. Nevertheless, -it dies a hard death, and long continues -to assert itself; witness the tendency of children -to bite their pencils and pen-holders; I -have known a child to gnaw through a bone -pen-holder, much in the same way as a carnivorous -animal gnaws at a bone.</p> - -<p>This instinct to chew for chewing’s sake manifests -itself all over the world. In our own -country not only do children bite pencils and -pen-holders, but they will chew small pieces of -india-rubber for hours together. The practice -of gum-chewing, so common among our American -cousins, evidently comes down from far-off<span class="pagenum" id="Page_128">[Pg 128]</span> -times, for the primitive Australians chew several -kinds of gum, attributing to them nutrient qualities,<a id="FNanchor_17" href="#Footnote_17" class="fnanchor">[17]</a> -and the Patagonians are said to keep -their teeth white and clean by chewing <i>matri</i>, a -gum which exudes from the incense bush, and -is carefully collected by the women and children.<a id="FNanchor_18" href="#Footnote_18" class="fnanchor">[18]</a></p> - -<p>A widespread custom in the East is betel-chewing, -which is met with in India, Malay, -Melanesia, and Polynesia, and even among the -primitive Veddahs of Ceylon. This article is -composed of the pungent leaf of the betel plant, -the areca nut and lime rolled together, and -when chewed yields a reddish juice which stains -the mouth and teeth. The Veddahs, failing -to get the genuine article, manufacture a quid -from the leaves of an aromatic plant, the barks -of one or two kinds of tree, and calcined small -shells.<a id="FNanchor_19" href="#Footnote_19" class="fnanchor">[19]</a> The compound must possess some -strange attraction, for otherwise such pains would -not be taken to secure it. What is the attraction? -Doubtless betel has stimulating properties, -and it must, moreover, be remembered -that the mere mechanical act of mastication -stimulates the circulation, a fact which helps to<span class="pagenum" id="Page_129">[Pg 129]</span> -explain the tendency for man, all the world over, -to chew non-nutrient substances. Tobacco-chewing -is common in many parts of the world, -and here, again, the effect for the time is stimulating. -Pitcherie is extensively chewed among -the aboriginal Australians; it consists of twigs -of about the thickness of rye-grass stems, which -are first chewed into a mass, then mixed with -the ash of gum trees, and made into a paste, -which is chewed for its stimulating and narcotic -effects.<a id="FNanchor_20" href="#Footnote_20" class="fnanchor">[20]</a></p> - -<p>I may allude in passing to the grinding of the -teeth, which takes place during sleep in disturbed -states of the nervous system. It is a -true masticatory act, in which the normal lateral -movement of the mandible is well marked, and -it may thus be regarded as a perverted manifestation -of the masticatory instinct.</p> - - -<h4><span class="smcap">The Causation of Inefficient Mastication</span></h4> - -<p>The effects for good upon the organism of -efficient mastication being profound and far-reaching, -it follows that inefficient mastication -must lead to many evils. What these are we -have now to consider; but first it will be well -to inquire into the causes of the defective mastication -which prevails among moderns.</p> - -<p>1. <i>Softness of food.</i>—By far the most impor<span class="pagenum" id="Page_130">[Pg 130]</span>tant -of these lies in the nature of the food taken. -The food of to-day—of the late agricultural -age period, as I have termed it—is for the -most part soft and pappy, of a kind which does -not compel thorough mastication; so much so, -indeed, that, as I have already said, we may -speak of this as the age of pap. This feature is -especially noticeable in the case of children’s -diet: under the modern system children are kept -on a liquid, or semi-liquid, diet, not merely during -the first months, but during the first years -of life, and at the seventh or eighth month all -kinds of artificial saccharide foods in liquid or -semi-liquid form are poured into the child’s -stomach; thereafter he is fed on such viands as -mashed potatoes and gravy, rusks soaked in -milk, milk puddings, bread dipped in bacon fat, -pounded mutton, thin bread-and-butter, and the -like; and we are told that this is the kind of -diet best suited to the young human, from the -time of weaning to the end of the second year! -The same pernicious methods are adopted subsequently. -“Perhaps the great majority of children -after they have got their complete set of -temporary teeth have,” writes Dr. Sim Wallace,<a id="FNanchor_21" href="#Footnote_21" class="fnanchor">[21]</a> -“a dietary such as the following. Breakfast: -bread-and-milk or porridge, milk, tea,<span class="pagenum" id="Page_131">[Pg 131]</span> -coffee, or cocoa, bread-and-butter, perhaps an -egg. Dinner: potatoes and gravy, or meat, -milk pudding. Tea: milk or tea with bread-and-butter, -jam, cakes. Supper: bread or biscuit -and milk.” Now food of this kind does not -invite mastication, and it finds its way into the -stomach all too readily. Hence the instinct to -masticate has little opportunity of exercise and, -not being properly exercised, tends, as I have -said, to die out. Small wonder that the child -nourished on such pappy food acquires the habit -of bolting it, and learns to reject hard, coarse -foods in favour of the softer kinds; everything -nowadays must be tender, pultaceous, or “short.” -Given a choice between a food compelling little or -no mastication and one necessitating prolonged -mastication—as between, say, fresh Vienna -bread and an Abernethy biscuit—and in nineteen -cases out of twenty the one which gives -the least trouble in eating will be chosen. To -such absurd lengths has this harmful custom -been pushed that even bread crust is avoided -by many. Witness the fashion of eating bread-and-butter -with a minimum of crust; order -bread-and-butter at any place of refreshment, -and the last thing you will be served with is a -plateful of crusts of bread. Many establishments, -indeed, make a regular practice of giving -away their crusts as unsaleable. Thus, the<span class="pagenum" id="Page_132">[Pg 132]</span> -rectangular loaves used for bread-and-butter in -the “Aërated bread-shops” are cut transversely -into slices, each loaf thus yielding two end -crusts which are put into baskets for the poor, -only the soft crumby pieces being reserved for -the customers, to be, in due course, no doubt -washed down by copious libations of tea and -coffee.</p> - -<p>When we trace the diet of the modern from -childhood upwards we find the same story: -it tends to remain soft and pappy to the end. -Animal food, especially as it comes to the tables -of the well-to-do, necessitates very little mastication. -It is the coarser varieties of vegetable -food alone which call out the full functional activity -of the masticatory apparatus, but the vegetable -food of to-day is rarely of a kind to do -this; cooked vegetables, such as potatoes, -greens, peas, and beans, can be, and generally -are, swallowed after little or no preliminary -mastication, and our flour is so carefully deprived -of its fibrous portions and so cunningly -dealt with in the bakehouse and kitchen in the -making of bread, cakes, and pastry which shall -eat light and short that these articles get very -little chewing; while such vegetable products -as rice, vermicelli, tapioca, and macaroni are, as -served at table, so soft that they slip down into -the stomach almost as readily as simple milk.<span class="pagenum" id="Page_133">[Pg 133]</span> -Let any one run through his dietary of any one -day, and he will realise how very little work his -masticatory apparatus is called upon to perform. -It will read something like the following. -Breakfast: porridge and milk, eggs, bacon, -bread, and marmalade. Lunch: fish, tender -meat, boiled vegetables, bread, some “sweet,” -and cheese. Tea: bread, butter, and cake. -Dinner: much the same as lunch. What opportunity, -I ask, does such a bill-of-fare afford -for the development of teeth and jaws, and for -the proper functional activity of the salivary -glands?</p> - -<p>2. <i>Defective masticatory apparatus.</i>—Another -potent cause of inefficient mastication is some -defect in the masticatory apparatus, and defects -of this kind are very common in those who -have not been accustomed to masticate thoroughly -in early life. Foremost among these are -irregularities of the teeth leading to faulty -“bite” and caries of the teeth which causes -them to be tender or to break away, if it does -not lead to their actual extraction. Mastication -cannot be thorough where the bite is defective, -for this not only leads to imperfect opposition -of the upper and lower teeth, but renders the -lower ones incapable of that ample lateral -movement, against the upper which is needful -to normal mastication.</p> - -<p><span class="pagenum" id="Page_134">[Pg 134]</span></p> - -<p>3. <i>Idiosyncrasy.</i>—Some are temperamentally -more disposed to hurry over their meals than -others. The katabolic, restless, nervous individual -is more apt to swallow his food hastily -than is his more deliberate and phlegmatic -brother. Individual differences in this respect -are even observed among the lower animals. -Thus, one of a pair of horses of about -the same age and build is nervous and excitable -and inclined to bolt its food, while its companion -of more stolid temperament is a thorough and -efficient masticator. The former shows comparatively -little wearing down of the teeth, and -often suffers from indigestion, a large portion of -corn grains passing through his digestive canal -intact; in the latter the teeth are well worn, -indigestion never occurs, and but very few -grains pass through the digestive tract unchanged. -It may be objected here that we cannot -help temperament, and to a large extent -this is true; but much can be done towards -modifying it, and it is something to know where -dangers, temperamental dangers, among others, -lie.</p> - -<p>4. <i>Circumstances of life.</i>—Again, in this -hurrying, strenuous age people are much less -deliberate than in the easy, slow-going days of -long ago. A meal is too often regarded as -something to be got through quickly, as taking<span class="pagenum" id="Page_135">[Pg 135]</span> -up time which might be devoted to something -more profitable. Especially is this true of -breakfast and lunch; it is no uncommon thing -for a business man to hurry through his breakfast -in a few minutes, preparatory to rushing off -to his train, and his lunch as likely as not is -as hastily swallowed in his office or at a bar. -Tradesmen are apt to take their meals in mere -snatches; apprentices, shop girls, and other -“hands” are often not allowed sufficient time -for their meals; while, to come to the professions, -we all know how the busy medical -man, for instance, is often obliged to take a -hurried snack in the short intervals between -seeing his patients. No wonder that thus circumstanced -people acquire the habit of bolting -their food. A meal should be regarded as an -end, and an important end, in itself. It should -be taken at leisure, body and mind being, for -the time being, given up to it, and to agreeable -social intercourse. If this rule were always observed -a most important source of inefficient -mastication would be removed.</p> - - -<p class="center small"><span class="smcap">Section III.</span> From <i>London Lancet</i>, July 25, 1903</p> - -<h4><span class="smcap">Evils resulting from Inefficient -Mastication</span></h4> - -<p><i>Too much food is eaten.</i>—Inefficient mastication -conduces to excessive eating. Now it is<span class="pagenum" id="Page_136">[Pg 136]</span> -obvious that soft foods, and these constitute the -bulk of our modern dietary, pass much more -readily into the stomach than coarse, hard foods -which compel a certain amount of preliminary -mastication, and for this reason the former predispose -to excessive eating: hence a danger at -all periods of life, not only in grown-ups but in -children, even infants; brought up as the latter -are, mainly on liquid and pappy foods, many of -them consume not only far more than is needful, -but far more than is healthful, their stomachs -being literally deluged with nutriment.</p> - -<p>When the food is of a kind necessitating -abundant mastication it is much less likely to be -taken in excess, for the longer the time spent in -mastication the less will the individual be tempted -to consume; even in the case of soft food, less -will probably be eaten if it be thoroughly masticated -and insalivated than if it be bolted. -Thorough mastication, however, not only tends -to diminish the amount of food consumed on -account of the time and labour which it entails; -it actually reduces the amount needful to constitute -a sufficiency, for the more perfectly the -food is chewed the more perfectly is it digested -and the more economically is it disposed of -in the system; the less, moreover, is the tendency -to that morbid craving for food which -is so frequent an accompaniment of defective<span class="pagenum" id="Page_137">[Pg 137]</span> -digestion. It is certain that appetite and the -needs of the system are sooner satisfied when -food is well masticated and digested than when -it is swallowed whole.</p> - -<p><i>A mass of unmasticated food may lodge in the -throat and cause fatal suffocation.</i>—This may -seem to be a very exceptional kind of evil, but -I am informed by one whose experience makes -him an authority on the ways of the British -soldier that it is by no means uncommon for -soldiers in barracks to die from this cause. -Usually it is when they are under the influence -of alcohol that fatal results occur, post-mortem -examination disclosing large undigested masses -of food in the stomach. A like experience is -also frequently met with in the case of men -killed by accident.</p> - -<p><i>The presence of masses of imperfectly masticated -food in the stomach may cause disturbance -either mechanically or by reason of their imperviousness -to the gastric juices.</i>—We have already -seen that the digestibility of a food is largely -determined by its consistence, and that many -articles of diet, such as cheese, hard-boiled egg, -cocoa-nut, lobster, and new bread, which have -the reputation of being very indigestible, can, if -finely comminuted by chewing or otherwise, be -rendered quite digestible. Such articles are indigestible -essentially by reason of their compact<span class="pagenum" id="Page_138">[Pg 138]</span>ness; -the compact lumps, but little pervious to -the gastric juice, tend to undergo abnormal chemical -change in the stomach, and may in this way -cause violent local irritation, even to the extent of -setting up acute gastritis; or they may paralyse -the nerves of the stomach and check gastric -secretion and movement, and thus remain <i>in loco</i> -wholly undigested for hours or even days; or, -again, more distant nervous effects may be produced, -such as frontal headache, which may be -felt almost immediately after ingestion of the -peccant substance, being of reflex rather than -toxic origin, and presumably in some cases, at -least, due to the mere mechanical irritation of -the stomach. The passage of imperfectly -digested food into the bowel may still further -aggravate matters. It does not seem improbable -that the habitual bolting of food, by the -prolonged local irritation to which it gives rise, -may predispose to cancer of the stomach: -Napoleon was a notorious fast eater and it is -well known that he died from this disease.</p> - -<p>While, however, the bolting of food readily -sets up disturbance in some, it must be conceded -that in many it seems to cause little or no -inconvenience; especially is this the case in the -young with vigorous muscular stomachs capable -of triturating the food, and thus doing duty for -the teeth. The human stomach is, indeed, a<span class="pagenum" id="Page_139">[Pg 139]</span> -long-suffering organ, and wonderfully tolerant of -ill-treatment, sometimes almost rivalling in its -hardiness the gizzard of the bird. Nor is this -surprising when we reflect that it is, in the -ordinary course of nature, constantly exposed -to the entrance of noxious substances. In this -respect it stands in marked contrast to the -intestines, for not only are highly irritant substances -often vomited rather than passed onwards, -but in ordinary circumstances the gastric -contents are not allowed to pass the pylorus, until -they have been duly prepared by the stomach; -the pylorus, in fact, stands guard over the -entrance to the bowel and is jealous of anything -passing it which is likely to injure that canal.</p> - -<p>And just as the pylorus protects the bowel so, -in exceptional cases, may the œsophagus protect -the stomach, regurgitating, after the fashion of -the ruminants, insufficiently masticated bits of -food, in order that they may be re-masticated. -I have myself met with cases in point. Sometimes, -in cases of this kind, the œsophagus -may be dilated into a sort of proventriculus, -which is capable of temporarily lodging a large -quantity of food. Such a proventriculus is said -to have developed in an apprentice who, not -being allowed sufficient time for his dinner, -rapidly bolted it, to regurgitate it after working -hours and to chew the cud at leisure. Whether<span class="pagenum" id="Page_140">[Pg 140]</span> -in these cases the food is ever returned from -the stomach itself I am unable to say.</p> - -<p>While the stomach is the organ especially -liable to be injured by the swallowing of lumps -of unmasticated food, the bowel may also suffer, -especially the cæcum and vermiform appendix. -And here we come to one of the most serious -indictments against the bolting of food; though -man has doubtless always suffered from appendicitis, -there can be little doubt that this malady -is more common now than it used to be; and -there is equally little doubt, in my own mind at -least, that the cause of its greater frequency is -related to his food. I do not propose to discuss -here in detail how food is capable of causing -appendicitis, but will merely refer to one of the -ways in which it may do so. I had already come -to the conclusion that the habit of bolting food -is a potent cause, when I read Sir Frederick -Treves’s Cavendish Lecture in which he makes -that contention. Sir Frederick Treves points -out that in this rushing age people, especially -business men, are apt to hurry over their meals -and to take them at irregular times and often -while standing at a bar; even when there is -more leisure, food is rarely masticated nowadays -in the same thorough way that it was in the old -time, when it was of a coarser nature: hence -solid lumps, especially in the case of such articles<span class="pagenum" id="Page_141">[Pg 141]</span> -as pine-apple, preserved ginger, nuts, tough -meat, and lobster, are apt to pass beyond the -pylorus and, escaping intestinal digestion, to -lodge in the cæcum and precipitate an attack -of appendicitis, the most common predisposing -cause of which is a loaded cæcum, often preceded -by constipation. Sir Frederick Treves -contends that this distended state of the cæcum -encourages catarrh of the appendix by dragging -upon it and blocking its orifice, as well as by -twisting it and thus interfering with its blood-supply.<a id="FNanchor_22" href="#Footnote_22" class="fnanchor">[22]</a></p> - -<p><i>An excess of starch is apt to pass into the -stomach.</i>—We have just seen that inefficient -mastication tends to promote over-eating, and -what has been said on this head applies to all -kinds of food, starchy foods among others. It -leads, however, to a further evil as regards these -latter; not only does it tend unduly to increase -the quantity of them consumed, but it too often -causes the stomach and intestines to become -flooded with starch in a wholly undigested form. -I cannot too frequently repeat that in ancient -times, especially in the pre-cooking age, laborious<span class="pagenum" id="Page_142">[Pg 142]</span> -mastication was needed in the case of all starchy -foods, partly because they were coarse and -fibrous, but chiefly because the starch and other -nutritive ingredients had, in order to become -available for nutrition, to be liberated from their -undigestible cellulose envelopes. In these days -of prepared, soft, starchy foods, however, mastication -is very little required for these purposes, -but in other respects it is as needful as ever, -indeed more needful, if the large quantities of -starch which are now consumed are to be insalivated -effectually. The laborious and sustained -mastication to which primitive man was compelled -to subject <i>his limited supplies of uncooked -starchy food, went far to effect complete digestion -of the starch within the mouth</i>, for raw starch is -freely digested by the saliva,<a id="FNanchor_23" href="#Footnote_23" class="fnanchor">[23]</a> and hence in his -case <i>very little passed into the stomach in a wholly -undigested form</i>. How different is the case with -us moderns. Since the opening of the era of -agriculture and cooking, man has enormously -multiplied his supplies of saccharide, and he now -consumes large quantities of starch which has -been freed from its cellulose framework by cooking, -milling, grinding, and the like, and reduced<span class="pagenum" id="Page_143">[Pg 143]</span> -to a soft or pappy form, such as milk puddings, -porridge, boiled potatoes, and new bread, all of -which can be swallowed with little or no preliminary -chewing; and when food can be -swallowed easily, without mastication, few will -take the trouble to masticate it. In these circumstances -the starch does not undergo adequate -salivary digestion, and a large quantity passes -wholly undigested into, and out of, the stomach, -not beginning to be digested until it reaches the -bowel. Small wonder that the latter should -rebel again this invasion and that flatulence, -pain, and other dyspeptic evils should result.</p> - -<p>It is especially in young children that these -evils are observed. Too often the stomach of -the child, semi-carnivorous, remember, by its -ancestry, is literally deluged with pure starch. -At the seventh or eighth month, or even earlier, -for many of the patent infant foods contain it, -this substance is poured into the stomach without -being afforded any opportunity of undergoing -salivary digestion; and for a long time after -infancy large quantities are given in the liquid or -pultaceous form, such as rusks soaked in milk, -puddings, and mashed potatoes. This practice -of deluging the digestive organs with starch, -besides leading to the more immediate troubles -connected with flatulent dyspepsia, gives rise to -abundant formation of toxins which, by irritating<span class="pagenum" id="Page_144">[Pg 144]</span> -the alimentary mucous membrane, set up gastro-intestinal -catarrh; this, again, intensifies the -dyspepsia already existing and causes a still -further production of toxins, so that the motions -become intensely fœtid. These poisons being -absorbed into the blood the tissues become -saturated with them and the nutrition of the -entire organism is disturbed, the faulty metabolism -manifesting itself by a diminished resistance -to pathogenic agencies, by a tendency on -the part of the tissues to inflame (as shown by a -liability in children thus fed to bronchitis, rhinitis, -naso-pharyngitis, and tonsillitis), by their proneness -to tuberculosis, and finally by a disposition -to rickets, which I little doubt is essentially of -toxæmic origin.</p> - -<p>Besides the above-mentioned troubles an -excess of starch in the stomach may set up -hyperchlorhydria—<i>i. e.</i>, that form of dyspepsia -in which there is excessive secretion of hydrochloric -acid. This affection occurs during the -most vigorous years of life and is apparently -due to excessive activity on the part of the -gastric glands. The excess of acid does not -give rise to any symptoms so long as there is -any unsatisfied proteid in the stomach to unite -with it, but directly all the proteid is satisfied -and free acid is present in the stomach, pain, -heartburn, and distention are apt to be felt; hence<span class="pagenum" id="Page_145">[Pg 145]</span> -these symptoms are generally removed temporarily -by a meal, the food ingested seizing upon -the free acid, and tend to recur in the course of -an hour or two. Other symptoms are mental -and bodily lassitude and great mental depression, -while, if the condition is long-continued, gastric -catarrh and dilatation ensue. Eructation of the -acrid mass, its removal with a tube, or its dilution -or neutralisation by an alkali, causes relief of the -symptoms. Now Dr. William Russell, who has -recently studied this form of dyspepsia, has -shown, and the fact is most significant from our -present point of view, that in it starch is the last -constituent to leave the stomach; that when this -organ has so far emptied itself as to contain but -one or two ounces of very acrid material the -residue consists chiefly of finely divided undigested -starch, which continues to stimulate the -gastric secretion; “and, there being no more -proteid with which to combine, the secretion -accumulates and leads to hyperacidity.”<a id="FNanchor_24" href="#Footnote_24" class="fnanchor">[24]</a> Inasmuch, -then, as inefficient mastication leads to an -excess of starch in the stomach, we see how it -may predispose to hyperchlorhydria and we -shall presently see that there is yet another -reason why it should do so.</p> - -<p>It will be gathered from the foregoing that -thorough mastication is the most effective way<span class="pagenum" id="Page_146">[Pg 146]</span> -of securing efficient starch digestion. This -simple fact has been most strangely overlooked. -Thus “van Valzah considers that not a little of -the difficulty of the digestion of starches and -cereals can be overcome by more thorough cooking. -Patients who cannot eat potatoes after ordinary -cooking are [he urges] often able to digest -them very readily if they are doubly cooked -before being served. Cereals, as a rule, should -[he contends] be allowed to simmer all night -and then be thoroughly cooked for a half hour -in the morning before being eaten.”<a id="FNanchor_25" href="#Footnote_25" class="fnanchor">[25]</a> This is an -admirable illustration of the modern tendency to -cheat the mouth of its proper work. A much -more rational way of facilitating starch digestion -in those who experience a difficulty in this -respect is by efficient mastication.</p> - -<p><i>Evils resulting from an insufficient quantity -of alkali in the stomach.</i>—I doubt if it is adequately -realised what a large amount of alkaline -saliva passes into the stomach as the result of -prolonged mastication. Its presence there serves -the useful purpose of prolonging the period of -starch digestion within the stomach, while it -further aids gastric digestion not only by exciting -the secretion of gastric juice, but also by its -influence on the reaction of the gastric contents; -it can scarcely be doubted that the effect is on<span class="pagenum" id="Page_147">[Pg 147]</span> -the whole one favourable to digestion in general. -We have just seen that defective mastication -may predispose to hyperchlorhydria by allowing -an excess of pure starch to pass into the stomach, -and I suggest that it may further operate in the -same direction by cheating the stomach of its -due supply of alkaline saliva. Now the saliva in -this affection is apt, as was pointed out by Sir -William Roberts, to be superalkaline, and for -this reason he recommended his acid-dyspeptics -to excite the flow of it by chewing gum-mastic -with the object of neutralising the gastric hyperacidity. -That relief can thus be obtained there -can be no doubt; but it is surely more rational -to get the patient to stimulate his salivary glands -by masticating actual food, by which we secure -the additional advantages accruing from its complete -insalivation and comminution as well as -from the reflex gastric effects. Actuated by -these considerations, I have long been in the -habit of recommending hyperchlorhydriacs to -subject their food to prolonged mastication, this -being, in my belief, the most rational and effective -way of breaking the stomach of its vicious habit. -In extreme cases we must insist that each morsel -of food should be chewed at least one hundred -times and not permit any relaxation of this -severe discipline, until the stomach has been -schooled into healthier ways.<span class="pagenum" id="Page_148">[Pg 148]</span> -<i>Evils in connection with the jaws and their -appendages and the adjacent structures: the nasal -passages, naso-pharynx, and faucial tonsils.</i>—In -those who do not masticate properly in early life -these parts fail to develop as they should, and -they are on this account alone predisposed to -disease; their resistance to disease is still further -lowered by the fact of their blood and lymph -flow not being adequately stimulated by the vigorous -exercise of the masticatory muscles. Now -we have seen that the great cause of defective -mastication in children is the softness of the food -given them and that the feeding of them upon an -excess of soft food, especially the starchy kind, -disturbs digestion, induces toxæmia, and in this -way evokes a catarrhal tendency. In children -thus fed we have therefore several conditions -which make for disease in the parts under consideration—defective -development, sluggish circulation, -and toxic saturation. Is it any wonder -that the modern child should be liable to disease -in these regions, that he should so frequently -suffer from rhinitis, naso-pharyngitis, tonsillitis, -and from hypertrophy of the pharyngeal tonsil -(“adenoids”) and of the faucial tonsils?</p> - -<p>It is in this way that I would explain the -frequency of adenoids among the children of -civilised communities. I claim, in fact, that this -disease is largely dietetic in origin. I submit<span class="pagenum" id="Page_149">[Pg 149]</span> -that a child whose nasal apparatus and naso-pharynx -are well-grown and habitually bathed -by a stream of pure blood and lymph, periodically -accelerated by an ample and vigorous use -of the masticatory muscles, is unlikely to contract -adenoids. On the other hand, I contend -that a child in whom these parts are ill-developed -and bathed by an habitually sluggish stream of -tainted blood and lymph—one, <i>i. e.</i>, that is not -only poisoned, but rarely, if ever, hurried along -its lazy course by due exercise of the muscles of -mastication—I submit that such a child runs -great risk of contracting the disease. The -influence in setting up adenoids of toxic saturation -with its resulting catarrhal tendency is -shown by the frequency with which this affection -follows upon the rhinitis and naso-pharyngitis -of measles and diphtheria, and in order to realise -how greatly the circulation of blood and lymph in -the walls of the naso-pharynx must be influenced -by mastication, one has but to remember how -very closely the pterygoids are related to this -region; in exploring it for adenoids they can, -indeed, often be felt to stand out prominently.<a id="FNanchor_26" href="#Footnote_26" class="fnanchor">[26]</a></p> - -<p><span class="pagenum" id="Page_150">[Pg 150]</span></p> - -<p>This, then, is my explanation of the truly -fearful prevalence of adenoids among the moderns. -It is essentially a disease of pap-fed -peoples. A child may, with the one exception -that he is fed on a pappy, super-saccharide diet, -be brought up under ideal health conditions. -He may live in the heart of a dry, open country, -far from the darkness, dust, and tainted -atmosphere of the town, sleep with the windows -open all night, live out of doors all day, -be fed on the most nourishing (too nourishing, -it may be) food, be clothed after the most approved -methods, and yet, in spite of all this, -we may find his naso-pharynx packed with -adenoids. This disease is, in fact, scarcely less -prevalent in the country than in the towns, -scarcely less common among the rich than -among the poor. Yet in primitive communities -it is practically unknown. And what, I would -ask, is the one condition in the material environment -of my supposititious child differing from -that of the primitive child? What but the factor -of diet? Therefore, I say, the prevalence of adenoids -among moderns must be the result of the -modern system of feeding children, and the defective -mastication which goes along with it.</p> - -<p>That the foregoing is a grave indictment<span class="pagenum" id="Page_151">[Pg 151]</span> -against that system, it need scarcely be said. -For adenoid disease is fraught with many evils, -among them mental hebetude, blocking of the -Eustachian tubes, and manifold other auditory -troubles, gastro-intestinal disturbances from the -passage into the stomach of unhealthy discharges, -and, most serious of all, nasal obstruction -and consequent mouth-breathing. So -serious are the evils connected with this latter -habit that they demand more than a passing -reference. Pronounced adenoid disease is always -associated with mouth-breathing, and -there can be no doubt that in the majority of -these cases, the nasal obstruction is not in the -nasal passages primarily, but is due to a blockage -of the posterior nares by the adenoid -growths, for it generally happens that nasal -breathing is rapidly re-established after their -removal, though in a certain proportion of -cases the obstruction still persists, and has to be -dealt with by treatment directed to the nasal -passages themselves. Some have, indeed, contended -that a primary nasal obstruction is one -important factor in the induction of adenoids, -leading as it does to a dry-cupping of the naso-pharynx -during inspiration and to a consequent -congestion of its lining membrane. I am -quite ready to allow that this mechanism may -play some part in causation, and such an assump<span class="pagenum" id="Page_152">[Pg 152]</span>tion -is in entire harmony with my main contention -that adenoid disease is of dietetic origin, for -nasal obstruction in children, other than that -caused by adenoids, is mainly due to defective -development of the nasal passages coupled with -inflammation of their lining membrane, both of -which conditions may, as we have seen, be essentially -the outcome of defective diet.</p> - -<p>Coming now to the evils resulting from mouth-breathing, -we have first to remember that normally -the air is inhaled through the nose, and is -thus warmed, moistened, and filtered before -being allowed to pass into the lungs; but in the -mouth-breather the air, which may be dry, -cold, and dust-laden, passes at once unprepared -through the mouth into the lungs, impinging -in its passage against the pharynx, -thus drying and mechanically irritating the -mouth, pharynx, larynx, and bronchial tubes, -all of which are thereby predisposed to disease. -In this way laryngitis and bronchitis, nay, even -phthisis, may be induced. Dental caries is also -predisposed to by the habit of breathing through -the mouth. Mouth-breathing further interferes -with the proper development of the cranial -bones, but especially of the maxilla, giving rise -to what may be termed the “mouth-breather’s -jaw,” so characteristic is it I do not propose -to discuss here the mechanism by which this<span class="pagenum" id="Page_153">[Pg 153]</span> -deformity is produced, interesting though the -question is; suffice it to say that nasal breathing -is essential to the normal development of the -jaws. The deformity in question, though it involves -the maxilla chiefly, affects also the mandible -from the fact of its being, to a large extent, -moulded on the maxilla; in typical cases the -maxilla is small and its alveolar ridge does -not attain its normal length, but is compressed -laterally towards the sagittal plane, giving rise -to the false appearance of a “high arch” and -often thrusting the anterior portion of the ridge -forwards; the teeth, the growth of which is not -so much interfered with as that of the imbedding -bone, are thus prevented from taking up their -proper positions and show irregularity, sometimes -extreme. Dental irregularity may also, as -we shall see, result from inadequate use of the -jaws in mastication, but not to the extent which -is frequently observed in the mouth-breather’s -jaws, and therefore pronounced dental irregularity -always shows that there has been protracted -nasal obstruction, and this in the vast majority -of cases implies the existence of adenoids, past -or present; I say in the “vast majority,” for in -a few rare cases long-continued nasal obstruction -in children originates primarily in the nose -and may lead to the typical mouth-breather’s -jaw, with the resulting dental irregularity.</p> - -<p><span class="pagenum" id="Page_154">[Pg 154]</span></p> - -<p><i>The tongue.</i>—If the tongue is not properly -exercised in childhood and youth, we find it -imperfectly developed; hence in inefficient masticators -it is generally small. It must not be -forgotten in this connection that this organ is -considerably exercised when the infant is at the -breast, from which the milk is obtained, not by -suction, but by a vigorous tugging and squeezing -of the nipple (in which the tongue takes -considerable part), whereby the gland is reflexly -excited to secrete. When, on the other hand, -the child feeds at the bottle he obtains his milk -by actual suction, and generally through an -orifice of such ample dimensions as to allow -the bottle to be rapidly emptied with comparatively -little exercise of the lips and tongue. -In short, the breast-fed infant has to do some -work for his living, and that of a sort calculated -to promote the health of the jaws and their appendages, -while the bottle-fed child can glut -himself by doing very little more than opening -his mouth; wherefore we find the tongue and -adjacent parts less developed in the latter than -in the former. It may be thought to be a matter -of indifference whether the tongue develops -to its normal proportions or remains small, but -such is by no means the case, for, as Dr. J. Sim -Wallace has shown, the pressure of this structure -against the teeth promotes the normal<span class="pagenum" id="Page_155">[Pg 155]</span> -development of the jaws, especially of the mandible, -and when it is small they are apt to be -so too.</p> - -<p><i>The salivary glands.</i>—Just as mastication -increases the functional activity of the salivary -glands and buccal glands and favours their normal -development, so, contrariwise, inefficient -mastication during early life fails to call forth -their normal functional activity and to secure -their adequate development. Thus we find -that a child who has been brought up on hard, -starchy foods, necessitating abundant mastication -has much larger and more active salivary -glands than one who has been fed on soft foods -which slip down into the stomach before they -have had the chance of being properly masticated, -and it is needless to say that the more -efficient these glands are the more likely is -digestion to be carried out satisfactorily.</p> - -<p><i>The jaw-bones.</i>—If the jaws are not adequately -exercised in youth by mastication they -fail to grow to their normal size and shape, and -there is apt in consequence to be overcrowding -of the teeth. The main defect of the jaws in -such cases is their smallness; they do not present -that pronounced lateral compression and -anterior protrusion which characterise the -mouth-breather’s jaw, nor such extreme dental -irregularity, the most common being overlap<span class="pagenum" id="Page_156">[Pg 156]</span>ping -of the incisors, displacement of the canines, -and difficulties in regard to the eruption of the -wisdom teeth from shortness of the alveolar -ridge. I have already referred to the progressive -shortening in the post-molar ridge, which -has been taking place during man’s evolution -from the anthropoid in correspondence with the -alteration in his diet.</p> - -<p>We thus see that defective use of the jaws -leads to irregularity of the teeth (1) directly -and (2) indirectly through the induction of -adenoids. This irregularity is not only unsightly -but leads to certain evils which thus primarily -owe their origin, in large measure at -least, to defective mastication. What, then, are -these evils? In the first place, dental irregularity -predisposes to dental caries by favouring the -lodgement of food between the teeth; in the -next place, it leads to defective “bite.” Now -when the bite is defective adequate mastication -is impossible, for not only is it impossible in -these circumstances to oppose the teeth properly, -but also, owing to their interlocking, to -accomplish that free lateral movement of the -lower teeth against the upper, which belongs to -normal mastication. I do not say that defective -bite is the sole cause of this imperfect lateral -movement; it may, indeed, be observed in -most moderns brought up on soft pappy food,<span class="pagenum" id="Page_157">[Pg 157]</span> -whether the bite be good or not. Normal mastication -is, in fact, becoming a lost art; the -average modern masticates mainly by a vertical -compression of the lower teeth against the -upper, and in only a small degree by a lateral -frictional movement which, it is needless to say, -is the more effective method for grinding purposes; -and it is, I doubt not, chiefly for this -reason that the teeth of modern man are so -much less worn down than those of primitive -peoples.</p> - -<p><i>The teeth.</i>—Imperfect use of the teeth leads -to many ills. When adequately exercised and -made to execute for one or two hours every -day a lively dance in their sockets, during -which the circulation of blood and lymph in -the tooth-pulp, periodontal membrane, and surrounding -tissue of the gum is vigorously stimulated, -and the cavity of the mouth is bathed -in a copious flow of salivary and other buccal -secretions, we have conditions which make alike -for the health of the buccal mucous membrane, -of the teeth, and of the periodontal membrane -and alveoli; but when the circulation is not duly -stimulated in this way the teeth do not develop -properly, while the secretions of the mouth are -apt to be scanty and unhealthy, both of which -conditions predispose to caries. How far dental -caries is due to inherent dental weakness and<span class="pagenum" id="Page_158">[Pg 158]</span> -how far to faulty conditions outside the teeth -we need not stop to inquire; Dr. Wallace attributes -little influence to the former factor, contending -that caries depends essentially upon -faulty dental environment; and one can scarcely -doubt that the state of the gums and of the oral -secretions profoundly influences the growth of -bacteria in the mouth, upon the acid yielded by -which organisms the corrosion of the dental -enamel essentially depends. Faulty conditions -of the oral secretions likewise favour the deposit -of tartar.</p> - -<p>Another result of imperfect use of the teeth -is undue thinness of the alveolar walls and periodontal -membrane, in consequence of which the -teeth are not so firmly held in their sockets as -they should be. This is, I believe, one of the -reasons why they are prone to fall out prematurely -among the moderns: we know that the -teeth tend to drop out in old people owing to a -senile atrophy of the alveolar walls; the Haversian -canals get smaller and may, indeed, disappear -entirely, and it stands to reason that this -atrophy must be hastened by inefficient exercise -of the teeth. So far as I am able to gather -from an examination of skulls in museums, the -teeth are rarely shed among primitive peoples -before extreme old age, while among moderns -they frequently fall out long ere this is attained.</p> - -<p><span class="pagenum" id="Page_159">[Pg 159]</span></p> - -<p>A still worse evil attaching to insufficient -use of the teeth is pyorrhœa alveolaris or -Riggs’s disease, which, in conjunction with the -deposit of tartar, is the great cause of the premature -loosening and shedding of the teeth -observed among latter-day civilised peoples. -This affection consists of a purulent inflammation -of the periodontal membrane, owing to the -invasion of it by pyogenic cocci, so that pus -wells up on pressing the gum against the teeth. -Now, when by a vigorous use of the teeth the -buccal cavity is kept well flushed with healthy -secretions, the growth of micro-organisms within -this chamber is kept down, and when, by the -same means, the vitality of the periodontal -membrane and adjacent tissues of the gum is -periodically stimulated, these tissues offer stout -resistance to the invasion of pathogenic organisms; -but when, contrariwise, the teeth are little -used, the secretions of the mouth are in consequence -defective both as to quality and quantity, -and the growth of organisms in the buccal -cavity is promoted; and when, further, the circulation -in the periodontal membrane and adjacent -soft tissues is not adequately stimulated by -vigorous mastication, their vitality is poor and -they offer but a feeble resistance to parasitic -invasion. We can thus, I think, safely infer that -inefficient mastication is a potent cause of pyor<span class="pagenum" id="Page_160">[Pg 160]</span>rhœa -alveolaris; and the chief cause of inefficient -mastication being the eating of soft foods, -we must also conclude that the latter practice -is chiefly responsible for the disease in question; -such foods further predispose to this affection -in that they are apt to lodge between the -teeth and by undergoing decomposition there -to favour the growth of micro-organisms within -the mouth. The condition of the teeth and -gums among the civilised poor is, alas, little calculated -to make us proud of our boasted civilisation—the -spongy pus-exuding gums, the -lengthening, loose, tartar-covered, carious teeth, -and the putrescent breath constitute a damning -indictment against our modern system of living -on a soft, pappy diet, and not giving the teeth -the work for which they are designed. I never -examine such a mouth without being impressed -with, and I may add oppressed by, this fact.</p> - -<p>I am not, of course, contending that pyorrhœa -alveolaris only occurs in those who masticate -inefficiently; whatever causes an unhealthy -condition of the gums and saliva predisposes to -it, but it is surely much less common in those -who masticate well than in those who masticate -ill. Confirmatory of this statement is the fact -that it is more frequent in those with irregular -teeth than in those with a good bite, who -are thus able to put their teeth to more<span class="pagenum" id="Page_161">[Pg 161]</span> -effective use. This affection is very common -among the carnivora of menageries as well -as among dogs and cats; indeed, one seldom -fails to find it in dogs over four years of age, -and in old dogs it is generally rampant. Doubtless -in all these cases the general conditions of -life play some part in the causation of the disease, -but I do not think that we can eliminate -from it the factor of defective use of the jaws -and teeth, for it is certain that dogs and cats -are fed largely on pappy foods and are often -insufficiently supplied with bones.</p> - -<p><i>The causation of dental caries.</i>—Dr. Wallace, -in his philosophical work on “The Cause and -Prevention of Decay in Teeth,” contends that -the cause of the prevalence of dental caries is -that the natural food-stuffs are, to a large extent, -ridded of their accompanying fibrous parts and -consumed in a form which renders them liable -to lodge and to undergo acid fermentation in -the mouth; while from the same cause and the -induced conditions the micro-organisms of the -mouth lodge and multiply and augment the rapidity -and intensity of the acid fermentation. -I am perfectly at one with Dr. Wallace in believing -that the removal of the fibrous portions -of food is the main cause of the prevalence of -caries among moderns, and I can hardly doubt -that foods so prepared tend to promote caries<span class="pagenum" id="Page_162">[Pg 162]</span> -in the way indicated, but I venture to think that -they do this even more by failing to call forth -the normal degree of mastication. I cannot but -think that if these same soft foods were as laboriously -masticated as they would need to be if -they retained their fibrous ingredients, dental -caries would be much less common than it actually -is. I have endeavoured to show how very -different the local conditions are in the efficient -from what they are in the inefficient masticator—how -in the former the jaws and teeth are -wont to be well developed, the bite to be good, -and the secretions which bathe the teeth to be of -a kind calculated to promote their health; and -how in the latter an entirely opposite set of conditions -is wont to prevail. That it is possible -to maintain a fine set of healthy teeth till past -middle life on ordinary civilised diet, provided -the food be habitually subjected to efficient -mastication, is shown in the case of the man -already referred to, and by numerous other cases -which I have observed.</p> - -<p>Since the application of cooking to food -there has been a progressive lessening in the -work of the jaws and teeth and, parallel with this, -a diminution in their size and an incursion of -dental caries. Among the anthropoids in their -natural state caries is practically unknown, and -I think we may conclude that the same was true<span class="pagenum" id="Page_163">[Pg 163]</span> -of man before he learnt to cook. In the pre-agricultural -races, such as the aboriginal Australians, -the effect of cooking the food is shown -in the lessening in the size of the wisdom teeth -and of the post-wisdom alveolar ridge; dental -caries, though rare among these people, does -occur, and especially in the wisdom teeth.<a id="FNanchor_27" href="#Footnote_27" class="fnanchor">[27]</a> -In the early agricultural period, owing to the -increasing softness of the vegetable food, the -jaws and teeth show a tendency to be smaller -than in the previous periods; the wisdom teeth -are decidedly smaller and more prone to caries, -while caries of the other teeth is by no means -rare. In the late agricultural period the jaws -and teeth often show very decided defects of -development, while dental caries is, as we know -but too well, rampant.</p> - -<p>What has been said concerning the relative -prevalence of caries in different diet epochs applies -to many other diseases of the teeth; thus, -along with the increase of caries, there has been -a parallel increase in the prevalence of pyorrhœa -alveolaris.</p> -<hr class="chap x-ebookmaker-drop" /> - - -<p><span class="pagenum" id="Page_164">[Pg 164]</span></p> - -<h4 class="nobreak" id="CONCLUDING_REMARKS">CONCLUDING REMARKS</h4> - - - -<p>I have now set forth some of the evils resulting -from inefficient mastication. They are many -and serious. The immediate evils, such as -over-eating, indigestion, adenoids, dental caries, -and pyorrhœa alveolaris, are bad enough, but -when we consider the secondary evils to which -these primary ones give rise,—and I have only -mentioned a few of them,—we must come to the -conclusion that an appalling amount of misery -and suffering may be saved by the simple expedient -of inculcating the habit of efficient mastication. -How this end can best be accomplished -will be considered in the next section.</p> - - -<p class="center small"><span class="smcap">Section IV.</span> From <i>London Lancet</i>, August 8, 1903</p> - -<h4>MEANS OF INSURING ADEQUATE -MASTICATION</h4> - - -<p>In order to secure the full advantages accruing -from the use of the jaws and their appendages, -it is, above all, necessary for them to -be adequately exercised during the period of -development. If this is done, not only will -the tendency to dental caries, adenoids, indiges<span class="pagenum" id="Page_165">[Pg 165]</span>tion, -and other evils be greatly diminished, but -the masticatory instinct will establish itself as a -permanent force, so that the individual will tend -for the rest of his life to subject even soft foods -to thorough mastication. The tongue, the lips, -and the jaws of the newly born child find their -natural exercise at the mother’s breast, and we -should, therefore, do our utmost to get the -mother to suckle her child, the bottle affording -neither the same kind nor the same amount of -exercise. If, unhappily, we fail in this, we must -see that the teat of the feeding-bottle is so constructed -as to compel the child to earn his meal -by, at any rate, some exercise. This kind of -exercise promotes the growth of the tongue and -thus of the jaws, especially of the mandible. -Directly the infant shows a disposition to bite -hard things the instinct should be gratified. We -may observe a tendency in this direction as -early as the third or fourth month, and it -becomes more and more pronounced when, the -time for the eruption of the teeth approaching, -the gums begin to swell up and to get tender, -and saliva begins to flow from the mouth; it is -now, more than ever, necessary to provide the -child with hard substances on which to exercise -the jaws and the gums, and a great deal of the -trouble of teething is due to the failure to recognise -this fact. What, then, are we to employ<span class="pagenum" id="Page_166">[Pg 166]</span> -for this purpose? I am convinced that it is a -mistake to rely solely, or even mainly, upon -baubles of ivory, coral, and the like useful -though these may be in their way; it is far -better to give the child something which is not -only hard but nutrient and pleasant to the taste, -something which will at one and the same time -exercise the maxillary apparatus, excite the -gustatory organs, and provide a certain amount -of nutriment. To this end we may, as the teething -time approaches, give a chop or chicken -bone, from which most of the meat has been -removed; by powdering the bone with white -sugar or salt we may increase its attractiveness. -From such bones a good deal of nutriment can -be extracted, and this of a kind which is most -acceptable to the infant stomach, for it must be -remembered that the young human is in the -main carnivorous. Indeed, since milk is a purely -animal diet, all the mammals must be regarded -as essentially carnivorous during the period of -suckling, while man, as already observed, from -the time he emerged from the anthropoid until -he learned to cook his food, was throughout life -mainly an animal feeder. Therefore we should -not hesitate to allow the teething infant animal -food in the form suggested. Chicken and chop -bones, yielding as they do before the pressure -on the gums, are, moreover, just of the right<span class="pagenum" id="Page_167">[Pg 167]</span> -degree of consistence for the purpose in view, -while they afford abundant exercise for the -tongue; ivory, coral, and the like are, on the -other hand, too hard and unyielding, and lack, -moreover, the attractiveness belonging to sapidity.</p> - -<p>By thus providing the maxillary apparatus -with suitable exercise we shall do much to facilitate -the eruption of the teeth and to favour the -growth of the jaws and their appendages, including -the salivary glands, and so to prepare -the mouth for the reception of vegetable food. -This should, of course, not be given till the -teeth appear. The order in which these make -their appearance gives some indication as to the -order in which vegetable food should be administered -to the child. The first teeth to penetrate -the gums are the lower incisors which appear -from the seventh to the eighth month; then -follow the upper incisors from the seventh to the -tenth month. These teeth enable the child to -<i>bite</i>, but not, be it observed, to <i>masticate</i>, for -which function the molars are necessary. Now -the first molars do not appear till the twelfth or -fourteenth month; the second molars not till -between the fourteenth and the twentieth month; -and it seems to me certain that our primitive -ancestors could not have obtained starch in any -quantity until they reached this age; at the<span class="pagenum" id="Page_168">[Pg 168]</span> -best, pre-cooking man was but scantily supplied -with starch, and such slender supply as he had -could only be rendered accessible to the digestive -juices by vigorous mastication, which broke -up the indigestible cellulose framework in which -all vegetable starch is contained; hence, until -the young human cut his molars, he had little -opportunity of securing any starch. These considerations -strongly suggest the desirability of -giving but small quantities of starch before the -twelfth month, and though the facts, that ptyaline -appears in the saliva about the time the first -incisors are cut, and that pancreatic juice develops -its amylolytic ferment at the same time, -show that the digestive organs are ready for the -reception of some starch at the seventh or -eighth month, yet I believe the quantity should -be strictly limited. I am ready to admit that -the modern child may have, indeed probably -has, a greater power of digesting starch than -his remote pre-agricultural ancestor; but even -so, I am convinced that we should be on our -guard not to over-gorge infants with this substance. -Only a small quantity should be given -before the twelfth month, and it should be gradually -increased up to the twentieth month.</p> - -<p>I have said that the pre-agricultural infant -was unable to secure starch in any quantity by -means of his incisors. These teeth enabled him,<span class="pagenum" id="Page_169">[Pg 169]</span> -however, to obtain some soluble nutriment from -fruits, and Dr. Sim Wallace has suggested that -the early eruption of the lower incisors is for the -purpose of enabling the infant to pierce the -outer covering of fruits so as to permit him to -extract the soluble contents by suction; and, -accordingly, when these teeth are cut we may -allow the child to bite at such vegetable -substances as apples, oranges, and sugar-cane. -The latter is a useful article of diet for children, -for it provides soluble saccharide in a diluted -form, and it is advisable that the child should -receive his cane sugar well diluted, for it must -be remembered that before the agricultural -period man’s supply of pure sugar was limited -to wild honey which, consisting as it does almost -entirely of mono-saccharide (grape sugar and -fruit sugar), is very easily disposed of by the -digestive organs. Nowadays, the less digestible -cane sugar (which is a di-saccharide) is very -largely consumed in the undiluted state, in which -it is apt to set up disturbance. When, however, -it is obtained by chewing the sugar-cane, -it is diluted both by the water in the cane and -by the saliva, and I should like to see children -obtain most of their cane sugar in this way.</p> - -<p>The consideration of the conditions obtaining -for pre-agricultural man not only strongly suggests -that the young human of to-day should<span class="pagenum" id="Page_170">[Pg 170]</span> -be given starch in very moderate quantities up -to the twelfth month, but it points an even more -important lesson—viz., that this substance -should be given not, as is the custom, as liquid -or pap, but in a form compelling vigorous mastication, -for it is certain that early man, from -the time he emerged from the ape till he discovered -how to cook his vegetable food, obtained -practically all his starch in such a form; it cannot -too often be repeated that uncooked starch -in the natural state, locked up as it is in chambers -of indigestible cellulose, has no nutritive -value; these chambers need first to be broken -up by prolonged and energetic chewing, and -in this way much or most of the starch is converted -in the mouth into dextrines and maltose, -very little passing into the stomach in the crude -state to set up disturbance in that organ and -later in the bowel. If it is given as liquid or -pap it will pass down as starch into the stomach, -while if it is administered in a form which -obliges the child to chew it properly, not only -will the jaws, the teeth, and the gums obtain the -exercise which they crave, and without which -they cannot develop normally, but the starch -will be so thoroughly insalivated that much of -it will be converted within the mouth into maltose. -How foolish to upset the child’s digestive -system by deluging it with liquid starch, and<span class="pagenum" id="Page_171">[Pg 171]</span> -then to endeavour to correct matters by giving -the malt extract which the child can and should -himself manufacture within the laboratory of -his buccal cavity.</p> - -<p>Clearly, then, the child should make his first -acquaintance with starch, not in the form of a -liquid or pappy patent food, but in a solid and -somewhat tough form. The best means of -achieving this end is occupying my attention, -and I hope soon to publish the results of my -investigation. Meanwhile, I would point out -that hard, well-baked crusts constitute a convenient -form in which to administer starch to -children. A piece of crust may be put in the -oven and re-baked; this not only hardens it but -helps to convert the starch into dextrine, which -is a stage on the road to maltose. If the crust -be then cut into a suitable shape and spread -with bacon fat or fresh butter, it constitutes a -most agreeable morsel. Later, we may give hard -plain biscuits. The same principle should be -acted upon during later childhood and youth: -we should always give, as far as possible, the -starch in a form compelling abundant mastication. -Loaves should be shaped so as to give a -maximum of crust and a minimum of crumb, -and should be baked hard. Such loaves are -quite as nutritious as the ordinary ones, and -much more digestible, containing as they do an<span class="pagenum" id="Page_172">[Pg 172]</span> -abundance of dextrine and not a little maltose, -and compelling efficient mastication, especially -if eaten, as they should be, without any fluid. -A lady who has the catering for a large number -of girls gives the bread in this way, and she -tells me that there is keen competition for the -most crusty portions.</p> - -<p>I do not say that starch in the liquid and -pappy form should find no place whatever in -man’s dietary at the present day, for this would -imply the prohibition of porridge, boiled potatoes, -milk puddings, and the like. We cannot -put back the hand of time and return to the -food of our primitive ancestors, nor is it desirable -that we should; but we can, at least, arrange -matters so that a large proportion of the starch -we consume shall be in a form inviting mastication, -such as crusts, stale bread, stale cake, -biscuits, and so forth. The less children eat of -pastry, or, indeed, of any luxurious foods, the -better; if brought up on a healthy dietary and -under healthy conditions generally, they will -relish their simple fare more than the choicest -dishes of the epicure. I do not, I say, object -to the child consuming a certain proportion of -starch in the liquid or pultaceous form, for if, -by bringing him up on a rational dietary, his -instinct to masticate be afforded due opportunity -to develop he will be likely to subject<span class="pagenum" id="Page_173">[Pg 173]</span> -even soft vegetable food to something like -adequate mastication; this will tend to mitigate -the evils associated with such food, not only by -facilitating the digestion of starch, but by flushing -the mouth and promoting the health of the -teeth and buccal mucous membrane.</p> - -<p>The question how far children should be -allowed to crack nuts may here be considered. -If the child has been brought up on pappy food, -and has in consequence brittle and ill-developed -teeth, the cracking of hard nuts will be likely to -injure them, and this is <i>a fortiori</i> true if any of -the teeth are carious or “filled.” And not -only nuts but hard food of any kind, such as -ship’s biscuits, may in these circumstances injure -the teeth, as many of those who went -through the recent South African campaign can -testify. But if, on the other hand, the child has -from the beginning been fed on coarse, hard -foods, so that the teeth have been allowed to -grow dense and strong, no harm is likely to -ensue from cracking such nuts as filberts and -Spanish nuts. If a squirrel or a monkey weighing -a few pounds can do so with impunity, -surely the young human should be able to -also. The cracking should, however, be done -by the molars, while such hard nuts as Brazils -had best not be tackled at all.</p> - -<p>Animal food does not need the same amount<span class="pagenum" id="Page_174">[Pg 174]</span> -of mastication as vegetable food, since it -is not digested in the mouth, though some -contend that the mixture of proteid with alkaline -saliva facilitates its subsequent peptonisation. -Cooked animal food is, however, all -the better for some mastication, owing to the -coagulation of the proteids, and, in order to -insure the efficient mastication of meat, fish, and -poultry, Dr. Sim Wallace recommends that they -should be given in large pieces cut thin. “Flat -pieces about one inch square generally <i>necessitate</i> -a certain amount of mastication. It is -difficult to swallow large flat pieces of meat -without mastication, but when finely minced -little or no mastication is called forth.” The -younger the child the more underdone should -the meat be.</p> - - -<h5><span class="smcap">Examination of the Mouth and Adjacent -Parts</span></h5> - -<p>If a child be brought up on the lines indicated -and under healthy conditions generally, it -is tolerably certain that the maxillary apparatus -will develop normally, that the teeth will be -strong and well opposed, and show little tendency -to disease; but, inasmuch as the methods -advocated are but seldom put into practice, disorders -of the teeth, more especially caries and -irregularities, are common, and hence with a<span class="pagenum" id="Page_175">[Pg 175]</span> -view to promote more efficient mastication it is -always advisable to examine our patient’s teeth.</p> - -<p>Each individual tooth should be inspected in -a good light for the presence of caries, and careful -note should be taken of the “bite,” a normal -bite implying not only a proper opposition of -the two rows of teeth but the capacity of the -lower ones to move freely across the upper; -mere vertical movement of the mandible does -not constitute efficient mastication. In this -connection it must not be forgotten that an -unopposed molar is useless for purposes of -mastication, and it is by no means rare to find -in a mouth several sound unopposed molars -which are for this reason absolutely functionless. -Nay, more than this, it may happen -that teeth, perfectly sound ones, too, far from -helping, may actually interfere with mastication; -thus, among the poor, we sometimes find -all the teeth gone save the upper canines and -the lower incisors, and the teeth and gums being -alike unable to come into contact, nothing worthy -of the name of mastication is possible; it would -be far better to be without any teeth whatever, -for the toothless gums would then be permitted -to come into contact along their entire extent, -under which condition they gradually harden -and come to be quite efficient grinding agents.</p> - -<p>Next the gums, the alveoli, and the roots of<span class="pagenum" id="Page_176">[Pg 176]</span> -the teeth must be examined, especially for the -presence of erosion, tartar, and pyorrhœa alveolaris, -this latter condition being evidenced by -the welling-up of pus upon pressing the gums -against the sides of the teeth.</p> - -<p>If our examination of the mouth discloses -anything likely to interfere with mastication the -aid of the dentist should at once be sought, but -every physician should be so far acquainted with -disorders of the teeth as to be able to say, in the -majority of cases, at all events, when this is -necessary. I am convinced that far more illness -than is generally supposed is attributable to -dental defects, and this even among the more -leisured classes. With regard to pyorrhœa -alveolaris, it has to be remembered that it not -only does harm by causing loosening, lengthening, -and shedding of the teeth, and thus interfering -with mastication, but also by contaminating -the stomach and the blood and thus upsetting -the digestion and causing constitutional diseases, -such as anæmia and arthritis; and inasmuch as -poisonous discharges from the nose, the naso-pharynx, -the pharynx, and the tonsils may act -in a similar way, these parts also should be -inspected in connection with the examination of -the teeth. In the dust-laden atmosphere of -towns they are very liable to disease, and even -when healthy are necessarily dirtied; some go<span class="pagenum" id="Page_177">[Pg 177]</span> -so far as to advise all town dwellers daily to -wash out the nasal passages and to gargle the -throat; but, whatever may be thought of this, it -is certain that under existing dietetic conditions -special means are needed in order to keep the -mouth and teeth clean. When man fed on raw -food this was not necessary, the food itself and -the copious flow of saliva, induced by prolonged -mastication, effectually cleansing these parts; -but, under present conditions, food tends to -remain within the mouth, especially between -the teeth and in their crevices, and therefore -special means are needed to remove it. This is -done by “cleaning the teeth” and by rinsing the -mouth.</p> - -<p><i>The tooth-brush.</i>—Probably the ideal method -of cleaning the teeth is that adopted by many -primitive and not a few semi-civilised peoples—viz., -rubbing them with a twig of wood which -has been teased out at one end so as to form a -sort of brush by means of which the teeth can -be burnished and food dislodged from them. -The modern tooth-brush requires to be used -with great caution, as it is capable of doing much -harm, not only by removing the mucoid film, -which, according to Dr. Wallace, protects the -teeth from corroding agencies,<a id="FNanchor_28" href="#Footnote_28" class="fnanchor">[28]</a> but probably<span class="pagenum" id="Page_178">[Pg 178]</span> -also by injuring the edge of the gum and the -neck of the teeth, and thus setting up the condition -known as “erosion.” Certain it is that -some of the best sets of teeth I have encountered -have been wholly unacquainted with the tooth-brush. -In any case the brush should be employed -with great care; it should be soft, and -should always be drawn away from the gums -both on the inner and outer aspect of the teeth -towards the biting surface, as well as across the -latter, never transversely across the outer surfaces, -as so frequently is done. The object of -these procedures is to dislodge any particles of -food that may have collected between the teeth -or in their crevices. For this purpose the toothpick -may also be employed judiciously. In -order to render the enamel of the teeth white it -is better to rub each tooth carefully with some -soft material, such as chamois leather, rather -than to scrub them with a brush. Tooth-powders -should not be used as a matter of routine, -but only occasionally and for appearance rather -than for cleanliness, and should consist of some -simple non-irritant material. Antiseptic powders -and washes are to be scrupulously avoided, -for it is neither desirable nor possible to render -the buccal cavity aseptic; myriads of bacteria -flourish within it, many of which play a useful -part as scavengers. The time of all others for<span class="pagenum" id="Page_179">[Pg 179]</span> -cleaning the teeth is just before going to bed, -so that the food shall not be allowed to decompose -in the mouth during the night. There will -then be no need to use the tooth-brush in the -morning.</p> - -<p><i>Rinsing the mouth.</i>—The mouth should be -rinsed out as a matter of routine after each -meal and on rising, and care should be taken to -do this before the early cup of tea, so as not to -contaminate the stomach with the buccal secretions -which have accumulated during the night. -Inasmuch as raw vegetable food has a cleansing -effect on the teeth, it is often a wise plan, especially -in the case of children, to finish a meal -with some kind of fruit, such as an apple or an -orange. It hardly seems necessary to insist -upon the necessity for keeping all artificial -dentures thoroughly clean.</p> - -<hr class="chap x-ebookmaker-drop" /> -<p><span class="pagenum" id="Page_180">[Pg 180]</span></p> - - -<h3 class="hang">PROFESSOR PAWLOW’S DEMONSTRATIONS -OF PSYCHIC INFLUENCE IN -DIGESTION</h3> -</div> - - -<div class="blockquot"> - -<p>[In presenting a theory of human alimentation involving -mental or nervous as well as mechanical and chemical factors -which influence it for good, it is not often that an author is -able to enlist the assistance of a complete battery of scientific -confirmation to fortify his own crude observations taken direct -from personal experience in the study of natural requirements.</p> - -<p>Professor Pawlow, with his marvellously skilful investigation -of the workings of the digestive secretions, and Dr. -Cannon of the Harvard Medical School, by aid of persistent -and patient X-ray studies, explain how it is that earned -appetite and thorough mouth-treatment of food are preliminary -necessities of easy digestion, and that disturbance or -shock of any sort during the process stop digestive proceedings -and endanger health. They show also that when the -mouth is used to do <i>all that it can do</i> in the work of digestion -all the rest is easily accomplished by the <span class="smcap">Natural Automatic -Processes</span> within the body.</p> - -<p>They both show that we have, each of us, a certain responsibility -in the matter of right digestion and healthy nutrition, -and that all this personal responsibility is located in the head, -in the mind, and in the mouth, and that while the alimentation -is proceeding it is a sacred duty to do our part <i>right</i>, according -to the intelligence that these most valuable demonstrations -teach.</p> - -<p>Professor Pawlow has allowed publication of his lectures in -Russian and German, and recently Professor W. H. Thompson -of the Physiological Department of Trinity College, -Dublin, has made an English translation which is issued by -Charles Griffin & Company of London and J. B. Lippincott of -Philadelphia.</p> - -<p><span class="pagenum" id="Page_181">[Pg 181]</span></p> - -<p>The author has to express special gratitude to Professor -Pawlow, Professor Thompson, Messrs Griffin and Lippincott -for permission to reprint herein some entire lectures and extracts -that bear especially on the practical understanding of -our subject.</p> - -<p>Professor Pawlow is one of the Board of Scientific Assessors -mentioned in the <span class="allsmcap">REPORT</span> of a <span class="allsmcap">PLAN</span> for an <span class="smcap">International -Inquiry</span> into the subject of <span class="smcap">Human Nutrition</span>.</p> - -<p>In one of the lectures, not here reprinted, Professor Pawlow -gives merited recognition of the early statements of the -French physiologist Blondlot relative to psychic influence on -the digestive secretions made some half century ago, but discredited -by physiologists since that time, owing to insufficiency -of evidence brought forward in support of the statements.</p> - -<p>Professor Pawlow’s acknowledgment is so gracefully rendered -that it is here given as a model of scientific courtesy.</p> - -<p>“I have depicted the work of the gastric glands as we have -seen it in our experiments, and as it has developed under our -hands. Is the picture a new one? In its details, yes; but not -in its fundamental features. However singular it may appear, -the sketch of this picture was more than fifty years ago outlined -by physiology. May this constitute another reason for -our science relinquishing its characteristic shyness of new -things and for its conversion to our interpretation of the -phenomena under consideration!</p> - -<p>“The talented author of the <i>Traité Analytique de la Digestion</i>—Blondlot—spoke -in plain words of the importance of -taking food, and of the specific excitability of the gastric -mucous membrane. The facts adduced in the working up of -his theory were naturally insufficient, but we must not forget -that the first experiments on dogs with artificial gastric -fistulæ had only just been performed. It is truly incomprehensible -that the researches of Blondlot and his views upon -the secretion of gastric juice have experienced during the past -fifty years no completion, no additions, but, on the contrary, -have passed out of sight, thanks to the faulty experiments and -erroneous representations of later authors. Only in the -works of a few writers—and those mostly French—has -Blondlot’s theory survived. Of other investigators we must -give mention to Heidenhain, who has enriched the physiology -of absorption in general, but more especially, in connection<span class="pagenum" id="Page_182">[Pg 182]</span> -with the secretory work of the stomach, has discovered many -important facts and has given birth to many fruitful ideas. -From him proceed the subdivision of the secretory process -according to periods and exciting agencies, as well as the suggestion -that it would be important to investigate the individual -food-stuffs in relation to the work of the stomach. Heidenhain’s -results are contained in his well-known article on -the secretion of the cardiac glands of the stomach, published -in the year 1879 in <span class="smcap">Pflüger’s Archives</span>. The work of -Blondlot and the additions of Heidenhain comprise almost -everything of importance which was accomplished by physiology -in fifty years concerning the conditions and mechanism of -the secretory work of the stomach during digestion. Full of -moment, however, for our subject was the obvious error that -mechanical stimulation constituted an effective excitant of the -gastric glands, and this error was in its turn a result of faulty -methods.”—<span class="smcap">Horace Fletcher.</span>]</p> -</div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="LECTURE_IV">LECTURE IV</h3> -</div> - - -<p class="hang">GENERAL SCHEME OF AN INNERVATION -MECHANISM—THE WORK OF THE NERVOUS -APPARATUS OF THE SALIVARY -GLANDS—APPETITE, THE FIRST AND -MOST POTENT EXCITER OF THE GASTRIC -SECRETION</p> - - -<div class="blockquot"> - -<p>Constituent parts of a complete innervation mechanism—The -special duty of the peripheral terminations of -afferent nerves—The specific qualities of nerve cells—Analogy -between the innervation mechanism of the -salivary glands and that of the deeper-lying glands -of digestion—The exciting agencies of the nervous -mechanism of the salivary glands; their particular -properties—Differences between the exciting agencies -of the different salivary glands—Discussion of the -sham feeding experiment—Mechanical and chemical -stimulation of the cavity of the mouth has no effect -on the gastric glands—The experiment of Bidder and<span class="pagenum" id="Page_183">[Pg 183]</span> -Schmidt relative to psychic excitation of the gastric -secretion—Conditions for success in this experiment—The -passionate longing for food—the appetite—alone -brings on the secretory effect in the sham -feeding experiment.</p> -</div> - - -<p><span class="smcap">Gentlemen</span>,—As you have learned in the -last lecture, and also in part have seen by direct -experiment, the nervous system can influence -the work of our glands in the most diverse -ways. The vagus nerve, already burdened with -many duties, has, in addition, proved itself to -be an undoubted exciter of the gastric glands -and of the pancreas. But we must also assign -to the sympathetic nerve a similar <i>rôle</i>. This is -a matter which cannot be doubted, so far as the -pancreas is concerned, and is highly probable -as regards the stomach. We also saw good -reason for believing that these two nerves contained -two different classes of fibres, secretory -and trophic, a condition which had already been -proved to exist by Heidenhain for the nerves of -the salivary glands. As a hypothesis we might -even have proceeded a step farther and have -divided Heidenhain’s trophic nerves into separate -classes of secretory fibres. Lastly, we advanced -important experimental evidence to -show the existence of special inhibitory fibres -to the glands, and these fibres also run in the -vagus, the list of whose functions seems almost -interminable.</p> - -<p><span class="pagenum" id="Page_184">[Pg 184]</span></p> - -<p>We obtained these results by division and artificial -excitation of the nerves which run to the -glands. But when, how, and by what means these -nerves are thrown into activity during the normal -course of physiological events remains a question.</p> - -<p>In order to avoid repetition, and at the same -time impart the utmost clearness to our representation, -it may be useful to bring before your -minds at once the plan of innervation of a given -organ, all the more since this scheme is seldom -completely followed out or adequately described -in physiological text-books. Consequently, it -is not borne in mind with sufficient precision by -the majority of medical men.</p> - -<p>A complete innervation mechanism consists -of the peripheral endings of the centripetal -(afferent) nerves, the centripetal nerves themselves, -the nerve cells (a group of nerve cells -connected with each other is termed a “nerve -centre”), the centrifugal (efferent) nerves, and, -lastly, their peripheral terminations. Physiology -now accepts it as a settled fact, that nerve -fibres serve only as <i>conductors</i> of nervous impulses, -which come in from contiguous links of -the nervous chain. Only the peripheral endings -of nerves and the nerve cells themselves have -the power of transforming the external stimulus<a id="FNanchor_29" href="#Footnote_29" class="fnanchor">[29]</a><span class="pagenum" id="Page_185">[Pg 185]</span> -into a nervous impulse. In other words, in the -intact organism these alone constitute the normal -receiving apparatus of the nervous system. -Whether the peripheral ends of centrifugal -(efferent) nerves are likewise able to function -as normal sites for the application of external -stimuli has still to be answered. Consequently, -when any external agency excites the peripheral -terminations—the receiving stations—of centripetal -nerves in this or that organ, the effect -of the stimulus will be conveyed through the -centripetal nerves, as through a receiving wire, -to the central station—the nerve cells. Here -it becomes changed into a definite impulse and -now comes back along the centrifugal nerves—the -outgoing wires.</p> - -<p>The utmost importance is to be attached to -the fact that only the peripheral endings of centripetal -(afferent) nerves, in contrast to nerve -fibres themselves, respond to <i>specific</i> stimuli; -that is to say, are able to transform definite -kinds of external stimuli into nervous impulses. -The function of the end organs with which they -are connected is therefore of a purposive nature; -in other words, these organs are only called into -play by certain definite conditions, and impart<span class="pagenum" id="Page_186">[Pg 186]</span> -the idea of being aware of their purpose, of -being conscious of their duty. We have long -known that the peripheral endings of sensory -nerves are possessed of a high degree of speciality, -and cannot therefore have any doubt regarding -the specific nature of the end organs of -other centripetal nerves. This is a sore point -in present-day physiology. But, notwithstanding -our knowledge of the separate parts of the animal -body, we shall only be able to form a true -conception of the motive agencies of the whole -complicated machine, when we have established -the specific excitability of the end apparatus -of every centripetal nerve, and have discovered -all the mechanical, chemical, and other factors -which throw this or that end apparatus into an -active condition. I always look upon it as a -period of scientific inadequacy so long as the -effects of the most diverse external agencies -upon any normal physiological process are -admitted to be indistinguishable. As the work -of the digestive canal is now represented in the -majority of text-books, and consequently presented -to the mind of the physician, it bears the -impress of this period. To impart to the physician -a more correct conception of this matter -was my chief object in giving these lectures. -I hope, indeed, to furnish you with evidence -sufficiently convincing, that the alimentary canal<span class="pagenum" id="Page_187">[Pg 187]</span> -is endowed not with mere general excitability; -that is to say, does not respond to every conceivable -form of agency, but only to special -conditions which are different for the different -portions of its length. Just as men and animals -in the world are only able to maintain their -existence and constantly adapt themselves to -changing circumstances by aid of the peripheral -endings of their sensory nerves, so every organ, -indeed every cell of every organ, can only maintain -its place in the animal microcosm, and -adapt itself to the activity of innumerable associates, -as well as to the general life of the whole, -by virtue of the fact that the peripheral end -apparatus of its centripetal nerves possesses a -specific excitability.</p> - -<p>The same applies to the nerve cells: obviously -they are endowed with specific sensibility. -Irrespective of the excitations which are communicated -to them from centripetal nerves, they -respond, as originators of nervous impulses, -only or at least mainly to definite forms of -mechanical, chemical, or other stimuli arising -in the organism. This follows not alone from a -number of physiological facts but also from -various pharmacological data. Thus we learn -that various drugs excite or annul the activity -of definite portions of the nervous system, at -least in the earlier phases of their effects. This<span class="pagenum" id="Page_188">[Pg 188]</span> -specific excitability of nerve cells, just as much -as the same property of peripheral end organs, -lies at the bottom of the purposive action of -these organs.</p> - -<p>Hence, our next duty is to endeavour to -discover the normal exciting conditions of the -centripetal nerves belonging to the glands which -we had under consideration in our last lecture, -or, more correctly, to find out the conditions -which excite the centres, as well as the peripheral -endings of the different nerves, which -form parts of the nervous apparatus of these -glands. We have, therefore, for each phase of -the work of secretion, to find out that portion -of the nervous mechanism which is for the time -being under excitation, and to discover the -primary agency by which this condition is -elicited. This would include an exact analysis -of the stimulating influence which mastication -and food exert upon the nervous mechanism of -these glands. We shall also be able more fully -to comprehend the inner mechanism underlying -the facts which formed the subject of the second -lecture. This, of course, is an ideal programme -which we can only follow out as far as the present -state of physiology permits. It may now -be instructive, and, for our further conclusions, -advantageous, to glance shortly at the nervous -control of the salivary glands.</p> - -<p><span class="pagenum" id="Page_189">[Pg 189]</span></p> - -<p>The salivary glands, whose innervation has -long ago been investigated, have generally been -accepted as types of the deeper-lying digestive -glands, and when it became necessary to form a -conception of the mode of activity of the latter, -medical science resorted to a bold analogy and -thought of the nervous apparatus of the salivary -glands. But the attempts of investigators to -apply rigidly to others the scheme of innervation -which holds good for the salivary glands, have -done considerable harm to the usefulness of the -analogy and have prevented our arriving at a -correct idea of the plan of innervation of the -abdominal glands. We have already had an example -of this nature before us. In the salivary -glands we have no clearly marked indications of -nervous inhibition, and this circumstance has -decidedly retarded the due development of our -knowledge of the nervous control of the abdominal -glands. Authors naturally expected to -see a simple and prompt stimulation-effect -from the same conditions of experiment which -sufficed for the salivary glands, and the failure -of this gave them, as they thought, the right -to deny the existence of any extrinsic nervous -influence upon the abdominal glands. The -error is now obvious; the abdominal glands -behave in some ways different from the salivary -glands, and for their successful investigation,<span class="pagenum" id="Page_190">[Pg 190]</span> -other conditions of experiment are necessary -than those which held good for the former. In -the working of the abdominal glands nervous -inhibitory processes play a large part, but they -are almost wholly absent in the case of the -salivary glands. This is an additional warning -that one must never push the conclusions drawn -from analogy too far, but must constantly bear -in mind that the life-functions of all organs are -extremely complicated, and that the work of -even the most apparently similar organs should -be submitted to separate and careful observation. -To me it appears that the unjustified analogy -drawn between the abdominal and salivary -glands has to be credited with another important -misapprehension. And precisely for this -reason I think it desirable to bring under consideration, -if only in brief fashion, the conditions -of work of the salivary glands, especially since -Dr. Glinski has instituted in the laboratory some -easily performed experiments which bear upon -the matter.</p> - -<p>The experiences of daily life teach us from -the outset, that the activity of the salivary glands -begins even before the introduction of food into -the mouth. With an empty stomach, the sight -of food or even the thought of it is sufficient to -set the salivary glands at once into activity; -indeed, the well-known expression, “to make<span class="pagenum" id="Page_191">[Pg 191]</span> -one’s mouth water,” is based upon this fact. -Hence a psychic event, the eager longing for -food, must be accepted as an undoubted excitant -of the nervous centre for the salivary glands. -On the other hand, the same every-day experience, -as well as numerous experiments upon -animals, teach us that a number of substances, -when brought into contact with the mucous -membrane of the mouth, are likewise able to -call forth a secretion of saliva. One even -acquires the impression that everything brought -into the mouth may reflexly influence these -glands, the only difference being a gradual shading -off in the effect, dependent upon the strength -of the stimulation which the substance introduced -is able to exert, and it appears to me that it is -precisely this impression which has driven the -idea into the background, that the peripheral -end apparatus of the centripetal nerves of the -digestive canal are specifically excitable. The -facts were here correctly observed, but their -indications erroneously interpreted.</p> - -<p>The great multiplicity of excitants of salivary -secretion, has without doubt, some connection -with the complicated physiological functions of -the saliva. This is the first fluid encountered -by everything which enters the alimentary canal. -It must, therefore, in a sense play the part of -host to every substance taken in—moisten the<span class="pagenum" id="Page_192">[Pg 192]</span> -dry, dissolve the soluble, envelop the hard and -bulky with mucus in order to facilitate its passage -down the narrow œsophagus; and submit -certain forms of food material, such as starch, to -a process of chemical elaboration. Nor is its -duty by any means ended here. The saliva is -secreted in the first compartment of the alimentary -canal, which is at the same time the sorting-room -of the organism. Much of what enters -the mouth may prove in the testing process to -be useless, or even noxious, and must either -have its deleterious properties neutralised or be -completely rejected. The saliva is secreted in -the first instance to obviate injurious effects in -some way; thus, for example, a strong acid is to -a certain degree neutralised, while other corroding -substances may be simply diluted, and by -mere reduction of concentration have their -harmfulness diminished.</p> - -<p>In the second place, when the injurious substances -have to be wholly removed, the saliva -plays the <i>rôle</i> of a washing-out fluid; otherwise -the material, by clinging to the mucous membrane -of the mouth, might in longer or shorter -time gain entry into the blood and there develop -its noxious influence. This last function of the -fluid is hardly taken into account at all in -physiology, and yet it is evident that the saliva, -as a cleansing fluid, must have a wide importance.<span class="pagenum" id="Page_193">[Pg 193]</span> -If you only think of how often we are impelled -to expectorate, that is, to wash out the mouth -with saliva after something unpleasant, this will -be clear. Such a view finds additional support -when we reflect that a feeling of disgust produces -almost as strong a flow of saliva as the -sight of a tasty meal. In both cases the secretion -performs the office of forerunner: in the -first it prepares for the washing out of the -mouth, in the second for the requisite elaboration -of the food. Think how often, when something -disagreeable enters the mouth, with what -rapidity the saliva is poured out, even after the -unpleasant substance has been for a considerable -time removed, and not a trace more is apparent -to the sense of taste. Indeed, long afterwards -one has only to recall the circumstances to -mind in order to bring on anew the secretion of -saliva. Apparently the psychic excitation of the -nerves of salivary secretion also ushers in the -act of vomiting, which, as is well known, can be -called forth by mental influence. Further, the -function of the saliva just mentioned is probably -the true physiological explanation of the feeling -of disgust which many persons experience at -the sight of the secretion itself.</p> - -<p>Hence I hold that substances which obtain -entry to the mouth set up a secretion of saliva -only because we have here the seat of a defi<span class="pagenum" id="Page_194">[Pg 194]</span>nite -physiological sense, and not because the -peripheral terminations of the buccal nerves -are devoid of specific excitability, and capable -of being thrown into action by every desired -form of stimulus. In other words, the specific -excitability of the peripheral endings of the -salivary nerves is very comprehensive and -widely extended. This is no picture of the -imagination, for it can be supported by facts. -To say nothing of the testimony of earlier authors, -that the salivary glands have each particular -exciting agencies to which they specially -respond, we can demonstrate the following facts -from the material collected in our laboratory.</p> - -<p>Dr. Glinski isolated the orifices of the salivary -glands in dogs with portions of the adjoining -mucous membrane, brought them out of the oral -cavity, and caused them to heal into the edges of -the skin wounds. In his first animal the ducts of -the submaxillary gland were thus led outwards. -By means of a Mendeljeff’s clip, the wide end -of a conical funnel of waterproof material was -attached to the skin surrounding the orifice. -To the narrow end a small test-tube, which -served to collect the saliva, was attached by a -wire. I now offer such an animal a piece of -flesh, and, as you see, the tube fills up at once -with saliva. I stop tempting the dog, hang on -a new test-tube, and give it a few pieces of flesh<span class="pagenum" id="Page_195">[Pg 195]</span> -to eat; once more a strong secretion of saliva -results. A new tube is now attached to the -funnel, the dog’s mouth is opened, and a pinch -of fine sand thrown in; again there is a flow of -saliva. Once more a new test-tube; and now -I apply to the buccal mucous membrane, the -plume of a feather dipped in acid solution, with -the result that I obtain a strong flow of saliva. -One may employ a number of substances in this -way, when a similar effect is always produced. -You see, in this, such a comprehensive excitability -of the innervation apparatus of the salivary -glands that you might readily interpret it as -meaning the power of response to all and sundry -forms of stimulation. We now proceed, however, -to another dog, whose parotid duct has in -a similar manner been diverted outwards. The -saliva is collected in the same way. We tempt -the dog with a piece of flesh, but to our -astonishment no saliva flows, and yet the animal -is most eager for the savoury meal offered. Now -we give it some raw flesh to eat; again the -secretion of saliva is as good as absent; only -when I come near can I detect one or two drops -of saliva running down the sides of the tube. -Probably you will say there is something wrong, -either with the method or with the glands of the -animal. But wait a little. I now give the dog -finely powdered dry flesh, and obtain at once an<span class="pagenum" id="Page_196">[Pg 196]</span> -abundant secretion. Should any one happen to -think that the variation in the result is dependent, -not on a different specific activity of the -glands, but on individual differences in the dogs, -I respond that Dr. Glinski has had an animal -with double parotid and submaxillary fistulæ, -and was able to observe on one and the same -dog, a like behaviour on the part of the glands -to that which we have just seen in two different -individuals. An analogous experiment with -bread was also carried out by Dr. Glinski. -The eating of fresh moist bread produced no -secretion worth mentioning, while dry bread, on -the other hand, caused the saliva to flow in -large quantities. The results of this experiment -permit us to draw extremely instructive conclusions. -In the first place, the several salivary -glands are, as a matter of fact, very sharply -differentiated in the conditions necessary for -their activity—that is to say, in respect to the -agencies which excite their nervous mechanisms. -Secondly, the innervation apparatus of the parotid -manifests a very sharp selective power in -the choice, so to speak, of an adequate stimulus. -The mechanical effect of large pieces of flesh is -naturally much greater than that of the finely -powdered material, and yet it was precisely to the -latter that the glands responded. The stimulus -is, therefore, not due to the mechanical, but to<span class="pagenum" id="Page_197">[Pg 197]</span> -some other property of the food. This other -property is obviously the dryness of the -material. Our example illustrates how that -which we may term “purposiveness” comes -into play in the working of our glands and also -how erroneous is the opinion that the mechanical -stimulus is all potent. Indeed, previous -authors have already pointed out that dry substances -cause a specially free secretion of saliva, -and yet physiological opinion throughout the -length and breadth of the land, as expressed in -text-books, has chosen to recognise a <i>universal</i> -instead of a <i>specific</i> excitability. Dr. Wulfson, -who is at present carrying on the investigation -of salivary secretion in our laboratory, has added -a very interesting observation to the results of -Dr. Glinski already related. The parotid gland, -which is hardly, if at all, excited when one offers -fresh meat to the animal, responds with a very -active secretion, when dry food (bread or powdered -meat) is offered. This phenomenon is -all the more surprising since the desire of the -animal for eating is much more strongly excited -by flesh than by dry bread. I am quite convinced -that an exact study of the exciting -agencies of the three salivary glands will furnish -a number of new data bearing upon the question -in hand.</p> - -<p>The second reagent which is poured out on<span class="pagenum" id="Page_198">[Pg 198]</span> -the raw material in the digestive canal is the -gastric juice. How, in the normal course of -events, is the work of the gastric glands, which -prepare this juice, called into play? With the -first, and manifestly important factor, which has -a relation thereto, you are already acquainted, -and, indeed, have already seen. I refer to the -production of gastric juice in the empty stomach, -as a result merely of the swallowing of food in -the so-called sham feeding of an œsophagotomised -dog. When one takes into consideration -the absolute independence of this factor, and -the intensity of the effect, which makes itself -evident in the secretion of a large quantity of -juice of high digestive power, the exciting agency -which brings about such secretion must be recognised -as one of the most important and effective -processes in gastric digestion. But in what does -it consist? At first sight it appears—and when -I previously drew your attention to the fact I -expressed the opinion—that there is here a -simple reflex effect from the cavity of the mouth -upon the secretory nerves of the stomach, similar -to the reflex excitation, <i>e.g.</i>, of the parotid gland, -by finely powdered flesh thrown into the mouth. -Now, however, I assert quite emphatically that -this is not the case. We have, it is true, in the -activity of the salivary glands an analogous -phenomenon to indicate—not, however, that<span class="pagenum" id="Page_199">[Pg 199]</span> -of which we have just spoken. We might apply -every conceivable form of stimulus which -could possibly come into play in the act of eating, -and yet would not obtain the slightest indication -of secretory activity in the stomach. In -this dog with a gastric fistula, and with also -a divided œsophagus, I will try such an experiment, -using the most effective chemical stimulus -to the buccal mucous membrane, viz., acid -solution.</p> - -<p>The secretion of saliva begins at once, as you -see; the acid is, therefore, effective. From the -stomach, however, in spite of continued excitation, -no secretion results, although the acid, -mixed with the saliva, is swallowed and flows out -again from the upper segment of the œsophagus—that -is to say, passes along precisely the same -path that the food takes in sham feeding.</p> - -<p>We could experiment in the same way with -a number of other substances: saline, bitters, -pepper (strong local excitation), mustard, and -so on, and always with the same results; a free -secretion of saliva, but perfect quiescence of the -gastric glands. We may even, with the same -object, employ the soluble constituents of flesh -in the form of a decoction, and likewise observe, -in most cases at least, no sign of activity on the -part of the gastric glands.</p> - -<p>With the chemical we may also combine a<span class="pagenum" id="Page_200">[Pg 200]</span> -mechanical stimulus. We can, for example, -wipe out the mouth with a sponge soaked in -the solution to be experimented with, but always -with the same negative result. We may finally -give such pieces of sponge, or even smooth -stones of considerable size, to the dog to swallow, -passing them back behind the anterior -pillars of the fauces and allowing them to fall -out again, from the upper portion of œsophagus. -It may be added that a well-taught dog puts up -with all these procedures without the slightest -protest. You see that all the manipulations in -this case are carried out with bare hands and without -instrumental aid. One can easily train a dog -to swallow stones which are placed in the anterior -part of the buccal cavity. It simply makes a -few chewing movements and swallows them -down. The dog on which the acid experiment -has just been made serves also for the swallowing -of the stones. The attendant now places -some pebbles in the front part of the mouth, -when the animal rolls them round, as if chewing -and gnawing them, and then swallows them. -The stones fall out, as you see, from the œsophagus, -and drop with an audible sound upon the -table. This play with the stones has now lasted -fifteen or twenty minutes (in the laboratory we -have often kept it up for hours), and yet not a -drop of gastric juice is to be seen.</p> - -<p><span class="pagenum" id="Page_201">[Pg 201]</span></p> - -<p>In order to prove that the dog is perfectly -healthy and normal, we lay aside the stones and -proceed to our old experiment of sham feeding. -As you see, the first drop of gastric juice makes -its appearance precisely at the end of five minutes, -and after a further five minutes we have -collected more than 15 c.c. of the fluid; consequently -there can be no doubt that in this dog -both gastric glands and nerves are uninjured -and function in normal manner. At one time -we even had a dog which voluntarily took the -stones out of one’s hand and swallowed them; -the sagacious creature had seen our object in -previous experiments and learned to perform it -of its own accord! But in this case also the -result was negative.</p> - -<p>Clearly, therefore, neither chemical nor mechanical -stimulation of the buccal mucous membrane -is capable of reflexly exciting the nerves -of the stomach. Further, it is obvious that the -excitation of these nerves in sham feeding is -not the result of a stimulation coincidently produced; -that is to say, the excitement of the -chewing and swallowing centres does not imply -simultaneous action of the secretory centre of -the gastric glands. In what, then, does this -influence consist which is intrinsic to the sham -feeding, but which we have not been able to reproduce -in our analytical investigation? There<span class="pagenum" id="Page_202">[Pg 202]</span> -is only one thing to think of, namely, the eager -desire for food, and the feeling of satisfaction -and contentment derived from its enjoyment.</p> - -<p>It has, indeed, been known for forty years, -thanks to the experiments of Bidder and -Schmidt, that at times, the offering of food to -a hungry dog, in other words, the excitement -of a keen desire for it, is sufficient to cause a -flow of gastric juice from the empty stomach. -We shall presently have occasion to observe -the force of this physiological factor. Here I -bring before you another dog, likewise having -a gastric fistula with divided œsophagus. The -stomach has been washed out half an hour ago, -and since then not a drop of gastric juice has -escaped. We begin to get ready a meal of flesh -and sausage before the animal as if we meant to -feed it. We take the pieces of flesh from one -place, chop them up, and lay them in another, -passing them in front of the dog’s nose, and so -on. The animal, as you see, manifests the liveliest -interest in our proceedings, stretches and -distends itself, endeavours to get out of its cage -and come to the food, chatters its teeth together, -swallows saliva, and so on. Precisely five minutes -after we began to tease the animal in this -way the first drops of gastric juice appear in -the fistula The secretion grows ever stronger -and stronger, till it flows in a considerable<span class="pagenum" id="Page_203">[Pg 203]</span> -stream. After the lapse of a few minutes we -can count the number of cubic centimetres by -tens. The meaning of this experiment is so -clear as to require no explanation; the passionate -longing for food, and this alone, has called -forth under our eyes a most intense activity of -the gastric glands. If the experiment be frequently -repeated, one can easily observe that -the keener and more eager the desire on the -part of the dog for the food, the more certain -and intense is the secretory effect. In extreme -cases there is even a quantitative relationship -between this effect and that of the sham feeding.</p> - -<p>Here is an experiment of Professor Ssanozki, -in which the secretory effect of the mere tempting -of the animal with the sight of food is compared -with that of sham feeding. A few threads -of alkaline mucus had just escaped from the -stomach, and then the excitation of the dog -with flesh was begun. After six minutes the -secretion commenced and continued as follows:</p> - - -<table class="standard" summary=""> -<tr> -<th class="nb tdc">Duration of the flow.</th> -<th class="nb tdc">Quantity of the juice.</th> -</tr> -<tr> -<th class="nb tdc">minutes</th> -<th class="nb tdc">c.c.</th> -</tr> -<tr> -<td class="tdc">8</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">4</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">4</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">8</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">8</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">19</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">19</td> -<td class="tdc">3</td> -</tr> -</table> - - -<p><span class="pagenum" id="Page_204">[Pg 204]</span></p> - -<p>Then followed a sham feeding for six minutes.</p> - -<table class="standard" summary=""> -<tr> -<th class="nb tdc">Duration of the flow.</th> -<th class="nb tdc">Quantity of the juice.</th> -</tr> -<tr> -<th class="nb tdc">minutes</th> -<th class="nb tdc">c.c.</th> -</tr> -<tr> -<td class="tdc">17</td> -<td class="tdc">10 </td> -</tr> -<tr> -<td class="tdc">9</td> -<td class="tdc">10</td> -</tr> -<tr> -<td class="tdc">8</td> -<td class="tdc">10</td> -</tr> -</table> - -<p>It is clear that in this case the tempting, -instead of being less effective than the sham -feeding, on the contrary excelled it.</p> - -<p>Consequently, the observation of Bidder and -Schmidt was perfectly correct. It cannot, however, -be said that it received general recognition -in physiology, or that it was sufficiently appreciated. -There are authors who could never -convince themselves of its reality, and in many -physiological text-books it is not once mentioned. -By way of explanation, we shall now -consider how this matter must be dealt with by -those who wish to observe the effect. It is only -under certain conditions that it can be seen. -Firstly, the animal must be healthy and vigorous; -it must have a perfectly uninjured gastric -mucous membrane; and this, from the description -in the case of many authors who obtained -a negative result, was not the case. Secondly, -the success of the experiment, as stated above, -is dependent upon the intensity of the desire -for eating, and this, again, is dependent upon -how freely and how long beforehand the dog -had eaten, and also upon what it is tempted<span class="pagenum" id="Page_205">[Pg 205]</span> -with, whether with a dish that excites its desire -or leaves its interest unawakened. It is known -that dogs have very different tastes, just as men -have. Thirdly, one may find among the dogs -positively careless, indifferent creatures, incapable -of being perturbed in this way by anything -which has not actually reached their mouths, -and patiently waiting till the food is given them. -Hence for success in the experiment, eager, -impressionable, and excitable animals are necessary. -Fourthly, one has to reckon with the -sense and cunning of the dog, a factor which is -not lightly to be disregarded. Often the animals -perceive at once that they are only being -teased with the food, become annoyed thereat, -and turn away offended at what is being done -before them. We must, therefore, so arrange -matters as if the animals were not going to be -disappointed but fed in reality. If attention -be paid to these conditions the experiment of -“psychic excitation of the gastric secretion,” as -we usually term it, will be found to be as reliable -as the experiment of sham feeding. When one -is occupied for a length of time with the study -of the gastric secretion under different conditions, -one becomes convinced of what a dangerous -source of error this psychic excitability -may become in the different experiments. We -must constantly fight, so to speak, against this<span class="pagenum" id="Page_206">[Pg 206]</span> -factor, keep it ever in view, and guard against it. -If the dog has not eaten for a long time, every -movement,—the going out of the room, the appearance -of the attendant who ordinarily feeds the -animal—in word, every little triviality may give -rise to excitation of the gastric glands. The minutest -attention is necessary in order to avoid such -sources of error, and we should not be far wrong -if we said that much which has been ascribed in -former investigations to the effect of this or that -agency was in reality a result of unobserved -psychic influence. Consequently, in order to -verify our own conclusions concerning the effects -of this or that condition, we have performed many -of our experiments on sleeping animals, having -beforehand convinced ourselves by frequent repetition -that sleep exercises no restraining influence -on the working of the gastric glands.</p> - -<p>When we recall to mind the failure of our -attempts to obtain a secretion of gastric juice -by any stimulation whatever of the buccal mucous -membrane, and at the same time see how -constant and intense the action of this psychic -impression is, we are forced to the inevitable -conclusion that in our sham feeding experiment -the whole secretory effect is due to the psychic -stimulus, that is to say, to the keen desire on -the part of the animal for food and the satisfaction -of enjoying it.</p> - -<p><span class="pagenum" id="Page_207">[Pg 207]</span></p> - -<p>In view of the importance of the act of eating, -which even now is apparent, but which will -become still more obvious when the succeeding -periods of secretion are investigated, we have -spared neither time nor trouble to arrive at a -correct explanation of the mechanism of this -factor. We have, therefore, taken in hand a -number of modifications of the sham feeding -experiment, and these investigations have confirmed -the opinion at which we had arrived. -If, for instance, the dog has been prepared by -a long fast of two to three days, a very intense -secretion of gastric juice will always be obtained -by the sham feeding experiment, no matter -what may be given it to eat, whether boiled or -raw flesh, bread or coagulated egg-white, etc. -The dog, however, which has not fasted, that is -to say has been fed fifteen to twenty hours before, -will pick and choose amongst the different -foods, eating one with great greed, tolerating another, -and refusing altogether a third, and, corresponding -therewith, the amount and quality -of the gastric juice will manifest wide variations. -The more eagerly the dog eats the more juice -will be secreted and the greater the digestive -power which it possesses. The majority of dogs -prefer flesh to bread, and correspondingly less -juice will be produced by sham feeding with -bread than with flesh. Sometimes, however,<span class="pagenum" id="Page_208">[Pg 208]</span> -we find dogs which will devour bread with -greater appetite than flesh. In these cases one -obtains more and stronger juice in sham feeding -with bread than with flesh. Here is a case in -point: a dog is given boiled meat which has -been cut into pieces of definite size, and the -pieces follow each other at regular intervals of -time. The animal eats, but soon, from its behaviour, -you see that it develops no particular -greed for the meal, and this observation is confirmed -by the fact that after fifteen to twenty -minutes it ceases taking the flesh. The secretion -of juice has meanwhile either not begun at -all, or only after a longer interval than five -minutes, and remains scanty to the end. Now -wait till the secretion has stopped and give the -same dog raw flesh, either forthwith or next -day, in pieces of the same size and at the same -rate as before. The raw meat tastes excellently -to the dog; it eats for hours at a time; the secretion -of gastric juice begins precisely after five -minutes and is very active. With another dog -which prefers boiled to raw meat exactly the -reverse occurs. Broth, soup, milk—towards -which dogs are usually more indifferent than -towards solid food—often produce in sham -feeding either no secretion at all or only very -little, although broth, for instance has essentially -the same taste as flesh.</p> - -<p><span class="pagenum" id="Page_209">[Pg 209]</span></p> - -<p>It is therefore clear that in sham feeding the -psychic effect may readily become an absolute -and independent factor. All the conditions -which we enumerated above, and which are -necessary for the successful production of the -psychic effect, hold good in combined form for -the sham feeding experiment. The dog eats -with greed before one’s eyes; the food which it -receives is pleasant; it not only imagines food -but actually eats it, and has therefore no reason -to feel offended, for naturally the idea does not -occur to any of the dogs that all their trouble is -in vain.</p> - -<p>Consequently, in the sham feeding experiment, -by the act of eating, the excitation of -the nerves of the gastric glands depends upon -a psychical factor which has here grown into a -physiological one, that is to say, is just as much -a matter of course, and appears quite as regularly -under given conditions as any other physiological -result. Regarded from the purely physiological -side, the process may be said to be a -complicated reflex act. Its complexity arises -from this, that the ultimate object is attained by -the joint working of many separate organic -functions. The material to be digested—the -food—is only found outside the organism in -the surrounding world. It is acquired not alone -by the exercise of muscular force, but also<span class="pagenum" id="Page_210">[Pg 210]</span> -by the intervention of higher functions, such as -judgment, will, desire. Hence the simultaneous -excitation of the different sense organs, of sight, -of hearing, of smell and taste, is the first and -strongest impulse towards the activity of the -gastric glands. This especially applies to the -two latter senses, since they are only excited -when the food has already entered the organism, -or at least has arrived very near it. It is by the -establishment of this passionate desire for eating -that unerring and untiring nature has linked the -seeking and finding of food with the commencement -of the work of digestion. That this factor, -which we have now carefully analysed, -stands in closest connection with an every-day -phenomenon of human life, namely, appetite, -may easily be predicated. This agency, which -is so important to life and so full of mystery to -science, becomes here at length incorporated -into flesh and blood, transformed from a subjective -sensation into a concrete factor of the -physiological laboratory.</p> - -<p>We are therefore justified in saying that the -appetite is the first and mightiest exciter of the -secretory nerves of the stomach, a factor which -embodies in itself a something capable of impelling -the empty stomach of the dog in the sham -feeding experiment to secrete large quantities -of the strongest juice. A good appetite in eat<span class="pagenum" id="Page_211">[Pg 211]</span>ing -is equivalent from the outset to a vigorous -secretion of the strongest juice; where there is -no appetite this juice is also absent. To restore -appetite to a man means to secure him a large -stock of gastric juice wherewith to begin the -digestion of the meal.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_212">[Pg 212]</span></p> - -<h4 class="nobreak" id="LECTURE_V">LECTURE V</h4> -</div> - - -<p class="hang">PERIOD OF OCCURRENCE AND IMPORTANCE -OF THE PSYCHIC OR APPETITE -JUICE IN THE SECRETORY WORK OF -THE STOMACH—THE INEFFICIENCY OF -MECHANICAL STIMULATION OF THE -NERVOUS APPARATUS OF THE GASTRIC -GLANDS</p> - -<div class="blockquot"> - -<p>The psychic secretion is the normal commencement, in the -majority of cases, of secretory activity on the part of the -gastric glands. If the meal be subdivided and administered -at intervals, the psychic juice appears each time—Demonstration -of “appetite juice” in a dog with an isolated -gastric <i>cul-de-sac</i>. The work of the gastric glands -if appetite juice be avoided by introducing food through -a gastric fistula unperceived by the animal—Digestion of -flesh by the stomach with and without sham feeding—Duration -of the secretory influence of sham feeding—After -the cessation of the psychic effect, how is the secretory -work of the stomach maintained?—Experiments -to prove the ineffectiveness of mechanical stimulation: -excitation of the mucous membrane by means of a glass -rod, a feather, a puff of sand, and by rhythmic dilatation -of an india-rubber ball—Contact between the food and -the stomach-wall may indirectly call the activity of the -glands into play by awakening or increasing the desire -for food.</p> -</div> - - -<p><span class="smcap">Gentlemen</span>,—On the last occasion we made -ourselves acquainted with the first normal impulse -which, in the natural course of events, -calls into activity the innervation apparatus of<span class="pagenum" id="Page_213">[Pg 213]</span> -the gastric glands. This impulse is a mental -one, and consists in a passionate longing for -food, that which in every-day life, and in the -practice of the physician, is called “appetite,” -and which everybody, both medical and lay, -endeavours carefully to promote. We may -now venture to say explicitly, <span class="allsmcap">APPETITE IS -JUICE</span>, a fact which at once displays the pre-eminent -importance of the sensation. Medical -science endeavours to assist the debilitated -stomach by introducing the active constituent -of gastric juice—pepsin—from without, or by -prescribing other remedies believed to promote -its secretion. It is, however, of interest to follow -our experimental investigation still farther. -What position is to be assigned to the “psychic” -or “appetite-juice”<a id="FNanchor_30" href="#Footnote_30" class="fnanchor">[30]</a> in the course of normal -gastric digestion? Is any definite <i>rôle</i> to be -attributed to it? What course does gastric -digestion take when it is absent? Fortunately -to all these important questions satisfactory -answers are forthcoming by experiment. We -have only to regret that these answers come -so late.</p> - -<p>Let us recall to memory how the secretion -of gastric juice proceeded after feeding with -flesh or bread in the case of our dog with the<span class="pagenum" id="Page_214">[Pg 214]</span> -isolated miniature stomach. The following are -the quantities and digestive capabilities of the -first two hourly portions of juice after the administration -of 200 grams of flesh or bread -(experiments by Dr. Chigin):</p> - -<table class="standard" summary=""> -<tr> -<th class="tdc" rowspan="2"> Hour.</th> -<th class="tdc" colspan="2">Flesh.</th> -<th class="tdc" colspan="2">Bread.</th> -</tr> -<tr> -<th class="tdc">Quantity<br /> of juice.</th> -<th class="tdc">Digestive<br />power.</th> -<th class="tdc">Quantity<br /> of juice.</th> -<th class="tdc">Digestive<br /> of juice.</th> -</tr> -<tr> -<td class="tdc_br"> </td> -<td class="tdc_br">c.c.</td> -<td class="tdc_br">mm.</td> -<td class="tdc_br">c.c.</td> -<td class="tdc">mm.</td> -</tr> -<tr> -<td class=" tdc_br">1st</td> -<td class=" tdc_br">12.4 c.c.</td> -<td class=" tdc_br">5.43 mm.</td> -<td class=" tdc_br">13.4 c.c.</td> -<td class=" tdc">5.37 mm.</td> -</tr> -<tr> -<td class=" tdc_brb">2nd</td> -<td class=" tdc_brb">13.5</td> -<td class=" tdc_brb">3.63</td> -<td class=" tdc_brb">>7.4”</td> -<td class=" tdc_bb">6.50</td> -</tr> -</table> - - -<p>You see at once that the secretion of the -first hour is identical in the two cases both as -regards quantity and digestive power, and only -in the second is the secretory work differentiated -according to the nature of the food. How are -we to explain the secretion which takes place -at the commencement? Is it not the same -which we have already seen in the sham feeding -experiments? Is not this first onrush of the -stream of secretion the preliminary psychic -juice? Unquestionably, gentlemen, this is the -case, and we may convince ourselves of the fact -in the most diverse ways. Above all, the following -is clear: whatever occurs in the so-called -sham feeding cannot wholly be absent in the -case of normal feeding, since the former is -nothing else than the isolated commencement<span class="pagenum" id="Page_215">[Pg 215]</span> -of normal digestion. This justifiable inference -is fully confirmed, if the secretion of the first -hours after the administration of flesh and bread -be compared with that after simple sham feeding. -In the case of feeding with flesh and bread, -the identically similar and high digestive power -of the first hourly portions is striking, and this -power coincides with what we have met in sham -feeding. Further, if the quantity of juice from -the miniature stomach during the first hour -be compared with that produced by the non-resected -part of the organ,—to do which we -must multiply it by ten, since the resected <i>cul-de-sac</i> -is approximately one-tenth of the whole -organ,—it is here again found that the quantity -approximately corresponds to the mean values -obtained by sham feeding. Finally, the depression -in digestive power or quantity of juice -(with flesh, decrease of digestive power; with -bread, decline in the quantity of juice), which -sets in soon after the taking of food, indicates -that the two conditions are connected with the -ingestion of food—<i>i. e.</i>, with a transitory factor -which soon passes away and gives place to other -conditions. Our explanation becomes still more -convincing when we take into consideration the -effects of other foods. If you give the dog, for -example, something else to eat which does not -interest it to the same degree as flesh or bread,<span class="pagenum" id="Page_216">[Pg 216]</span> -you will find the initial increase in quantity and -strength of juice does not appear. Offer the -animal milk, for example, which in sham feeding, -especially if it does not last long, calls -forth, as a rule, no secretion, or at all events -only very little, and the rapid flow of the commencement—the -already-mentioned initial rise—absolutely -fails to appear. You have already -seen the figures which deal with this matter; -I think it necessary, however, to bring them -forward again in order that you may be better -able to compare them with the secretion after -flesh and bread.</p> - -<p>The dog was given 600 c.c. of milk (experiment -by Dr. Chigin).</p> - - -<table class="standard" summary=""> -<tr> -<td class="tdc">Hour.</td> -<td class="tdc">Quantity of juice.<br />c.c.</td> -<td class="tdc">Digestive power.<br />mm.</td> -</tr> -<tr> -<td class="tdc">1st</td> -<td class="tdc">4.2</td> -<td class="tdc">3.57</td> -</tr> -<tr> -<td class="tdc">2nd</td> -<td class="tdc">12.4</td> -<td class="tdc">2.63</td> -</tr> -</table> - - -<p>We have now begun the analytical examination -of the variations of our secretory curve. -But owing to the importance of the matter we -did not confine ourselves to conclusions which -might be drawn from earlier investigations. -We turned to new forms of experiment for -further proof.</p> - -<p>Thus we divided the ordinary ration of flesh -given to our dogs—400 grams—into four equal -parts, which were administered at intervals of -an hour and a half. (Experiments by Privat<span class="pagenum" id="Page_217">[Pg 217]</span> -docent Kotljar and Dr. Lobassoff.) Each time -after the dog received its 100 grams of flesh we -were able to detect a rise both in the quantity -and in the digestive power of the juice. The -following table shows the figures in question:</p> - -<table class="standard" summary=""> -<tr> -<th class="tdc">Half-hour<br />periods.</th> -<th class="tdc">Quantity<br />of juice.</th> -<th class="tdc">Digestive<br />power.</th> -<th class="tdc">Remarks.</th> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br">c.c.</td> -<td class="tdc_br">mm.</td> -<td class="tdc">grms. flesh given.</td> -</tr> -<tr> -<td class="tdc_br">1st</td> -<td class="tdc_br">3.1</td> -<td class="tdc_br">5.13</td> -<td class="tdc">100</td> -</tr> -<tr> -<td class="tdc_br">2nd</td> -<td class="tdc_br">5.0</td> -<td class="tdc_br">4.63</td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdc_br">3rd</td> -<td class="tdc_br">4.7</td> -<td class="tdc_br">4.50</td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdc_br">4th</td> -<td class="tdc_br">5.4</td> -<td class="tdc_br">4.88</td> -<td class="tdc">100</td> -</tr> -<tr> -<td class="tdc_br">5th</td> -<td class="tdc_br">5.5</td> -<td class="tdc_br">3.38</td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdc_br">6th</td> -<td class="tdc_br">4.7</td> -<td class="tdc_br">2.75</td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdc_br">7th</td> -<td class="tdc_br">6.0</td> -<td class="tdc_br">3.75</td> -<td class="tdc">100</td> -</tr> -<tr> -<td class="tdc_br">8th</td> -<td class="tdc_br">5.4</td> -<td class="tdc_br">2.50</td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdc_br">9th</td> -<td class="tdc_br">5.9</td> -<td class="tdc_br">2.50</td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdc_br">10th</td> -<td class="tdc_br">5.4</td> -<td class="tdc_br">3.88</td> -<td class="tdc">100</td> -</tr> -<tr> -<td class="tdc_br">11th</td> -<td class="tdc_br">5.3</td> -<td class="tdc_br">3.0</td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdc_brb">12th</td> -<td class="tdc_brb">4.2</td> -<td class="tdc_brb">2.5</td> -<td class="tdc_bb"></td> -</tr> -</table> - -<p>In the curve which follows, only the variations -of digestive power are represented.</p> - -<p>It is clear that the increase, both of digestive -power and of juice volume, is connected with -the act of taking in food.</p> - -<div class="figright illowp68" id="illus-256" style="max-width: 37.5em;"> - <img src="images/illus-256.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 1.</span>—Curve of digestive power constructed -from the foregoing table.</div> -</div> - -<p>It appeared of interest definitely to determine -the volume and properties of the secretion -called forth by the act of eating in the dog with -the isolated stomach. We endeavoured, therefore, -at the beginning, to imitate the conditions -of sham feeding as they occurred in the case of -the dog with divided œsophagus. In addition -to the fistular orifice leading into the isolated<span class="pagenum" id="Page_218">[Pg 218]</span> -miniature stomach, another was opened into the -main portion of the organ. If we now fed the -dog in the ordinary way with small pieces of -flesh, these were received back again at the -orifice of the latter fistula, covered with saliva. -Precisely as in -sham feeding, -after five minutes -the juice -began to flow -simultaneously, -from both the -large and small -stomachs. The -secretion ran a -corresponding -course in the -two cavities and -ceased at the -same length of -time in both after the administration of food was -stopped. Here is an instance taken from such -an experiment performed by Dr. Lobassoff.</p> - -<p>In five minutes the dog had eaten eighty -pieces of flesh (weighing 172 grams), all of -which soon afterwards dropped out at the fistula. -The secretion began in both stomachs after the -lapse of seven minutes from the commencement -of the feeding, and proceeded as follows:</p> - -<p><span class="pagenum" id="Page_219">[Pg 219]</span></p> - - -<table class="standard" summary=""> -<tr> -<th class="tdc" rowspan="2">Hour.</th> -<th class="tdc" colspan="2">Miniature stomach.</th> -<th class="tdc" colspan="3">Main stomach.</th> -</tr> -<tr> - -<th class="tdc">Quantity<br />of juice.</th> -<th class="tdc">Digestive<br />power.</th> -<th class="tdc">Quantity of<br /> juice.</th> -<th class="tdc">Digestive power.</th> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br">c.c.</td> -<td class="tdc_br">mm.</td> -<td class="tdc_br">c.c.</td> -<td class="tdc">mm.</td> -</tr> -<tr> -<td class="tdc_br">1</td> -<td class="tdc_br">7.7</td> -<td class="tdc_br"> </td> -<td class="tdc_br">83.2</td> -<td class="tdc">5.35 mm.</td> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br"></td> -<td class="tdc_br"></td> -<td class="tdc_br"></td> -<td class="tdc_bb" rowspan="4">In consequence of a mixture with -bile (10-15 c.c.) the digestive power was greatly reduced.</td> -</tr> -<tr> -<td class="tdc_br">2</td> -<td class="tdc_br">4.5</td> -<td class="tdc_brb" rowspan="2">6.25 mm</td> -<td class="tdc_br">58.1</td> -</tr> -<tr> - -<td class="tdc_brb">2½</td> -<td class="tdc_brb">0.6</td> - -<td class="tdc_brb">8.5</td> - -</tr> -</table> - - -<p>The secretion from both cavities also came to -an end at the same time.</p> - -<p>This experiment proves to us, first, that the -main and miniature stomachs work in perfectly -parallel manner with each other. The beginning, -the end, and the intermediate variations of -the secretion correspond in both cases. Secondly, -the digestive power of the secretion -coincides in both, and is the same which was -observed in the so-called sham feeding. It has -here remained at the same height till the cessation -of the secretion, without falling to the -lower value which we observed from the beginning -of the second hour onwards, after normal -flesh feeding.</p> - -<p>This was also confirmed later, when we -performed an œsophagotomy on the dog, and -carried out sham feeding in typical form. Here<span class="pagenum" id="Page_220">[Pg 220]</span> -follows one of these experiments taken from -Dr. Lobassoff’s article.</p> - -<p>The first drop of juice appeared from both -cavities during the sixth minute after commencing -the feeding, which was kept up for half an -hour. The further course of the secretion was -as follows:</p> - -<table class="standard" summary=""> -<tr> -<th class="tdc" rowspan="2">Hour.</th> -<th class="tdc" colspan="2">Miniature stomach.</th> -<th class="tdc" colspan="2">Main stomach.</th> -</tr> -<tr> -<th class="tdc">Quantity<br />of juice.</th> -<th class="tdc">Digestive<br />power.</th> -<th class="tdc">Quantity<br />of juice.</th> -<th class="tdc">Digestive<br />power.</th> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br">c.c.</td> -<td class="tdc_br">mm.</td> -<td class="tdc_br">c.c.</td> -<td class="tdc">mm.</td> -</tr> -<tr> -<td class="tdc_br">1st</td> -<td class="tdc_br">7.6</td> -<td class="tdc_br">5.88</td> -<td class="tdc_br">68.25</td> -<td class="tdc">5.5</td> -</tr> -<tr> -<td class="tdc_br">2nd</td> -<td class="tdc_br">4.7</td> -<td class="tdc_br">5.75</td> -<td class="tdc_br">41.5</td> -<td class="tdc">5.5</td> -</tr> -<tr> -<td class="tdc_br">3rd</td> -<td class="tdc_br">1.1</td> -<td class="tdc_br">5.5</td> -<td class="tdc_br">14.0</td> -<td class="tdc">5.38</td> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br"> ——</td> -<td class="tdc_br">——</td> -<td class="tdc_br">———</td> -<td class="tdc">——</td> -</tr> -<tr> - -<td class="tdc_brb"></td> -<td class="tdc_brb"> 13.5 (total)</td> -<td class="tdc_brb">5.75 (mean)</td> -<td class="tdc_brb">123.75 (total)</td> -<td class="tdc_bb">5.5 (mean)</td> -</tr> -</table> - - -<p>The secretion came to an end in both -stomachs at the same time.</p> - -<p>The above is represented in curves in Figs. -2 and 3, the scale on which that for the main -stomach is drawn being ten times less than that -for the small. As you see, the progress of -secretion is identical in both.</p> - -<p>The existence of a fistula leading into the -large stomach affords us also the possibility of -performing an experiment upon our dog which -is exactly the converse of the sham feeding -experiment, and which constitutes a real <i>experimentum -crucis</i>. While in sham feeding, we had<span class="pagenum" id="Page_221">[Pg 221]</span> -only, so to speak, the beginning of digestion -before us, we are now able in our cross experiment -to start at the continuation of this beginning. -For this purpose it is only necessary to -bring the food into the stomach through the -fistula, without attracting the dog’s attention. -Since in this experiment it is above all necessary -not to excite the dog’s appetite, it is best to -carry out the procedure on the sleeping animal. -I may add at once, however, that the same -result can be obtained on the waking animal, -only the process must be performed unnoticed, -and the animal’s attention must be diverted from -thoughts of food.</p> - -<div class="figleft illowp45" id="illus-259a" style="max-width: 28.125em;"> - <img src="images/illus-259a.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 2.</span>—Curve of secretion -from the miniature stomach.</div> -</div> - -<div class="figright illowp45" id="illus-259b" style="max-width: 21.875em;"> - <img src="images/illus-259b.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 3.</span>—The same from -the main stomach reduced ten -times.</div> -</div> - -<p>The results of this experiment are striking, -and do not in any way resemble the secretion -after normal feeding. Some kinds of food, for -instance bread and coagulated white of the hen’s<span class="pagenum" id="Page_222">[Pg 222]</span> -egg, when directly introduced into the stomach, -do not yield a single drop of juice during the -first hour or more afterwards. This holds good -both for the small and large stomachs. When -a glass rod is introduced into the food contained -in the organ it remains dry. Flesh, if introduced -at this stage, is able to excite a secretion, but -the appearance of the juice is considerably -retarded. It begins from fifteen to forty-five -minutes after the feeding, instead of from six -to ten, is under normal circumstances extremely -scanty during the first hour (3 c.c. to 5 c.c. instead -of 12 c.c. to 15 c.c.), and possesses a -very low digestive power.</p> - -<p>Here is an experiment by Dr. Lobassoff:</p> - - -<table class="standard" summary=""> -<tr> -<th class="nb tdc" colspan="3">400 grms. of flesh were brought into the stomach.</th> -</tr> -<tr> -<th class="nb tdc">Hour.</th> -<th class="nb tdc">Quantity of juice.<br />c.c.</th> -<th class="nb tdc">Digestive power.<br />mm.</th> -</tr> -<tr> -<td class="tdc">1st</td> -<td class="tdc">3.7</td> -<td class="tdc">2.0</td> -</tr> -<tr> -<td class="tdc">2nd</td> -<td class="tdc">10.6</td> -<td class="tdc">1.63</td> -</tr> -<tr> -<td class="tdc">3rd</td> -<td class="tdc">9.2</td> -<td class="tdc">1.5</td> -</tr> -<tr> -<td class="tdc">4th</td> -<td class="tdc">7.0</td> -<td class="tdc">1.88</td> -</tr> -<tr> -<td class="tdc">5th</td> -<td class="tdc">5.6</td> -<td class="tdc">2.25</td> -</tr> -<tr> -<td class="tdc">6th</td> -<td class="tdc">6.6</td> -<td class="tdc">2.63</td> -</tr> -<tr> -<td class="tdc">7th</td> -<td class="tdc">7.5</td> -<td class="tdc">1.88</td> -</tr> -<tr> -<td class="tdc">8th</td> -<td class="tdc">5.3</td> -<td class="tdc">2.0</td> -</tr> -<tr> -<td class="tdc">9th</td> -<td class="tdc">3.0</td> -<td class="tdc">5.0</td> -</tr> -<tr> -<td class="tdc">10th</td> -<td class="tdc">0.2</td> -<td class="tdc">—</td> -</tr> -</table> - - -<p>The secretion began twenty-five minutes after -introducing the food. I now ask you to compare -the following tables:</p> - -<p><span class="pagenum" id="Page_223">[Pg 223]</span></p> - - -<table class="standard" summary=""> -<tr> - -<th class="tdc" rowspan="2">Hour.</th> -<th class="tdc" colspan="2">Fed with 200 grms.<br />of flesh (Chigin).</th> -<th class="tdc" colspan="2">Flesh (150 grms.) brought<br />into stomach (Lobassoff).</th> -<th class="tdc" colspan="2">Sham feeding<br />(Lobassoff).</th> -<th class="tdc" colspan="2">Total quantity<br />of juice in two<br />experiments</th> -</tr> -<tr> -<th class="tdc">Quantity<br />of juice.</th> -<th class="tdc">Digestive<br />power.</th> -<th class="tdc">Quantity<br />of juice.</th> -<th class="tdc">Digestive<br />power.</th> -<th class="tdc">Quantity<br />of juice.</th> -<th class="tdc">Digestive<br />power.</th> -<th class="tdc"></th> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br">c.c.</td> -<td class="tdc_br">mm.</td> -<td class="tdc_br">cc.</td> -<td class="tdc_br">mm.</td> -<td class="tdc_br">cc.</td> -<td class="tdc_br">mm.</td> -<td class="tdc">cc.</td> -</tr> -<tr> -<td class="tdc_br">1st</td> -<td class="tdc_br">12.4</td> -<td class="tdc_br">5.43</td> -<td class="tdc_br">5.0</td> -<td class="tdc_br">2.5</td> -<td class="tdc_br">7.7</td> -<td class="tdc_br">6.4</td> -<td class="tdc">12.7</td> -</tr> -<tr> -<td class="tdc_br">2nd</td> -<td class="tdc_br">13.5</td> -<td class="tdc_br">3.63</td> -<td class="tdc_br">7.8</td> -<td class="tdc_br">2.75</td> -<td class="tdc_br">4.5</td> -<td class="tdc_br">5.3</td> -<td class="tdc">12.3</td> -</tr> -<tr> -<td class="tdc_br">3rd</td> -<td class="tdc_br">7.5</td> -<td class="tdc_br">3.5</td> -<td class="tdc_br">6.4</td> -<td class="tdc_br">3.75</td> -<td class="tdc_br">0.6</td> -<td class="tdc_br">5.75</td> -<td class="tdc">7.0</td> -</tr> -<tr> -<td class="tdc_brb">4th</td> -<td class="tdc_brb">4.2</td> -<td class="tdc_brb">3.12</td> -<td class="tdc_brb">5.0</td> -<td class="tdc_brb">3.75</td> -<td class="tdc_brb">—</td> -<td class="tdc_brb">—</td> -<td class="tdc_bb">5.0</td> -</tr> -</table> - -<p><span class="pagenum" id="Page_224">[Pg 224]</span></p> - -<p>The progress of juice secretion in the above -is also represented in the following curves:</p> - - -<div class="figcenter illowp100" id="illus-262" style="max-width: 62.5em;"> - <img src="images/illus-262.jpg" alt="" /> - <div class="caption"><span class="smcap">Figures 4-7.</span>—A. Ordinary curve of gastric secretion (200 grms. -flesh). B. Curve from direct introduction of food (150 grms. -flesh). C. Sham feeding with same. D. Summation of B and C.</div> -</div> - -<p>As you see, the curve which represents the -results of the direct introduction of flesh ascends -much more slowly and does not attain anything -like the height of that caused by normal feeding -with the same food. But if the quantities -obtained by direct introduction of the flesh be -added to those of sham feeding, the resulting -curve is almost identical with the normal.</p> - -<p>In like manner the digestive power of the -secretion in the foregoing experiments can be -dealt with, and with the same result. It is a -good instance of how a secretion curve can be -synthetically constructed from its constituent -factors.</p> - -<p><span class="pagenum" id="Page_225">[Pg 225]</span></p> - -<p>Finally, I am able to demonstrate to you -the following instructive experiment. In the -presence of some of my listeners, whom I had -invited to attend an hour before the lecture, I -carried out the following procedures on two dogs, -both of which had ordinary gastric fistulæ and -were, besides, œsophagotomised. Into the stomach -of one, while its attention was distracted by -patting and speaking kindly to it in order to -avoid arousing any thoughts of feeding, a definite -number of pieces of flesh were introduced -through the fistula. The morsels were threaded -on a string, the free end of which was fastened -to the fistular cannula by inserting a cork. The -dog was then brought into a separate room and -left to itself. A like number of pieces was introduced -into the stomach of the other dog in the -same way, but during the process a vigorous -sham feeding was kept up, the animal being -afterwards left alone. Each dog received 100 -grams of flesh. Since then an hour and a half -have elapsed, and now we may draw the pieces -of flesh out by means of the thread and weigh -them. The loss of weight, and consequently the -amount of flesh digested, is very different in the -two cases. In that of the dog without sham -feeding the loss of weight amounts to merely 6 -grams, while the flesh withdrawn from the stomach -of the other dog weighs only 70 grams, that<span class="pagenum" id="Page_226">[Pg 226]</span> -is to say, was reduced by 30 grams. This, therefore, -represents the digestive value of the passage -of food through the mouth, the value of an -eager desire for food, the value of an appetite.</p> - -<p>I give also a series of figures obtained by -Dr. Lobassoff in analogous experiments. Into -the dog’s stomach 25 pieces of flesh (100 grams) -were brought. The flesh remained two hours -in the cavity. Without sham feeding 6.5 per -cent, with eight minutes’ sham feeding 31.6 per -cent, of the quantity was digested.</p> - -<p>Again: the flesh remained an hour and a -half in the stomach; without sham feeding 5.6 -per cent, with five minutes’ sham feeding 15 -per cent, was digested.</p> - -<p>Once more: the flesh remained five hours -in the stomach; without sham feeding 58 per -cent, with sham feeding 85 per cent, was digested, -the balance of undigested food being 42 -per cent in the one case and 15 per cent in the -other.</p> - -<p>I must, however, add that from the nature -of this experiment it is not well adapted for -class demonstration, and may often fail. On the -one hand, it is not at all easy to conceal the -introduction of the flesh from the dog; on -the other, the unusual and distracting surroundings -of the animal often causes a short period -of sham feeding to have less effect than would<span class="pagenum" id="Page_227">[Pg 227]</span> -otherwise pertain. In order to avoid such failures -it is better before an audience to carry -out this experiment only on dogs accustomed -to appear in the lecture theatre, and of whose -temperament the experimenter is well assured.</p> - -<p>I hope you have now been convinced of the -great importance which is to be attached to the -passage of food through the mouth and œsophagus, -or, in other words—and this, according to -our former experiences, means the same thing—to -the eager desire for food. Without this -longing, without the assistance of appetite, -many forms of food-stuffs which gain entry to -the stomach remain wholly devoid of gastric -juice. Others, it is true, excite a secretion, but -the juice poured out is scanty and weak.</p> - -<p>It is only later, when we have still more -fully recognised the conditions upon which the -secretory work of the gastric glands depends, -that we shall be able to grasp the meaning of -these facts in a more comprehensive manner. -For instance, why does bread brought unnoticed -into the stomach of the dog cause no secretion -for hours, while flesh tolerably soon (after -twenty to forty minutes) provokes this act? -This will be explained in the next lecture; now, -however, we must consider other questions.</p> - -<p>How long does the after-effect, the echo of -the first impulse to the secretory nerves of the<span class="pagenum" id="Page_228">[Pg 228]</span> -stomach, continue to last? How long does appetite -juice continue to flow after the normal act -of eating, which, especially in the case of animals, -is not of long duration? We have already -determined many times, not only on our dog -with the isolated stomach, but also on other animals, -how long the after-effect of sham feeding -is continued.</p> - -<p>Here, for example, is an experiment from -the article of Professor Ssanozki which deals -with the point. The dog had a gastric fistula -and also an opening leading into the œsophagus. -After a sham feeding of five minutes the -secretion began, and was continued as follows:</p> - - -<table class="standard" summary=""> -<tr> -<th class="nb tdc">Time in<br />minutes.</th> -<th class="nb tdc">Quantity.</th> -<th class="nb tdc">Digestive<br />power.</th> -</tr> -<tr> -<td class="tdc"></td> -<td class="tdc">c.c.</td> -<td class="tdc">mm.</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">25.5</td> -<td class="tdc">8.1</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">20.0</td> -<td class="tdc">8.0</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">13.5</td> -<td class="tdc">6.8</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">11.0</td> -<td class="tdc">7.5</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">8.5</td> -<td class="tdc">8.1</td> -</tr> -<tr> -<td class="tdc">10</td> -<td class="tdc">6.5</td> -<td class="tdc">9.0</td> -</tr> -<tr> -<td class="tdc">20</td> -<td class="tdc">13.5</td> -<td class="tdc">7.4</td> -</tr> -<tr> -<td class="tdc">20</td> -<td class="tdc">11.0</td> -<td class="tdc">7.2</td> -</tr> -<tr> -<td class="tdc">20</td> -<td class="tdc">7.0</td> -<td class="tdc">7.2</td> -</tr> -<tr> -<td class="tdc">20</td> -<td class="tdc">11.5</td> -<td class="tdc">6.8</td> -</tr> -<tr> -<td class="tdc">20</td> -<td class="tdc">11.0</td> -<td class="tdc">6.5</td> -</tr> -<tr> -<td class="tdc">30</td> -<td class="tdc">6.5</td> -<td class="tdc">7.6</td> -</tr> -<tr> -<td class="tdc">20</td> -<td class="tdc">5.5</td> -<td class="tdc">7.2</td> -</tr> -</table> - -<p>The effect, therefore, even after a short -period of sham feeding, stretches over a length -of time. Naturally the same holds good for the -taking of food in the normal way. One must,<span class="pagenum" id="Page_229">[Pg 229]</span> -however, bear in mind that in sham feeding, -with all the force and reality of a hunger sensation -not satisfied, the eager desire for food, -the effective agency, becomes more and more -accentuated, and therefore the secretory influence -is prolonged and more powerful. In -normal feeding, however, the quelling of the -longing, the feeling of satisfaction which, as is -well known, sets in long before the termination -of the digestive period from the mere filling and -distension of the stomach, must diminish the -desire for food, and, consequently, bring the -secretory effect to an end.</p> - -<p>It is, therefore, improbable that the whole -secretory process in the stomach, which, in the -case of certain kinds and quantities of food, -lasts from ten to twelve hours, is dependent on -the factors which we have up to the present -investigated. This is all the more obvious since -a sham feeding of five minutes, even under the -most favourable circumstances, does not call -forth a secretion for longer than three to four -hours. We must, therefore, seek for other exciting -agencies of the innervation apparatus of -the gastric glands.</p> - -<p>Why and wherefore is the secretion instituted -by psychic influence maintained? What -would first occur to all your minds is naturally -the immediate influence which the food exerts<span class="pagenum" id="Page_230">[Pg 230]</span> -upon the walls of the stomach. And this is -true, but it does not happen in the simple, direct -fashion current in the minds of many physiologists -and physicians. When I said that bread -or boiled white of egg, introduced directly into -the stomach, may not for hours produce a trace -of secretion, probably many of my hearers may -have asked themselves with natural astonishment, -“How, then, is the effect of the forced -feeding of phthisical and insane patients, and -the artificial feeding of those with gastric fistulæ -(performed on account of stricture of the -œsophagus) to be explained?” I will introduce -my answer by a very unexpected pronouncement -relative to the assertion that mechanical -stimulation of the stomach wall by food constitutes -a reliable and effective means of calling -forth the secretory work of the glands. This -assertion, which is so categorically set forth in -many text-books of physiology, and which consequently -has gained hold of the mind of the physician, -is nothing else than a sad misconception -degenerated into a stubborn prejudice. My -own statement, repeated in many published articles, -and at the meetings of various medical societies, -that this dictum is only a picture of the -imagination, has met, for the most part, either -with an unbelieving shake of the head or else -with a direct avowal that “it cannot be so.” I<span class="pagenum" id="Page_231">[Pg 231]</span> -regret exceedingly that these steadfast unbelievers -are not here, so that we might together -bring the matter before the tribunal of fact, to -the demonstration of which we will now proceed. -To this matter I attribute very great importance. -It is on this ground, according to my opinion, -that the whole battle must be fought out between -the generally accepted view that every -agency is capable of exciting the gastric mucous -membrane and the theory that it is only -excitable by specific and selected stimuli. If -once the defenders of the old opinion are driven -from their position and obliged to admit the -inefficiency of mechanical stimulation, there -would be nothing further left for them than to -build up new theories and search out old facts -concerning gland work which have hitherto been -rigidly kept in the shade. We may take it that -it is mainly because people were so seized with -the belief in the direct and simple mechanical -explanation that Bidder and Schmidt’s experiment -of the excitation of gastric secretion by -mental effect has been so little taken into consideration, -notwithstanding that it appeared so -thoroughly reliable and convincing.</p> - -<p>I will now repeat the experiment of mechanical -stimulation of the gastric mucous membrane -before you in the well-known, traditional, and -classic manner. Here is a dog with a gastric<span class="pagenum" id="Page_232">[Pg 232]</span> -fistula on which a cervical œsophagotomy has -in addition been performed. I open the fistula; -as you see, nothing flows out of the stomach; -it was washed out clean with water an hour ago. -We take the celebrated feather and also a tolerably -strong glass rod. Folds of blotting-paper -saturated with red and blue tincture of litmus -are placed at hand. I now ask my assistant to -continuously move the feather and glass rod, -alternately, in all possible directions in the -stomach, changing from one to the other every -five minutes. On removal from the stomach -each is carefully dried with red and blue blotting-paper. -You have all seen, gentlemen, that -this procedure has now been kept up for half an -hour. From the fistular orifice not even a single -drop has escaped, and, moreover, the drops -of moisture on all the pieces of red blotting-paper -I have been able to hand to you have -assumed a distinct blue tinge, caused by the -moisture of the alkaline mucous membrane. -The blue pieces, however, have merely been -made wet without altering their colour. Consequently, -with the most thorough mechanical -stimulation of the whole cavity of the stomach, -we have not been able to find a single spot -possessing a noticeable acid reaction. Where, -then, are the streams of pure gastric juice of -which we read in text-books! What objection<span class="pagenum" id="Page_233">[Pg 233]</span> -can be raised against the conclusiveness of this -experiment? In my opinion only one: that we -are dealing with a dog out of health, whose gastric -glands from some possible cause are unable -to react normally. This single objection can -be set aside before your eyes. After failing -with the mechanical stimulation, we proceed -forthwith to the sham feeding of the same animal. -The dog takes the food offered it with -keen appetite, and you see that, exactly five -minutes after beginning the feeding, the first -drops of juice appear from the stomach, followed -by others faster and faster. I catch a couple -of drops on the blue litmus paper, and you see -that they produce bright red specks on the blue -sheet. After thirty minutes’ sham feeding we -have collected 150 c.c. of juice, which, without -filtering, looks as clear and transparent as -water.</p> - -<p>We cannot, therefore, possibly doubt that, -when the proper stimulus is used, the gastric -glands react to it in a perfectly normal fashion, -furnishing a healthy gastric juice. From this it -irrefutably follows that only one explanation is -to be found for the negative result in the first -half of our experiment, viz., that the mucous -membrane of the stomach, so far as secretory -activity goes, is perfectly indifferent to mechanical -excitation. And yet this mechanical stimu<span class="pagenum" id="Page_234">[Pg 234]</span>lus -is demonstrated as an exciting agency in -the physiological lecture theatre. I venture to -think that this lecture experiment from now onwards -will quit the field, and give place to the -one I have just shown you. This apparently -simple experiment of mechanical stimulation -can, however, only be successfully performed -when certain very obvious rules are followed. -These, however, physiologists have not observed, -probably on account of a preconceived belief -in the effectiveness of the mechanical stimulus. -These rules are two. First, it is necessary that -the stomach should be clean, and that nothing -shall gain entry to it from without. Such conditions -were not formerly fulfilled. It is true -the stomach was emptied by removing the -stopper from the fistular cannula, but it was not -washed out till an acid reaction was no longer -given, and consequently preformed gastric juice -was left behind between the folds of the mucous -membrane. At the same time saliva from the -cavity of the mouth could gain entry, which -quickly became acidified in the incompletely -emptied and imperfectly washed-out organ. It -is, therefore, not surprising that the glass tube, -by setting up contractions of the stomach, was -the means of expressing small quantities of -acid fluid from the fistula-tube. (The relationship -between mechanical stimulation and the<span class="pagenum" id="Page_235">[Pg 235]</span> -motor functions of the stomach is not to be confounded -with what we are here speaking of.) -That matters are as I state, and that the facts -correspond to the explanation is proved by -this; namely, that nobody till now has obtained -genuinely pure gastric juice of an acidity -amounting to 0.5 or 0.6 per cent. It is only -necessary to call to mind that Heidenhain, when -determining the acidity of the juice first obtained -from the resected stomach, was placed in -no little doubt as to whether his results (0.5 to -0.6) were correct, and his assistant at the time -(Gscheidlen) was set to verify the correctness -of his standard solutions. The acidity of the -“purest” juice known at that time was scarcely -0.3 per cent. As a further proof that none of -the older observers ever really obtained a secretion -from mechanical stimulation pure and simple, -we may adduce the fact that none of them -made mention of the constant and precise period -of five minutes’ latency. To overlook this was -not possible if a genuine excitation of the -glands had been obtained.</p> - -<p>Of no less importance is the second condition -when we wish to perform the experiment -of mechanical stimulation in the correct way. -It is very necessary that the gastric glands be -not already in activity at the beginning of the -experiment, and also that during the experi<span class="pagenum" id="Page_236">[Pg 236]</span>ment -no impulse comes into play, which of -itself, apart from mechanical excitation, could -excite the glands to secretion. Nor have we -any proof that observers formerly waited for -hours before commencing the experiment and -convinced themselves that the gastric glands -had ceased working. On the contrary, we have -not the slightest evidence to indicate that the -authors had attempted to guard against accidental -psychical stimulation of the glands—a -matter which we have seen is of considerable -difficulty. And some dogs are so easily excited -in this way that it is almost impossible to bring -their glands to rest, or at least it is necessary to -wait for hours. The experimenter must strain -his whole attention to preserve such an experiment -free from objection. It is only necessary -that some food be near the dog, or that the -hands of the attendant who has prepared the -food should smell of it, or that some other -similar circumstance should come into play, -and the glass tube, quite undeservedly, will be -made answerable for the excitation of the gastric -glands. As you have just seen, both of our -conditions have been fulfilled on the dog before -you, and the result of the experiment stands -in irreconcilable contradiction to those of the -laboratory and lecture experiment of former -times.</p> - -<p><span class="pagenum" id="Page_237">[Pg 237]</span></p> - -<p>The importance of the experiment, which I -have already dwelt upon, justifies me in making -still further demands upon your attention in -order to show you two modifications of it. -Nobody has as yet said, with regard to mechanical -stimulation, that in order to obtain results -the mechanical agency must simultaneously come -into contact with numerous points of the inner -surface of the stomach. But in order to meet -this possible objection I will now show you two -new modifications. Again a similar dog is -used, that is to say, one on which both gastrotomy -and œsophagotomy have been performed. -The stomach has been washed out clean and is -at present in a state of complete rest. Into the -fistula I bring a thick glass tube containing a -number of small openings (2 to 3 mm. diameter) -at its rounded end. The other end of the tube -is connected with a glass ball containing tolerably -coarse sand. Leading into the ball is a -second tube, with which an india-rubber pump -can be connected and a blast of sand blown -through. By rhythmic compression of the india-rubber -ball I inject sand with considerable force -into the stomach, and this play is kept up for -ten to fifteen minutes; nevertheless, we see no -trace of gastric juice. The sand falls out again -between the side of the cannula and the glass -tube, and it is either dry or scarcely moistened,<span class="pagenum" id="Page_238">[Pg 238]</span> -but in no case is it able to turn blue litmus red. -And yet we are here dealing with a strong and -widely diffused stimulus. Look for a moment -at the performance of the bellows outside the -stomach. From every opening of the tube—numbering -considerably more than ten—a -strong stream of sand is ejected. If you hold -your hand against it, you feel quite distinctly -that the grains of sand strike with considerable -force. And now, when our experiment is ended, -we may convince ourselves by sham feeding, in -easy and unquestionable fashion, that the innervation -of the dog’s stomach is perfectly normal.</p> - -<p>Yet another experiment on a similar dog. -Into its empty and resting stomach an india-rubber -ball is introduced. This is distended with -air by means of a syringe till it is as large as a -child’s head and maintained in this condition for -a time, afterwards being allowed to collapse. -The procedure is kept up for ten to fifteen -minutes. During this time not a single drop of -juice has appeared from the stomach. The surface -of the ball taken out of the organ is everywhere -alkaline. And here also subsequent sham -feeding shows that the dog is in a suitable condition -for the experiment. I must add that in -making this observation the dog must not be -too hungry, that is to say, must have been fed -within ten to twelve hours before, otherwise a<span class="pagenum" id="Page_239">[Pg 239]</span> -psychic excitation of the secretion can readily -be induced.</p> - -<p>If one dispassionately regards this question, -and if any of our methods for the study of gastric -secretion are reliable, one must be convinced -step by step in the laboratory of the -uselessness of mechanical stimulation. In the -case of dogs with an ordinary gastric fistula, -and failing some special reason, not a drop of -gastric juice ever escapes from the stomach -other than during the digestive period. How -could this be the case if the mechanical stimulus -were effective, since the inner rim of the -fistula-tube is continuously in contact with the -gastric mucous membrane? The same holds -good for the dog with resected stomach. During -the experiment a glass or india-rubber tube -is brought sufficiently far into the <i>cul-de-sac</i> to -catch the juice, and yet not a drop flows through -the tube, nor does its inner surface ever become -acid, so long as true secretory conditions are -absent. Moreover, the tube has tolerably often -to be taken out and set right.</p> - -<p>In the ordinary gastric fistula in dogs, when -the operation has lasted a long time—over a -year—folds of mucous membrane are often -formed in the neighbourhood of its inner orifice -which completely close the tube. In these cases -a long, thick, perforated metal tube has to be<span class="pagenum" id="Page_240">[Pg 240]</span> -passed in deeply, and yet the manipulation of -itself never calls forth a secretion. Further, it -is a daily occurrence to find in the stomach of -the dog thick rolls of hair, and yet their presence -in no way hinders the arrest of the secretion, -which occurs when digestion has ceased. -Such an occurrence would have been specially -obvious in our dog with the isolated stomach, -since it was bedded with sawdust in order to -guard against maceration of the wound by juice -trickling out. Very often we found enormous -quantities of sawdust in the stomach, as much -as half a pound weight; obviously the dog had -licked the wound from adherent sawdust, which -it then swallowed, together with that sticking -to its nose. And yet these particles of sawdust -of themselves, which certainly acted as mechanical -stimuli, never caused a secretion. It appears -to me that this long series of facts ought to -suffice to carry the supposition to its grave -that by direct mechanical stimulation one is -able to set the neuro-secretory apparatus of the -stomach into activity.</p> - -<p>And yet the feather and the glass tube -continue the even tenor of their ways to this -moment and function in some text-books, yea, -even in articles which specially treat of gastric -secretion as exciters of the gastric glands. -There are, it is true, a few physiologists who<span class="pagenum" id="Page_241">[Pg 241]</span> -hold mechanical stimulation, in relation to gastric -secretion, not to be very effective, and give -it a subordinate position in the series of exciting -agencies, but as yet I know of no other physiologist -who has wholly denied its influence, and -who has not held it possible to obtain at least -some juice by it.</p> - -<p>To conclude this lecture, we will take into -consideration a question connected with the -matter we have just discussed. Since the contact -of food with the gastric mucous membrane -has no direct influence on the secretion, is its -entry into the stomach devoid of all connection -with the secretory process?</p> - -<p>It can hardly be doubted that, under normal -conditions, the stomach is the seat of certain -definite sensations, that is to say, its surface has -a certain degree of tactile sensibility. This sensation -is, as a rule, very weak, and the majority -of people become accustomed to pay no heed -to it in the normal course of digestion. They -obtain their sensations of general well-being, -and especially of satisfaction from the enjoyment -of food, without taking cognisance of the -factors contributing to them. The feeling of -general hunger, however, is referred solely to -the stomach.</p> - -<p>On the other hand, all of us have met with -men who could describe exactly, and with gusto,<span class="pagenum" id="Page_242">[Pg 242]</span> -how they were able to follow a special tit-bit, -or a mouthful of a favourite wine, the whole -way through the œsophagus down to the -stomach, especially when the latter happened -to be empty. Naturally the gourmand, who -directs his attention continuously to the act of -eating, can in the end distinctly perceive sensations, -and even call them up to the consciousness, -which in other people are normally -masked by other sensations and impressions. -We may therefore take it that the satisfaction -derived from eating is caused not only by -stimulation of the mouth and throat, but also -by impulses awakened by the passage of the -food along the deeper portions of the œsophagus -and by its entry into the stomach. In other -words, food which merely passes through the -mouth and throat produces less enjoyment and -excites, therefore, a less feeling of appetite than -the food which passes the whole way into the -stomach. The appetite, the eager craving after -food, is, indeed, a very complex sensation, and -often not merely the need of the organism for -food material is necessary for its excitement, -but also a condition of thorough well-being, -together with a normal healthy feeling in all -parts of the digestive tract. For this reason -it is easy to understand how patients who have -diseased sensations in these organs, and who<span class="pagenum" id="Page_243">[Pg 243]</span> -have no feeling of appetite, no desire for food, -remember the sensations, whether consciously -or unconsciously, even when they are no longer -present. Cases are known to neuro-pathologists -where people with gastric anæsthesia -suffered from this loss of appetite. Such -patients are no longer conscious of having -stomachs, and dislike the idea of eating because -the food, as they express it, appears to fall into -a strange empty sack. In this way one can also -conceive how the appetite becomes lost in cases -of long-continued obstruction of the alimentary -tube. The patients forget their stomachs, and -in such instances direct introduction of food into -the organ, after an operation, may suddenly -bring back the appetite.</p> - -<p>As a further illustration, I may be permitted -to give an instance from my own personal experience. -After an illness with which a transient -but high fever was associated, although -otherwise fully recovered, I had lost all desire -for food. There was something curious in this -complete indifference towards eating. Perfectly -well, I only differed from others in that I could -with ease abstain from all food. Fearing that -I should collapse, I resolved on the second or -third day to endeavour to create an appetite by -swallowing a mouthful of wine. I felt it quite -distinctly pass along the œsophagus into the<span class="pagenum" id="Page_244">[Pg 244]</span> -stomach, and literally at that moment perceived -the onset of a strong appetite. This observation -teaches that the tactile sensation of the stomach -at the moment of entry of food is capable of -awakening or increasing the appetite. It is -known that withholding food from the organism, -or in other words the creation of a necessity -for food, does not lead immediately, nor in -all cases, to the production of an appetite, to a -passionate craving for food. How often does -it happen that the ordinary hour for a meal has -struck, and yet, owing to some keenly interesting -occupation, not the least desire for food is felt? -It is known to everybody, indeed it has become -a proverb, that real appetite first sets in with -eating. If this be true, the initial impulse towards -awakening an appetite may originate in the -stomach and not in the buccal cavity. When -we spoke above of the desire for food being the -excitant of the secretory nerves of the stomach, -we naturally meant the passionate and conscious -longing for food, that which is called “appetite,” -and not the latent need of the organism for -nourishment, the lack of nutrition, which has -not yet been transformed into a concrete passionate -desire. A good example which enables -us to differentiate between these two factors is -furnished by our dogs with sham feeding. The -necessity for food exists in such cases even<span class="pagenum" id="Page_245">[Pg 245]</span> -before the experiment; the juice, however, only -begins to flow as soon as this need has taken -the form of a passionate longing. It is therefore -quite possible that in the case of some -dogs, and at a certain stage of hunger, the -touching of the gastric mucous membrane with -any object at hand, its mechanical excitation, -its distension by the food mass, may give the -impulse which excites the appetite, and when -the appetite is awakened the juice flows. This -is possibly a third reason why, in the old experiment, -the mechanical stimulus came to be -considered effective. Viewed from this point -it may, to a certain degree, lead to a reconciliation -between my assertion concerning the inefficiency -of the mechanical stimulus and the -generally prevailing belief. I further also admit -that mechanical excitation will at times call into -play the work of the gastric glands, not however -directly by means of a simple physiological -reflex, but indirectly, after it has first awakened -and enlivened the idea of food in the dog’s consciousness, -and thereby called forth the passionate -desire. I hope that the foregoing will in no -way lead to a confusion of ideas in your minds, -but will assist you to an exact and concrete -analysis of the previous simple explanation of -the facts. This representation, which bears -more or less of a hypothetical character, could,<span class="pagenum" id="Page_246">[Pg 246]</span> -of course, be submitted to experimental proof. -For such it is only necessary to compare the -influence which sham feeding exercises in an -œsophagotomised dog with that in one having -a simple gastric fistula.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_247">[Pg 247]</span></p> - -<h3 class="nobreak" id="LECTURE_VIII">LECTURE VIII<br /> - - -<small>PHYSIOLOGICAL ACTION AND THE TEACHING -OF INSTINCT: EXPERIENCES OF -THE PHYSICIAN</small></h3> -</div> - -<div class="blockquot"> - -<p>It would be desirable, in the interests of medicine, that -the methods described in these lectures should be -employed in experimental investigations into the pathology -and therapeutics of the digestive canal on the -lines laid down—The fact that the beginning of the -secretory work in the stomach depends upon a psychic -effect harmonises with the experiences of every-day -life, namely, that food should be eaten with attention -and relish—To restore the appetite has from all ages -been the endeavour of the physician—The indifference -of the present-day physician towards appetite—Probable -causes of this—Curative remedies based upon a restoration -of appetite—The therapeutic effects of bitters -depend upon the excitation of appetite—The usages -of the mid-day meal are in agreement with physiological -requirements—Physiological reasons for certain instinctive -customs and empirical regulations—Importance -of an acid reaction of the food—Dietetics of fat and -its therapeutic application—The peculiar position of -milk among food-stuffs is based on physiological reasons—Explanation -of the curative effects of sodium bicarbonate -and sodium chloride—The causes of individual -differences in the work of the digestive glands—Participation -of the inhibitory nerves of secretion in the -production of pathological effects.</p> -</div> - - -<p><span class="smcap">Gentlemen</span>,—To-day we shall endeavour to -bring the previously communicated results of<span class="pagenum" id="Page_248">[Pg 248]</span> -our laboratory investigations into reconciliation -with the customs observed in the ingestion of -food, and with the regulations prescribed by the -physician in disorders of the digestive apparatus. -To bring our knowledge to full fruition, and so -secure for it the most useful application, the -same methods should be applied from the same -standpoint to the experimental investigation of -the pathology and therapeutics of the alimentary -canal. Nor should we be likely to encounter -insuperable difficulties. Thanks to the advances -of bacteriology, many of the pathological processes -can now be experimentally produced in -the laboratory. Moreover, we would, in a sense, -have to deal with external ailments, since our -present methods enable us to obtain access to -any desired part of the inner surface of the -digestive canal. In such pathological animals -the functional diseases of the apparatus could -be studied in a precise and detailed manner; -that is to say, the alterations of secretory -activity, the properties of the fluids, and the -conditions under which they appear could be -examined. On such animals therapeutic remedies -could also be tested, the whole process of -healing and the final result experimentally -observed, while the conditions of secretory -activity during every phase of the healing -process could be investigated. It can hardly<span class="pagenum" id="Page_249">[Pg 249]</span> -be doubted that scientific, that is to say ideal, -medicine, can only take its proper position as -a science when, in addition to an Experimental -Physiology and Pathology, there has also been -built up an Experimental Therapeutics. A -proof that this is possible is furnished by the -recent vigorous strides made by the science of -bacteriology.</p> - -<p>I have already described one of such pathological -therapeutic experiments; namely, on the -dog whose vagi nerves were divided in the neck. -Other similar cases I can also call to mind. -Our dog with the two stomachs suffered at one -time from a slight and transitory gastric catarrh. -It was then very interesting to observe that the -pathological process (which we were usually -able to wholly guard against) spread from the -large to the small stomach. It manifested itself -here in an almost continuous slimy secretion -of very slight acidity, but of strong digestive -power. At the beginning of the ailment, indeed -before it became fully established, the psychic -stimulation was remarkably effective (that is to -say, still furnished juice in appropriate quantity), -while local excitants almost completely failed. -One may conceive that the deeper layers of the -mucous membrane with the gastric glands were -still healthy, and thus easily thrown into activity -by central impulses, whilst the surface of the<span class="pagenum" id="Page_250">[Pg 250]</span> -membrane with the end apparatus of the centripetal -nerves was already distinctly damaged. -I mention these, which I may call impressions -rather than precise observations, because I -wish to point out what a fruitful field awaits the -investigator who wishes to study, with the aid -of our present methods, the pathological conditions -of the digestive organs and their treatment. -Such an investigation is all the more desirable -because clinical study of the same subject -(notwithstanding the zeal devoted to it during -the last ten years and the results derived therefrom) -has to contend with serious difficulties. -We must not forget that the sound or stomach-tube, -the chief clinical instrument, is more -uncomfortable than the ordinary form of gastric -fistula which was previously practised on animals, -and yet the physiology of the stomach, -even with the aid of the latter, made no material -progress for many long years. Nor is this -difficult to understand. The investigator obtained -through the fistula a mixture of substances -from which it was difficult, or even at -times impossible, to decide anything.</p> - -<p>Hence the exact scientific study of therapeutic -questions in this region still belongs to the -future. But this does not exclude the probability -that the newer acquirements of physiology -may fruitfully influence the work of the<span class="pagenum" id="Page_251">[Pg 251]</span> -physician. But physiology naturally can make -no pretence to guide the field of medicine, -since the knowledge at its disposal is incomplete -and is much more restricted than that of the -broad world of clinical reality. As a recompense -for this, however, physiological knowledge -is often able to explain the causation of an -illness and the meaning of empirical curative -methods. To employ a remedy the mode of -action of which is not clear is quite a different -thing from knowing precisely what we are -doing. In the latter case the treatment of the -diseased organ will be more effective because -it will be better adapted to the special needs of -the case. It is thus that medicine, being daily -enriched by new physiological facts, will at -length grow into what it ideally must become; -namely, the art of repairing the damaged -machinery of the human body, based upon -<i>exact</i> knowledge, or, in other words, applied -physiology.</p> - -<p>We may now return to our subject. If it -be at all admitted that human instinct is the -outcome of an every-day experience, which has -led to the unconscious adoption of the most -favourable conditions for life, it is particularly -so with regard to the phenomena of digestion. -The expression that physiology merely confirms -the precepts of instinct is justified here more<span class="pagenum" id="Page_252">[Pg 252]</span> -than anywhere else. It appears to me also -that, in relation to the foregoing facts, instinct -has often made out a brilliant case when brought -before the tribunal of physiology. Perhaps the -old and empirical requirement, that food should -be eaten with interest and enjoyment, is the -most imperatively emphasised and strengthened -of all. In every land the act of eating is connected -with certain customs designed to distract -from the business of daily life. A suitable -time of day is chosen, a company of relatives, -acquaintances, or comrades assemble. Certain -preparations are carried out (in England a -change of raiment is usually effected, and often -a blessing is asked upon the meal by the oldest -of the family). In the case of the well-to-do a -special room for meals is set apart, musical and -other guests are invited to while away the time -at meals—in a word, everything is directed to -take away the thoughts from the cares of daily -life, and to concentrate them on the repast. -From this point of view it is also plain why -heated discussions and serious readings are held -to be unsuitable during meal-times. Probably -this also explains the use of alcoholic beverages -at meals, for alcohol, even in the lighter phases -of its action, induces a mild narcosis, which contributes -towards distraction from the pressing -burden of the daily work. Naturally this highly<span class="pagenum" id="Page_253">[Pg 253]</span> -developed hygiene of eating is only found in the -intelligent and well-to-do classes, first, because -here the mental activity is more strained and -the various questions of life more burning; and -secondly, because here also the food is served in -greater quantity than is required for the wants -of the organism. In the case of the poorer -classes, where mental activity is less highly -developed, the greater amount of muscular -activity and the constant lack of more than -sufficient nourishment insure a strong and lively -desire for food in a normal manner, without recourse -to any special regulations or customs. -The same conditions explain why the preparation -of food is so choice in the case of the upper -classes and so simple in that of the lower. -Further, all the accessories of the meal, which -are foretastes of the actual repast, are obviously -designed to awaken the curiosity and interest, -and to augment the desire for food. How often -do we see that a person who begins his customary -meal with indifference afterwards enjoys it -with obvious pleasure when his taste has been -awakened by something piquant or, as we say, -appetising. It was here only necessary to give -an impulse to the organs of taste, that is, to -excite them, in order that their activity might -be later maintained by less powerful excitants, -for a person who feels hungry such extra in<span class="pagenum" id="Page_254">[Pg 254]</span>ducements -are, of course, not necessary. The -quelling of hunger in his case affords of itself -sufficient enjoyment. It is not, therefore, without -reason that it is often said that “Hunger is -the best sauce.” This dictum, however, is only -right up to a certain point, for some degree of -appetising taste is desired by everybody, even -by animals. Thus, a dog which has not fasted -for more than some hours will not eat everything -with equal pleasure which dogs usually -eat, but will seek out the food which it relishes -best. Hence the presence of a certain kind of -spice is a general requirement, although naturally -individual tastes differ.</p> - -<p>This short discussion as to how different -people behave with regard to the act of eating -is of itself testimony that care should ever be -taken to keep alive the attention and interest -for food and to promote enjoyment of the -repast—that is to say, that care should be -taken of the appetite. Every one knows that a -normal, useful food is a food eaten with appetite, -with perceptible enjoyment. Every other -form of eating, eating to order or from conviction, -soon becomes worse than useless, and the -instinct strives against it. One of the most -frequent requests addressed to the physician is -to restore the appetite. Medical men of all -times and of every land have held it to be a<span class="pagenum" id="Page_255">[Pg 255]</span> -pressing duty, after overcoming the fundamental -illnesses of their patients, to pay special attention -to the restoration of the appetite. I believe -that in this they are not only animated by an -endeavour to free their patients from troublesome -symptoms, but also by the conviction that -the return of appetite of itself will favour the -restitution of normal digestive conditions. It -may be said that to the same extent to which -the patient wishes back his appetite the physician -has effectively employed measures to restore -it. Hence we have not a few remedies -which are specially named “gastric tonics,” -and whose action is to promote appetite. Unfortunately -medical science has latterly deviated -from this, the correct treatment of the appetite, -and that which corresponds to the real conditions. -If one reads current text-books on disorders -of digestion, it is remarkable how little -attention is paid to appetite as a symptom or to -its special therapy. Only in a few of them is -its importance indicated, and then merely in -short, parenthetic phrases. On the other hand, -one may meet statements in which the physician -is recommended to adopt no special means for -counteracting so unimportant a subjective symptom -as a bad appetite! After what I have said -and demonstrated to you in these lectures, one -can only designate such views as gross miscon<span class="pagenum" id="Page_256">[Pg 256]</span>ceptions. -If anywhere, it is precisely here that -symptomatic treatment is essential. When the -physician finds it necessary, in disorders of -digestion, to promote secretory activity by -different remedies, this object can most certainly -and completely be achieved by endeavouring to -restore the appetite. We have already seen -that no other excitant of gastric secretion, so far -as quantity and quality of the juice are concerned, -can compare with the passionate craving -for food.</p> - -<p>To a certain degree we can understand—and -this contributes to an explanation of matters—how -medical science of our time has -come to regard so lightly the loss of appetite -as a special object for treatment. Now, however, -the experimental method has penetrated -more and more into medical science, with the -result that many pathological factors and therapeutic -agents are judged of according to whether -they hold good in the laboratory or not—that -is to say, they are valued only in so far as they -can be verified by laboratory experiments. -Naturally we do not doubt that a movement in -this direction indicates a great advance, but -even here, as with every undertaking of mankind, -things do not proceed without mistakes -and exaggerations. We must not consider an -event to be a mere picture of the imagination<span class="pagenum" id="Page_257">[Pg 257]</span> -because it is not realisable under given experimental -conditions. We often do not know all -the essential conditions for the production of -the phenomenon in question, nor are we yet -able to grasp the connection between all the -separate functions of life as fully as may be -desired. Thus in the clinical treatment and -pathology of digestion assistance was sought -for in the laboratory, but nothing was there met -with which had a relation to appetite, and consequently -this factor was overlooked in medical -practice. As stated above, the psychic gastric -juice obtained only cursory mention in physiology, -and this not even by all authors; and -when it was noticed it was related more as a -curiosity. Great importance was, on the other -hand, assigned to the mechanical stimulus, the -efficiency of which, now that our knowledge is -more complete, has been shown to be purely -imaginary. Each of the contending factors has -at length been assigned its proper place, and -if clinical medicine maintains her worthy desire -of following out the experimental investigation -of her problems, she must in actual practice -accord to appetite its old claim for consideration -and treatment.</p> - -<p>But notwithstanding the indifference of -physicians to appetite in itself, many therapeutic -measures are based on the promotion of it.<span class="pagenum" id="Page_258">[Pg 258]</span> -And in this the truth of empiricism makes itself -irresistibly felt. When the patient is enjoined -to eat sparingly, or when he is restrained from -eating at all till the physician expressly permits, -or again, when he is (for instance, during convalescence) -removed from his ordinary surroundings -and sent to an establishment where -the whole life, and particularly the eating, is -regulated according to physiological needs—in -all these cases the physician seeks to awaken -appetite, and relies upon it as a factor in the -cure. In the first case, where the food is prescribed -in small portions, in addition to preventing -the overfilling of a weak stomach, the -oft-recurrence of appetite juice, which is so rich -in quantity and so strong in digestive power, -is of great importance. I ask you here to call -to mind one of our experiments in which food -was given in small portions to a dog, and thus -led to a secretion of much stronger juice than -if the whole ration had been eaten at once. -This was an exact experimental reproduction -of the customary treatment of a weak stomach. -And such a regulation of diet is all the more -necessary, since, in the commonest disorders -of the stomach, only the surface layers of the -mucous membrane are affected. It may, consequently, -happen that the sensory surface of -the stomach, which should take up the stimulus<span class="pagenum" id="Page_259">[Pg 259]</span> -of the chemical excitant, is not able to fulfil its -duty, and the period of chemical secretion, -which ordinarily lasts for a long time, is for the -most part disturbed, or even wholly absent. A -strong psychic excitation, a keen feeling of -appetite, may evoke the secretory impulse -in the central nervous system and send it -unhindered to the glands which lie in the -deeper as yet unaffected layers of the mucous -membrane.</p> - -<p>An instance of this, taken from the pathological -material of the laboratory, I have already -related at the beginning of this lecture. It is -obvious in these cases that the indication is to -promote digestion by exciting a flow of appetite -juice, and not to rely upon that excited by -chemical stimuli. From this point of view the -meaning of removing a patient, the subject of -chronic weakness of the stomach, from his -customary surroundings is also plain. Take, -for instance, a mentally overstrained individual, -or a responsible official; how often does it -happen that he cannot for a moment distract -his thoughts from his daily work. He eats -without noticing it, or eats and carries on his -work at the same time. This often happens, -particularly in the case of people who live in -the midst of the incessant turmoil of great cities. -The systematic inattention to the act of eating<span class="pagenum" id="Page_260">[Pg 260]</span> -prepares the way for digestive disturbances in -the near future, with all their consequences. -There is no appetite juice, no “igniting juice,” -or, at most, very little. The secretory activity -comes slowly into play; the food remains much -longer in the digestive canal than is necessary, -or passes, for want of sufficient digestive juices, -into a state of decomposition which irritates the -mucous membrane of the alimentary canal and -brings it into a condition of disease. No -medicinal treatment can help such a patient -while he remains surrounded by his old conditions. -The fundamental cause of his illness -still continues in progress. There is only one -course to pursue; namely, to take him completely -away, to free him from his occupation, -to interrupt the interminable train of thought, -and to substitute for a time, as his only object -in life, the care of his health, and a regard for -what he eats. This is attained by sending the -patient to travel, or by placing him in a hydropathic -establishment. It is the duty of the -physician to regulate not only the life of individual -patients according to such rules, but -also to have a care that in wider circles of the -community a due conception of the importance -of eating should be disseminated. This is -particularly so with the Russian physician. It -is precisely in the so-called intelligent classes<span class="pagenum" id="Page_261">[Pg 261]</span> -of Russians that a proper conception of life -generally is often found wanting, and where an -absolutely unphysiological indifference towards -eating often exists. More methodical nations, -like the English, have made a species of cult -of the art of eating. It is, of course, degrading -to indulge excessively and exclusively in culinary -enjoyments, but, on the other hand, a lofty contempt -for eating is also reprehensible. As so -often is the case, the best course here also lies -between the two extremes.</p> - -<p>With the establishment of mental effect upon -the secretion of juice the influence of condiments -enters upon a new phase. The conclusion had -already been empirically arrived at that it was -not alone sufficient for the food to be composed -exclusively of nutrient substances, but that it -should also be tasty. Now, however, we know -why this is so. For this reason the physician, -who has often to express an opinion upon the -suitability of the dietaries of different persons, -or even of whole communities, should constantly -bear in mind the question of psychic secretion; -that is to say, he should inquire after and learn -how the food has been eaten, whether with or -without enjoyment. But how often do the -people who have charge of the commissariat -pay attention solely to the nutritive value of the -food, or place a higher value on everything else<span class="pagenum" id="Page_262">[Pg 262]</span> -than taste? We must, further, in the interest -of the public weal, direct attention especially -to the feeding of children. If this or that inclination -of the taste ultimately determines the -relation of grown-up individuals towards food, -a matter with which the commencing phase of -digestion is closely linked, it would seem undesirable -to habituate children solely to a nicety -and uniformity of gustatory sensations. Such -might effect their capabilities of adapting themselves -to other conditions in after life.</p> - -<p>The question of the therapeutic influence of -the so-called bitters, it appears to me, bears the -closest connection with that of appetite. After -a long period of high repute these substances -have been almost expelled from the list of -pharmaceutic remedies. When tested in the -laboratory, they were unable to justify their old -and valued reputation; when directly introduced -into the stomach, many of them were unable to -produce a flow of gastric juice. Consequently, -in the eyes of the clinician, they became greatly -discredited, so that many were quite ready to -discard their use altogether. Obviously, the -simple conclusion was drawn that a weak digestion -could only be assisted by a remedy which -directly excites secretory activity. In this, however, -it was forgotten that the conditions of the -experiment possibly had not corresponded with<span class="pagenum" id="Page_263">[Pg 263]</span> -the actual state of affairs. The whole question -of the therapeutic importance of the bitters, -however, acquires a different significance when -we link it with another question, such, for -instance, as how do bitters affect the appetite? -It is the universal opinion of the earlier and -later physicians that bitters increase the appetite, -and if this be so everything is said. They -are, in consequence, real secretory stimulants, -since the appetite, as has many times been -repeated in these lectures, is the strongest of -all stimuli to the digestive glands. It is, however, -not by any means strange that this had -not previously been observed in the laboratory. -The substances were either introduced directly -into the stomachs of normal dogs or else injected -into the circulation. But their action is -chiefly bound up with their effect upon the gustatory -nerves, and it was not, therefore, without -some reason that this large group of remedies, -consisting of substances of the most varied chemical -composition, were grouped together mainly -on account of a certain bitter taste common to -them all. A person who suffers from digestive -disturbance has, moreover, a blunted taste, a -certain degree of gustatory indifference. The -ordinary foods, which are agreeable to other -people, and also to himself when in health, now -appear tasteless. They not only arouse no desire<span class="pagenum" id="Page_264">[Pg 264]</span> -for eating, but may even cause a feeling of dislike; -there is no sense of taste, or at best a -perverse one. It is necessary, therefore, that -the gustatory apparatus should receive a strong -stimulus in order to restore a normal sensation. -As experience teaches, this object is -most quickly attained by exciting sharp, unpleasant, -gustatory impressions, which by contrast -awaken the idea of pleasant ones. In either -case there is no longer indifference, and this -is the foundation upon which an appetite for -this or that kind of food may be awakened, and -here a general physiological law is illustrated. -The light appears brighter after darkness, a -sound louder after silence, the enjoyment of -blithesome health more intense after illness, -and so on. This explanation of the appetising -effects of bitters proceeding from the mouth -does not exclude the possibility of some such -similar influence coming also from the stomach. -As has been already stated in the fifth lecture, -there is some reason for believing that certain -impulses from the cavity of the stomach are -likewise necessary for the excitation of appetite. -It is possible that bitters not only act directly -on the gustatory nerves in the mouth, but that -they also act on the mucous membrane of the -stomach in such a way that sensations are generated -which contribute to the passionate crav<span class="pagenum" id="Page_265">[Pg 265]</span>ing -for food. As a matter of fact, it has been -confirmed by many clinicians that after the -administration of bitters some such special sensations -do arise in the stomach. The effect of -these remedies consists, therefore, not merely -in the generation of a simple reflex, but in the -production of a certain psychic effect, which -indirectly excites a physiological secretory activity. -The same probably applies to other -substances, such as condiments. In any case, -whether our explanation corresponds to the -actuality or not, the question of the therapeutic -effect of bitters is settled in the affirmative the -moment we acknowledge that these substances -awaken appetite. The problem, therefore, of -an experimental investigation of bitters consists -in establishing the fact that they have an effect -upon the appetite. The question is a difficult -one, and has not hitherto been attempted in -the laboratory. It is not sufficient to hand over -clinical observations to the laboratory as experimental -proofs. One must have, in addition, the -assurance that the investigation has been correctly -carried out; that is to say, that it dealt -exactly with the point under consideration. It -is interesting to observe that the connection -between appetite and gastric juice is by many -physicians, and in many text-books of medicine, -exactly reversed. Thus it is represented that<span class="pagenum" id="Page_266">[Pg 266]</span> -some medicinal remedy calls forth a secretion -of gastric juice, and this, by its presence in the -stomach, awakens an appetite. Here we have -to deal with a false explanation of a true fact, -and that because it was not recognised that a -psychic effect could by any possibility be a -powerful excitant of secretory nerves. The -customs of the chief meal of the day also correspond -with our physiological results. After -this or that <i>hors d’œuvre</i>, perhaps also with a -liqueur of brandy (especially customary in -Russia), both of which are designed to awaken -the appetite, the repast proper begins, and, in -the majority of cases, with something hot, consisting -mostly of meat broth (<i>bouillon</i>, different -soups, and so on). After this comes the really -nourishing food—meat of different kinds served -in various ways, or, in the case of poorer people, -stews made with vegetables, and therefore rich -in carbohydrate material. This sequence of -foods, from the standpoint of physiology, is -quite rational. Meat broth, as we have already -seen, is an important chemical excitant of gastric -secretion. An attempt is therefore made in two -ways to secure a free secretion of gastric juice -to act on the chief food; first, in the excitement -of the appetite juice by the <i>hors d’œuvre</i>, and -secondly, in the promotion of the flow by the -action of the meat broth. It is in this way that<span class="pagenum" id="Page_267">[Pg 267]</span> -human instinct has made provisions for the -digestion of the chief meal. A good meat -broth can only be afforded by well-to-do people, -and consequently with the poorer classes a less -expensive, and, indeed, also a less effective, -chemical excitant is used for awakening the -early secretion. For example, <i>kwas</i><a id="FNanchor_31" href="#Footnote_31" class="fnanchor">[31]</a> serves -in this way with the Russian population, while -in Germany, where the price of meat is high, -different kinds of soups are used, consisting of -water mixed with flour, bread, etc. It is further -to be borne in mind that the quantity of the -digestive juices in general stands in close connection -with the content of water in the organism. -This has been shown by the experiments -of Dr. Walther for the pancreatic juice, and by -my own for the gastric juice. If this sequence -of foods, therefore, holds good for healthy -people, it must be even more strictly adhered -to in pathological conditions. Thus, when a -person has no appetite, or only a weak one, -he has no psychic juice or only very little; consequently, -the meal must in every case be begun -with a strong chemical excitant—for example, -with a solution of the extractives of flesh.<span class="pagenum" id="Page_268">[Pg 268]</span> -Otherwise solid foods, particularly if they do -not consist of meat, would remain long in the -stomach without any digestion whatever. It is, -therefore, in every way desirable to prescribe -meat juice, strong broth, or meat extract to -people who have no appetite. The same applies -also to forced feeding, for instance, of the -insane. It is true that the method of introduction -in this case necessarily secures the presence -of a chemical excitant, since the food can only -be introduced in a fluid form. In any case the -addition of meat extract would be very useful. -If one arranged the ordinary fluid foods in descending -order, according to the influence of -the chemical excitants, the following would be -the series: first, the preparations of the flesh, -such as meat juice and the like; secondly, milk; -thirdly, water.</p> - -<p>The usual termination of the repast is also, -from the physiological standpoint, easy to be -understood. The chief meal is generally ended -with something sweet, and everybody knows -that sweets are pleasant. The meaning of this -is easy to guess. The repast, begun with pleasure, -consequent on the pressing need for food, -must also, notwithstanding the stilling of hunger, -be terminated with an agreeable sensation. At -the same time the digestive canal must not be -burdened with work at this stage; it is only the<span class="pagenum" id="Page_269">[Pg 269]</span> -gustatory nerves which should be agreeably -excited. After thus dealing in general with the -usual arrangement of our meals, we may now -speak of some special points.</p> - -<p>Above all comes the acid reaction of the -food. It is apparent that acidity enjoys a -special preference in the human taste. We -use quite a number of acid substances. Thus, -for example, one of the commonest seasoning -substances is vinegar, which figures in a number -of sauces and such like. Further, many -kinds of wine have a somewhat acid taste. In -Russia, <i>kwas</i>, especially in the acid form, is -consumed in great quantities. Moreover, acid -fruits and green vegetables are used as food, and -they are either of themselves acid, or made so -in the preparation. In medicine this instinct -is likewise often made use of, and acid solutions, -especially of hydrochloric and phosphoric -acids, are prescribed in digestive disturbances. -Finally, Nature itself constantly endeavours to -prepare lactic acid in the stomach in addition -to the hydrochloric acid. The former arises -from the food introduced, and is consequently -always present. These facts are all physiologically -comprehensible when we know that an -acid reaction is not only necessary for an efficient -action of the peptic ferment, but is at the -same time the strongest excitant of the pan<span class="pagenum" id="Page_270">[Pg 270]</span>creatic -gland. It is even conceivable that in -certain cases the whole digestion may depend -upon the stimulating properties of acids, since -the pancreatic juice exerts a ferment action -upon all the constituents of the food. In this -way acids may either assist digestion in the -stomach where too little gastric juice is present, -or bring about vicarious digestion by the -pancreas where it is wholly absent. It is -easy, therefore, to understand why the Russian -peasant enjoys his <i>kwas</i> with bread. The -enormous quantity of starch which he consumes, -either as bread or porridge, demands -a greater activity upon the part of the pancreatic -gland, and this is directly brought about -by the acid. Further, in certain affections of -the stomach, associated with loss of appetite, -we make use of acids, both from instinct as -well as medical direction, the explanation being -that they excite an increased activity of -the pancreatic gland, and thus supplement the -weak action of the stomach. It appears to -me that a knowledge of the special relations -of acids to the pancreas ought to be very useful -in medicine, since it brings the gland—a -digestive organ at once so powerful and so -difficult of access—under the control of the -physician. We could, for instance, intentionally -discard digestion in the stomach, and thus<span class="pagenum" id="Page_271">[Pg 271]</span> -transfer it to the bowel, by prescribing substances -which do not excite the gastric glands. -On the other hand, by lessening the acidity of -the gastric juice we could reduce the activity -of the pancreas, and these are matters which -might be made use of in various special diseases, -or even in some general disturbances -of the digestive apparatus.</p> - -<p>No less instructive is a comparison of the -results of our experiments upon fat, with the -demands of instinct and also with the precepts -of dietetics and therapeutics. Everybody knows -that fatty foods are heavy, that is, difficult of digestion, -and in the case of weak stomachs they -are usually avoided. We are now in a position -to understand this physiologically. The existence -of fat in large quantities in the chyme -restrains in its own interest the further secretion -of gastric juice, and thus impedes the digestion -of proteid substances; consequently, a -combination of fat and proteid-holding foods -is particularly difficult to digest, and can only -be borne by those who have good stomachs -and keen appetites. The combination of bread -and butter is less difficult, as might <i>a priori</i> be -inferred from its wide employment. Bread requires -for itself, especially when calculated per -unit, but little gastric juice and but little acid, -while the fat which excites the pancreatic gland<span class="pagenum" id="Page_272">[Pg 272]</span> -insures a rich production of ferment both for -itself and also for the starch and proteid of -bread. Fat alone does not count by any means -as a heavy food, as may be seen from the fact -that large quantities of lard are consumed in -certain districts of Russia with impunity. This -also is comprehensible, since the inhibitory influence -of the fat in this case does not prevent -the digestion of any other food-stuff, and is -conducive to the assimilation of the fat itself. -There is no struggle in this case between the -several food constituents, and therefore no one -of them suffers. In harmony also with daily -experience the physician, in cases of weakness -of the stomach, totally excludes fatty food and -recommends meat of a fat-free kind; for example, -game, etc. In pathological cases, however, -where an excessive activity of the gastric glands -is manifested, fatty food, or fat as emulsion, is -prescribed. And here medicine has empirically -brought to its aid the restraining action -of fat, which we have so strikingly seen in our -experiments.</p> - -<p>Amongst all the articles of human food, milk -takes a special position, and this is unanimously -recognised, both in daily experience and in the -practice of medicine. By everybody milk is considered -a light food, and is given in cases of weak -digestion as well as in a whole series of severe<span class="pagenum" id="Page_273">[Pg 273]</span> -illnesses; for example, in heart and kidney affections. -The extreme importance of this substance, -a food prepared by Nature itself, we can now -well understand. There are three properties of -milk which secure it an exceptional position. -As we already know, in comparison with nitrogenous -equivalents of other foods, the weakest -gastric juice and the smallest quantity of pancreatic -fluid are poured out on milk; consequently, -the secretory activity requisite for -its assimilation is much less than with any other -food-stuff. In addition, milk possesses a further -important property. Thus, when it is introduced -unobserved into the stomach of an animal -it causes a secretion both in the stomach and -also one from the pancreas; consequently, it -appears to be an independent chemical excitant -of the digestive canal; and in this action it is -remarkable that we perceive no essential difference -in the effect when the milk is brought -unnoticed into the stomach from that which -occurs when it is given to the animal to lap. -Although flesh is a better chemical excitant, -it is by no means a matter of indifference how -it gets into the stomach. It must, therefore, be -accepted that milk excites not only a really -effective, but at the same time a very economic, -secretion, and also that the appetite is unable -to stimulate this secretion into a more active<span class="pagenum" id="Page_274">[Pg 274]</span> -or abundant flow. The secret of the relation -of milk to the secretion of the digestive juices -can, unfortunately, at present be submitted to -no further analysis or investigation. We are at -liberty, however, to suppose that the fat on the -one hand is of importance for the inhibition -of the gastric glands, and the alkalinity on the -other for the restraint of the pancreas. Thus -the gastric glands and the pancreas, notwithstanding -the presence of excitants, are maintained -by milk at a certain but not too high -degree of activity, a matter which is in every -way desirable in consideration of the easy -digestibility of its constituents. Finally, the -third characteristic which is observed to belong -to milk, and which is probably only an expression -of the first, consists in the following. When -one administers to an animal equivalent quantities -of nitrogen, in the one case as milk, in the -other as bread, and afterwards estimates the -hourly output of nitrogen in the urine, it results -that the increase during the first seven to ten -hours after the milk (compared with the excretion -beforehand) amounts only to from 12 per -cent to 15 per cent of the nitrogen taken in, -while after bread it amounts to 50 per cent. -If the hourly rate of absorption and the extent -to which milk and bread are respectively used -up be taken into consideration, it has to be<span class="pagenum" id="Page_275">[Pg 275]</span> -admitted that these augmentations of urinary -nitrogen which appear soon after feeding must -be expressions of the functional activity of the -digestive canal itself, and that this activity in -the case of bread is three or four times greater -than in the case of milk (<i>Experiments of Prof. -Rjasanzew</i>); consequently, in the case of milk -a much larger fraction of its nitrogen is free to -be used up by the organism at large (irrespective -of the organs of digestion) than in that of any -other kind of food. In other words, the price -which the organism pays for the nitrogen of -milk, in the form of work on the part of its -digestive apparatus, is much less than that for -other foods. How admirably, therefore, the -food prepared by Nature distinguishes itself -when compared with all others!</p> - -<p>The facts just related bring forward a new -aspect from which the relative nutritive values -of different foods may be judged. The older -criteria must frankly make room for the new or -else be displaced by them. Experiments upon -the utilisation of food-stuffs, in which what remains -undigested is determined as well as what -is absorbed into the body fluids, cannot alone -be trusted to solve the question in a satisfactory -manner. Suppose, for instance, that in the -digestion of a given food the alimentary canal -has been given a certain work to perform; if it<span class="pagenum" id="Page_276">[Pg 276]</span> -be in health the work will be accomplished in -the best possible manner—that is to say, with -complete abstraction of everything nutrient. -You will thus learn how much nutrient material -was contained in the food, but the question of -its digestibility remains as obscure as before. -In your experiment you do not know how great -an effort it has cost the alimentary canal to -extract all the nourishment from the food. Nor -can artificial digestion experiments settle the -question of digestibility, for experiments in -which food is normally partaken of are quite -different from those in the test-tube, where we -have to deal with only one juice, and not with -the interaction of different juices and different -food constituents. That one must here, as a -matter of fact, make a distinction is clear from -the observation of Dr. Walther in our laboratory. -Fibrin, which is regarded by all as the most -easily digested proteid, proved, when compared -with a nitrogen equivalent of milk, to be a much -stronger excitant of the pancreas, although milk -contains, in addition to nitrogenous substances, -a good deal of other non-nitrogenous material. -The digestibility and nutritive value of foods -must obviously be decided by an estimation -of the real work which they entail upon the -digestive apparatus, both in regard to the quantity -and quality of the juices poured out on a<span class="pagenum" id="Page_277">[Pg 277]</span> -given amount of nutrient material. The energy -used up in gland metabolism must be deducted -from that of food taken in. The remainder will -then indicate the value of the food to the organism; -that is to say, will give the amount available -for use by all the other organs exclusive of the -digestive apparatus. From this point of view -those materials must be taken as less nourishing -and less digestible which are in large part used -up to make good the expenditure entailed by -their digestion on the part of the alimentary -canal; that is to say, those food-stuffs are less -useful whose nutritive value little more than covers -the cost of their digestion; consequently, -it is of great practical importance to compare -from this aspect the same foods differently -prepared—for example, boiled and roast meat, -hard and soft boiled eggs, boiled and unboiled -milk, etc.</p> - -<p>A discussion of some further medical questions -may here be taken up. The first concerns -the therapeutic use of the neutral and alkaline -salts of sodium. In clinical, pharmacological, -and physiological text-books it is stated now, as -ever, that these salts promote a flow of gastric -juice. We may look in vain, however, for any -experimental foundation to support this doctrine. -The experiments brought forward cannot be regarded -as conclusive. When Blondlot sprinkled<span class="pagenum" id="Page_278">[Pg 278]</span> -sodium bicarbonate upon flesh, or Braun and -Grützner introduced sodium chloride solutions -directly into the blood, they began with methods -either false in themselves or far removed from -normal conditions. In this case, however, the -gaps in the experiment were happily made good -by the clinician, for the experiment appeared to -be confirmatory of clinical experience. That -sodium salts (the chloride and bicarbonate) are -useful in disorders of the digestive apparatus -there can be no doubt. How do they act, however? -It appears to me that here, as in some -other cases, medical science has fallen into error. -When we know that an effect takes place it does -not by any means imply that we know the mechanism -by which it occurs; and although medicine -is broad enough and comprehensive enough -to make free use of empiricism in practice, yet -it often thinks in narrow grooves when it turns to -the explanation of facts. It frequently tries to -explain complicated healing processes in the -simplest way, on supposed physiological data. -And this is true in the present case, which -affords an example of prevalent medical reasoning; -the alkalies work favourably in digestive -disturbances—therefore they are succagogues. -Naturally the stomach, under the influence of -alkalies, sometimes begins to secrete a greater -quantity of juice. This means, however, that it<span class="pagenum" id="Page_279">[Pg 279]</span> -has recovered from a disordered state and has -returned to normal conditions. Consequently, -the effect is due to the fact of recovery, and -not to a direct influence of the alkalies. This -latter, however, must be specially proved. The -assistance afforded by the alkalies to the organism -might be capable of another explanation; -for example, that which is ordinarily given. In -this case, however, I venture to offer a reason -for the effects of sodium chloride, and of the -alkaline salts of sodium, which is exactly the -opposite of that generally accepted. We were -unable to convince ourselves of any succagogue -influence on the part of these salts. Indeed, -both on the stomach and pancreas they proved -in our hands to have an inhibitory effect. In -addition to the experiments which I previously -brought forward concerning the relation of alkalies -to gastric and pancreatic juice, I may -relate the following observation. A dog which -fortunately had survived the performance, one -after the other, of a gastric fistula, a pancreatic -fistula, and an œsophagotomy, received daily -during the course of several weeks an addition -of soda to its food. The animal enjoyed good -health and had an excellent appetite. When -the first sham feeding experiment was carried -out, the relatively small effect of this otherwise -very active juice-exciting procedure at once<span class="pagenum" id="Page_280">[Pg 280]</span> -struck us. At the same time we observed that -the pieces of flesh which fell from the upper end -of the œsophagus, contrary to the ordinary rule, -were hardly at all insalivated. In this dog, therefore, -a greatly lowered activity of several digestive -glands—viz., of the gastric, pancreatic, and -salivary glands—simultaneously existed. With -regard to the salivary glands the circumstance -was naturally submitted to closer investigation. -I believe that the inhibitory influence of the alkalies -on the digestive glands, which was here -proved experimentally, may furnish a basis for -the following representation of their mode of -action in producing healing effects. Catarrhal -affections of the stomach are characterised by an -incessant or very protracted secretion of slimy, -weakly acid gastric juice. Further, in many -cases the affection begins with a hypersecretion, -that is an abnormal excitability, of the secretory -apparatus which makes itself evident in a superfluous -and useless flow. The same must be -conceived to happen in disorders of the pancreatic -gland; at least such a condition sets in after -operations performed for physiological purposes. -It is, further, justifiable to suppose that, when -an affection is once set up by this or that cause, -it may later maintain itself independently; for -continuous activity has undoubtedly a harmful -influence on the glands. The due nourishment,<span class="pagenum" id="Page_281">[Pg 281]</span> -and the restoration of organs after activity, proceeds -best during rest. In the normal course -of events, after a period of active work follows a -pause, during which the latent work of restoration -is accomplished. When, therefore, a remedy -effectively restrains the excessive work of a diseased -organ, it may in this way contribute to the -removal of the pathological condition, and thus -to a restoration of the normal state. In this consists, -in my opinion, the healing effects of the -alkalies. One might draw a parallel between -the action of these substances in digestive disturbances -and that of digitalis in compensatory -disturbances of the heart. An uncompensated -heart beats rapidly, and thereby only aggravates -its condition. Its time of rest, that is of -recovery, of restitution of the organ, is shortened. -A vicious cycle is set up. The weak action of -the heart lowers blood pressure; the lowering of -this leads (from known physiological causes) to -an increase in the number of beats; the quickening -leads to weakening of the organ. Without -doubt the digitalis aids by breaking through -this vicious cycle, in that it greatly slows the -pulse, and thereby gives new power to the heart. -With our explanation of the action of the alkalies -harmonises the further circumstance that, with -the use of the salts in question, a strict diet is -generally prescribed, which means that a certain<span class="pagenum" id="Page_282">[Pg 282]</span> -amount of rest is secured for the digestive glands. -It is interesting that in clinical investigations -with the stomach-tube, after a period when the -alkalies were looked upon as succagogues, a new -phase has also set in, mention being now more -frequently made of a restraining effect.</p> - -<p>The cause of the erroneous belief that alkalies -promote a flow of juice obviously lies in this, -that people omitted to compare the effects of -the saline solutions with those of like quantities -of water (<i>Dr. Chigin</i>).</p> - -<p>The second point which we may consider is -the following. The chief difficulty of the physician -who wishes to regulate the diet of patients -when they suffer from digestive disturbances -consists in the fact that idiosyncrasy plays a -very important <i>rôle</i>. In one and the same illness, -different patients react to the same diet -in wholly different ways. That which is agreeable -to one, and is well borne and useful, may -be rank poison to another. Consequently, the -golden rule in dietetics is to give no directions -with regard to food till one has made inquiries -concerning the inclinations and habits of the -patient. What does all this indicate? Till now -physiology had no experimental answer to the -question. But our facts, it appears to me, contribute -to a clearing up of the situation. Every -food determines a certain amount of digestive<span class="pagenum" id="Page_283">[Pg 283]</span> -work, and when a given dietary is long continued, -definite and fixed types of glands are set up -which can only slowly and with difficulty be -altered. In consequence, digestive disturbances -are often instituted if a change be suddenly -made from one dietetic <i>régime</i> to another, especially -from a sparse to a rich diet; such, for instance, -as happens after the long Russian fasts. -These disturbances are expressions of the temporary -insufficiency of the digestive glands to -meet the new demands made upon them.</p> - -<p>Finally, it may be of some use to relate the -following here. There are often cases of sudden -and unaccountable digestive disturbances. -From the standpoint of modern physiology they -might be explained by an activity of the secreto-inhibitory -nervous system, which from some -cause or other has been excessively and abnormally -stimulated. In any case this system is -now a factor of which the physician has to take -due account.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_284">[Pg 284]</span></p> - -<h3 class="nobreak" id="SWALLOWING_AND_MOVEMENTS_OF">SWALLOWING AND MOVEMENTS OF -THE STOMACH AND INTESTINES<br /> - -<small><span class="smcap">By W. B. Cannon, M.D.</span></small><br /> - -<small><i>Of the Physiological Laboratory of the Harvard Medical School -Boston, Mass., U. S. A.</i></small></h3> -</div> - -<div class="blockquot"> - -<p>[<span class="smcap">Note.</span>—In the beginning of 1896 Dr. Professor Henry -Pickering Bowditch, one of our Board of Scientific Assessors -in the Nutrition Case suggested the use of the Röntgen ray -as a means of learning more than was then known about the -mechanism of swallowing. There was much difference of -opinion among research physiologists about this important -function, and the question was far from settled. Magendie -published a theory of deglutition, in Paris, in 1836, which was -practically accepted until 1876, when Dr. Professor Angelo -Mosso, of the University of Turin, Turin, Italy, established -the theory of sole peristaltic assistance in swallowing. Again -in 1880 Dr. Professor Kronecker, of Berne, Switzerland, in -connection with Dr. Falk, and later in connection with Dr. -Meltzer, of New York, produced evidence to prove a more -complicated process in deglutition than that of peristalsis -alone. But even Kronecker and Meltzer found, as they went -on, evidence to modify their earlier beliefs, and hence the subject -was not cleared up to a point of general agreement.</p> - -<p>The suggestion made by Dr. Bowditch was taken up in -the Harvard Physiological Laboratory and formed the beginning -of a series of studies of the mechanical factors in digestion. -The reports of these studies, presented by Dr. W. B. -Cannon and collaborators, in the <i>American Journal of Physiology</i>, -in the volumes of 1898 and 1903, are so understandable, -even to the layman ignorant of physiological nomenclature, -that we are prompted to give them, almost entire, leaving out -only the technical description of the methods employed, which -are only interesting to research students who have access to -the <i>Journal</i>.</p> - -<p><span class="pagenum" id="Page_285">[Pg 285]</span></p> - -<p>It will be noted that three of the professors of physiology -mentioned in connection with this preliminary study of -the nutrition problem—Bowditch, Mosso, and Kronecker—are -members of our presently organised Board.—<span class="smcap">Horace -Fletcher.</span>]</p> -</div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="THE_MOVEMENTS_OF_THE_FOOD">THE MOVEMENTS OF THE FOOD -IN THE ŒSOPHAGUS<br /> - -<small><span class="smcap">By W. B. Cannon and A. Moser</span><br /></small> - -<small><i>From the Laboratory of Physiology in the Harvard Medical School</i></small><br /> - -<small>Extracts from <i>American Journal of Physiology</i>, 1898</small></h3> -</div> - - -<p>The movements of deglutition, in common -with many other physiological processes, were -explained by the older physiologists on anatomical -grounds. Thus, Magendie divided the -act into three parts, corresponding to the anatomical -regions of the mouth, pharynx, and -œsophagus. The muscles of each of these -divisions were considered the active agents in -propelling the food onward. The function of -moving the mass to the pharynx was variously -ascribed to the tongue itself, to the mylohyoid -muscles, and to gravity. For the second part, -the movement through the pharynx, there was -more unanimity of opinion, since the constrictors, -especially the middle and lower, were -evidently concerned.</p> - -<p>Direct observations on the movement of -swallowed masses in the œsophagus were first -made by Mosso. The œsophagus of a dog<span class="pagenum" id="Page_286">[Pg 286]</span> -was laid bare, and a transverse incision made -through it, or a piece of it excised. A small -wooden ball was placed in the canal below the -excised part, and the animal was then stimulated -to swallow. One or two seconds after the -contraction of the pharyngeal muscles a peristaltic -wave began to traverse the œsophagus. -This wave did not stop at the point of excision, -but in due time reappeared below, and carried -the ball to the stomach. Thus the act was -shown to be controlled by the central nervous -system. Peristalsis was so plainly the motive -power that the action was never doubted. Yet -this belief was soon to be questioned.</p> - -<p>In 1880 Falk and Kronecker studied the -movements in the mouth and pharynx, and advanced -the theory that deglutition was accomplished -by the rapid contraction of the muscles -of the mouth. During the act of swallowing the -air-tight buccal cavity shows a manometric pressure -of twenty centimetres of water. The same -pressure was demonstrated to be present also in -the œsophagus, but not in the stomach. This -pressure was considered sufficient to force food -through the œsophagus before the peristaltic -wave traversed it. Another argument for rapid -descent was found in the fact that cold water -can be felt in the epigastric region almost immediately -after being swallowed. Further, when<span class="pagenum" id="Page_287">[Pg 287]</span> -strong acids pass through the gullet, they corrode -but small parts of it, and not the entire -mucous membrane, as would be the case were -the acid carried to the stomach by peristalsis.</p> - -<p>Over a year and a half ago it was suggested -by Prof. H. P. Bowditch that if some substance -opaque to the Röntgen rays were swallowed, it -could be seen in its passage to the stomach, and -the nature of its movement thus determined. -Anæsthesia could be dispensed with,—a desirable -condition, since observers had found that -it interfered greatly with the deglutition reflex. -It would be unnecessary to open either the -abdominal or the pleural cavity. The reflex -stimulus of food, moreover, would be better -than electrical stimulation of the superior laryngeal -nerve. In short, the animal would swallow -normal food under practically normal conditions. -At Dr. Bowditch’s suggestion and with -his valuable assistance—which we gratefully -acknowledge—we made the following series of -experiments.</p> - -<p>To render the swallowed mass opaque, subnitrate -of bismuth was used. The salt is tasteless, -practically inert, and can be fed in large quantities -without harm. In order that observations -could be made by more than one person, all -experiments were conducted in a dark room. -On the side of the animal opposite the Crookes<span class="pagenum" id="Page_288">[Pg 288]</span> -tube was placed an open fluorescent screen, on -which the different tissues of the animal were -outlined with varying degrees of light and shade. -Among these shadows the swallowed mass appeared -as a darker object, and thus its motion -could be studied.</p> - -<p>For the first experiments the goose was -selected. The head and neck were held stationary -by a tall pasteboard collar, which allowed -free movement of the head without constriction -of the neck. The fluorescent screen was placed -against this collar at a uniform distance of thirty -centimetres from the tube. When a bolus of -corn-meal mush mixed with bismuth was placed -in the pharynx, it descended slowly and regularly, -and occupied about twelve seconds in -passing over a distance of fifteen centimetres. -The screen was marked at intervals of two centimetres -with cross lines, by means of which the -relative rate in different parts of the œsophagus -could be studied. A vibrator marking tenths -of a second was interrupted whenever the bolus -crossed a line. An average of over one hundred -such observations showed that the rate -became slightly slower as the bolus proceeded.</p> - -<p>In order to test liquids, molasses was mixed -with bismuth to such a consistency as to drop -easily from a glass rod. When this was fed with -a pipette, it passed slowly and regularly down<span class="pagenum" id="Page_289">[Pg 289]</span> -the œsophagus, clearly by peristalsis. The rate -was about the same as for solid food. In both -these experiments the addition of water would -sometimes cause irregularities in the descent. -Microscopic sections from four different parts -of the œsophagus of the goose showed no histological -difference.</p> - -<p>In the experiments on the cat, the animal -was placed on its back and left side on a holder. -The extremities were secured by straps. The -head was held between two upright rods, connected -above by a thong; this allowed free -movement of the head, without resistance to the -passage of food. Shreds of meat dipped in bismuth -were ordinarily masticated and swallowed -without difficulty. For soft solids, bread and -milk were used, so fluid as to be easily drawn -up into a pipette. The insolubility of the bismuth -salt rendered the study of liquids more -difficult. Strong solutions of potassic iodide -and other salts, and suspension of bismuth, in -acacia and molasses were tried; but a simple -mixture of milk and bismuth, shaken in a test -tube and immediately drawn up into a pipette, -was found most practicable.</p> - -<p>Inasmuch as the movement of these different -foods varied in different parts of the œsophagus, -it will be convenient to divide the latter into -three sections. The first or cervical portion<span class="pagenum" id="Page_290">[Pg 290]</span> -extends from the pharynx to the thorax; the -second or thoracic, from here to the lower half -of the heart; and the third comprises the rest -of the canal. The relative length of these three -parts is about in the ratio of 9:8:6.</p> - -<p>The beginning of deglutition was noted by -one observer by a finger on the larynx; the -same observer called out when the bolus arrived -at the thorax, heart, and stomach respectively, -while the other observer noted the time. The -movement of solids will first be considered. -The descent the entire way was by peristalsis, -but the rapidity varied. The duration of the -movement in the cervical portion was two and a -half seconds, and in the thoracic region a little -less than two seconds. At the lower end of the -heart there was sometimes a slight pause. In -the lower section, from the heart to the stomach, -the movement was decidedly different; the -rate was always very slow. The distance was -less than one-third of the entire canal, yet the -time consumed in this part ranged from six to -seven seconds, or three-fifths of the entire time -of descent. The character of the movement -here was also peculiar. Whereas in the upper -sections the passage was uniform and regular, -with a slight acceleration in the thoracic region, -here it was apparently irregular, for the bolus -descended about one centimetre with each in<span class="pagenum" id="Page_291">[Pg 291]</span>spiratory -movement of the diaphragm, and -remained stationary or descended very slightly -during expiration. Thus a series of hitches -seemed to carry the bolus to the cardia. A -probable explanation of this peculiar movement -is that the stomach and lower œsophagus were -pulled down with each descent of the diaphragm. -This would make the movement appear irregular, -although it was really a slow peristalsis. -It may be well to remark here that this movement -was invariably observed in the cat with -every kind of food.</p> - -<p>Semi-solids, namely, a mush of bread and -milk, descended in the same way as solids; but -the rate was slightly faster in the upper œsophagus, -for the bolus took about a second less to -reach the cardiac level. From here the rate -was the same as with solids.</p> - -<p>For liquids, one and a half to two seconds -sufficed for the descent to the midheart region. -Here there often occurred a long pause, from -a few seconds to a minute or more. Then the -œsophagus apparently contracted above the -liquid, which slowly passed on to the stomach, -as already described. Sometimes it seemed -as if a swallowing movement, evidenced by a -rise of the larynx, started the peristaltic wave. -Again, several swallows would succeed one another -before the liquid passed on. A few times<span class="pagenum" id="Page_292">[Pg 292]</span> -the bismuth and milk seemed strung out along -the œsophagus; some more liquid descending -would gather this up, and the whole mass, -assuming an ovoid form, would move into the -stomach.</p> - -<p>Thus in the cat the total time for deglutition -varies from nine to twelve seconds. The -lowest section presents no change ascribable to -a difference in consistency, while in the upper -sections the rate does slightly increase with the -more liquid character of the food.</p> - -<p>In experiments on the dog, bismuth enclosed -in capsules or wrapped in shreds of meat -was fed as the solid. The general phenomena -were as follows: With the rise of the larynx -there was a quick, propulsive movement of the -bolus, which descended rapidly for a few centimetres, -sometimes as far as the clavicle. From -this point the rapidity was diminished, yet no -pause was observed; the bolus simply moved -more slowly. This rate was then continued to -the stomach without a slackening of speed in the -diaphragmatic region, as was observed in the -cat. Semi-solids moved in the same way as -solids. The total time of descent from larynx -to stomach was from four to five seconds.</p> - -<p>Liquids gave even a more decided squirt in -the beginning of the movement. To render the -œsophagus as lax and free as possible, the head<span class="pagenum" id="Page_293">[Pg 293]</span> -of the dog was released from the upright rods -and held by the hands after the food was placed -in the mouth. Sometimes the liquid descended -rather rapidly as far as the heart, at other times -no further than the clavicle; then without a -pause it passed on slowly and regularly, reaching -the stomach in about the same time as solids -and semi-solids.</p> - -<p>Thus in the dog and cat but little variation -was seen in the swallowing of liquids and solids. -The liquids pass somewhat faster in the upper -œsophagus. But in some animals the difference -of rate with foods of varying consistency is much -more marked. In the horse, for instance, mere -observation shows a decided variation in the rate -of movement in the œsophagus. Liquids shoot -along the gullet, while solids move clearly by -peristalsis. To determine the rate of solids, one -hand was placed on the larynx of a horse to -note the beginning of swallowing, and the other -hand near the shoulders, where the bolus could -be easily felt in its passage. The time consumed -by the bolus in passing over a certain -distance was measured by a stop watch. The -rate obtained for solids, such as hay or grain, -was from thirty-five to forty centimetres a -second.</p> - -<p>For semi-solids, a mixture of bran and water -was made, thin enough to run easily between<span class="pagenum" id="Page_294">[Pg 294]</span> -the fingers. Each bolus was watched by a -separate observer with a separate watch. The -average rate obtained was the same as for -solids.</p> - -<p>Liquids in the horse pass with a rapidity too -great to be affected by peristalsis. Another -force must be sought. Among the various -muscles supposed to be effectual in moving food -into the pharynx, the mylohyoids were shown -by Meltzer to be essential. The styloglossi -were cut by him without much interference with -deglutition, but section of the mylohyoid nerves -rendered the act impossible. The activity of -these muscles in the horse during swallowing is -easily perceived by the hand. Their energetic -contraction is a sufficient explanation of the -rapid passage of water through the œsophagus. -The motion here is more than five times as rapid -as that of solids and semi-solids.</p> - -<p>Meltzer’s experiment to measure the rate of -liquids in man by passing a stomach tube containing -litmus paper was repeated by us with -some modifications. Congo red paper was used, -since it is more sensitive than litmus; it also -furnishes a means of differentiating between -mineral and organic acids, as the discolouration -produced on Congo red by mineral acids is -removed by ether. It was thus possible to distinguish -between the discolouration produced by<span class="pagenum" id="Page_295">[Pg 295]</span> -gastric regurgitation and that produced by the -swallowed liquid. For the swallowed liquid, -one-half per cent lactic acid was found most -satisfactory, as the colour produced by it on -Congo red test paper is almost instantly discharged -in ether. By this method the paper -was found discoloured within half a second after -the rise of the larynx, certainly too short a -period for a peristaltic wave to carry the liquid -to the neighbourhood of the cardia.</p> - -<p>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<span class="pagenum" id="Page_296">[Pg 296]</span> -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.</p> - -<p>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.</p> - -<p>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.</p> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_297">[Pg 297]</span> -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<span class="pagenum" id="Page_298">[Pg 298]</span> -the canal. The depth reached depends on the -quantity swallowed, the force used, and the -tonicity of the lower part of the œsophagus.</p> - -<p>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.</p> - - -<h4><span class="smcap">Summary.</span></h4> - -<p>The phenomena of œsophageal deglutition -as determined by our experiments may then be -described as follows:—</p> - -<p><span class="pagenum" id="Page_299">[Pg 299]</span></p> - -<p>There is a difference in swallowing according -to the animal and the food which is used.</p> - -<p>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.</p> - -<p>In the cat the movement is always peristaltic, -and slightly faster than in fowls. A bolus takes -from nine to twelve seconds in reaching the -stomach. Liquids move somewhat more rapidly -than semi-solids in the upper œsophagus. In -the lower or diaphragmatic part the rate is very -much slower than above, and is the same for -liquids as for solids.</p> - -<p>In the dog the total time for the descent of -a bolus is from four to five seconds. The food -is always propelled rapidly in the upper œsophagus, -and moves more slowly below. This rapid -movement is frequently continued further with -liquid food. No distinct pause was observed -when the movement of the bolus changed from -the rapid to the slower rate.</p> - -<p><span class="pagenum" id="Page_300">[Pg 300]</span></p> - -<p>In man and the horse liquids are propelled -deep into the œsophagus at a rate of several -feet a second by the rapid contraction of the -mylohyoid muscles. Solids and semi-solids are -slowly carried through the entire œsophagus -by peristalsis alone.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_301">[Pg 301]</span></p> - -<h3 class="nobreak" id="THE_MOVEMENTS_OF_THE_STOMACH">THE MOVEMENTS OF THE STOMACH -STUDIED BY MEANS OF THE RÖNTGEN RAYS<br /> - -<small><span class="smcap">By W. B. Cannon, M.D.</span></small><br /> - -<small><i>From the Laboratory of Physiology in the Harvard Medical School</i></small><br /> - -<small>Extracts from <i>American Journal of Physiology</i>, 1898</small></h3> -</div> - -<p>Since the stomach gives no obvious external -sign of its workings, investigators of gastric movements -have hitherto been obliged to confine their -studies to pathological subjects or to animals -subjected to serious operative interference. -Observations made under these necessarily -abnormal conditions have yielded a literature -which is full of conflicting statements and uncertain -results. The only sure conclusion to be -drawn from this material is that when the -stomach receives food obscure peristaltic contractions -are set going, which in some way -churn the food to a liquid chyme and force it -into the intestines. How imperfectly this describes -the real workings of the stomach will -appear from the following account of the actions -of the organ studied by a new method. The mixing -of a small quantity of subnitrate of bismuth -with the food allows not only the contractions of<span class="pagenum" id="Page_302">[Pg 302]</span> -the gastric wall, but also the movements of the -gastric contents to be seen with the Röntgen -rays in the uninjured animal during normal -digestion. An unsuspected nicety of mechanical -action and a surprising sensitiveness to nervous -conditions have thereby been disclosed.</p> - - -<h4><span class="smcap">Introductory Literature</span></h4> - -<p>The early writings on the subject of gastric -movements are characterised by general inferences -from physical laws and from the anatomical -structure of the stomach. According to -Galen the stomach had four functions: to draw -the food from the mouth (<i>facultas attractrix</i>), -to retain the food (<i>facultas retentrix</i>) during -the process of chemical digestion (<i>facultas -alteratrix</i>), and, finally, to pass the changed -material onward (<i>facultas expultrix</i>). In later -writings the <i>facultas attractrix</i> failed to appear -as one of the functions of the stomach. Fallopius, -in the sixteenth century, changed the notion -of the <i>facultas retentrix</i> by suggesting that the -pylorus alone performed this office, and that the -muscles of the gastric wall could help only by -remaining quiet. Thus the <i>facultas alteratrix</i> -and the <i>facultas expultrix</i> are left as true gastric -functions. It is with the latter activity and its -effects that this paper is concerned.</p> - -<p>The ideas of the early writers concerning the<span class="pagenum" id="Page_303">[Pg 303]</span> -pylorus and cardia are of interest. The cardia, -they were agreed, is closed during normal digestion -in order to keep the food from re-entering -the œsophagus. The pylorus they looked -upon as the ruler of the actions of the stomach. -Such names as pylorus (keeper of the gate), -janitor justus, and rector, which the first investigators -gave to the sphincter, indicate their -theories of its functions. The passage of chyme -into the duodenum, the keeping of undigested -food in the stomach, the act of vomiting, were -all dependent, they believed, on the “will” of -the pylorus.</p> - -<p>No substantial advance was made beyond -these hypotheses until the beginning of the -eighteenth century, when Wepfer and Schwartz -applied the experimental method to the study -of the gastric movements and laid the foundation -of a more accurate knowledge. Wepfer vivisected -wolves, dogs, and cats, and observed constrictions -following stimulation of the stomach. -He remarked a general contraction of the pyloric -part in vomiting and noted peristaltic and antiperistaltic -movements passing over the organ. -About the middle of the stomach he frequently -saw a deep constriction. The investigations of -Schwartz are more valuable in that his search -was for the normal action of the muscular coats. -The movements, as he observed them, were gen<span class="pagenum" id="Page_304">[Pg 304]</span>erally -only slight. They began either at the -pylorus and passed to the left, half-way to the -cardia, or started at the fundus and went to -the pylorus. The contractions and relaxations, -following one another, formed larger or smaller -depressions and elevations, <i>i. e.</i>, more or less -definite waves.</p> - -<p>Near the middle of the last century Haller, -after confirming the results obtained by Schwartz -and Wepfer, summarised his knowledge of the -motor functions of the stomach as follows. In -general, contraction alternates with relaxation, -so that the stomach is, now here, now there, -made narrower by longitudinal or transverse -depressions; then in these same places relaxation -and bulging occur. So long as both apertures -are closed the food is driven hither and -thither by the shifting movements. It first takes -a definite direction when the cardia or the pylorus -opens. If the cardia opens, there is an -antiperistalsis followed by regurgitation and -vomiting. If, on the contrary, the pylorus -relaxes, a contraction, starting at the œsophagus, -pushes the contents of the stomach into -the duodenum. The pylorus allows the passage -of fluids, but if it be stimulated by over -distention or by hard pieces of food, it closes -tightly.</p> - -<p>Such was the knowledge of gastric move<span class="pagenum" id="Page_305">[Pg 305]</span>ments -in Haller’s time. A comparison of his -descriptions with those in any standard work on -physiology published ten or fifteen years ago -will show that, despite very many researches, -little advance had been made. Examinations -of animals and men with gastric fistulas, studies -of the stomach through the atrophied abdominal -wall, and vivisection have yielded numerous results; -but these have not been harmonious, and -have led to much controversy. Prominent in -this mass of material as a valuable contribution -are Beaumont’s careful observations through the -gastric fistula of Alexis St. Martin. Beaumont’s -work has recently been confirmed by Hofmeister -and Schütz, who, with Rossbach, Hirsch, Openchowski, -and others, have presented during the -last twelve years much new and interesting information. -Since, however, it will conduce to -clearness to set forth the results of these investigations -in connection with my own work, their -consideration will be deferred until later.</p> - -<p>It will then appear that these later investigations, -like the earlier researches, disagree as -to the details of the stomach movements. Such -differences in results are the proper outcome of -the abnormal conditions under which the studies -have been conducted. Obviously, in order to see -the natural movements of the stomach, the -organ should be observed in its natural state,<span class="pagenum" id="Page_306">[Pg 306]</span> -and not after it has been disturbed by removal -from the abdomen, or by the adhesions and -losses of substance incident to gastric fistulas.</p> - -<p>As a means of watching the gastric motor -activities under normal circumstances, Dr. H. P. -Bowditch, in the autumn of 1896, suggested the -use of the Röntgen rays. The present paper is -the result of the work thus far completed. The -kind assistance and stimulating counsel of Dr. -Bowditch throughout the investigation are -gratefully acknowledged.</p> - - -<h4><span class="smcap">The Anatomy of the Stomach and its -Relations to the Shadow</span></h4> - -<p>It must be constantly borne in mind that the -shadows described in this research are cast by -the gastric contents, not by the stomach itself. -Therefore the movements of the organ are not -seen directly, but are indicated by their effect on -the contained food. Variations in the length -and breadth of the stomach can be inferred from -changes in the outline of the shadow, but variations -in the front-to-back diameter of the organ -must be judged from changes in the intensity of -the shadow.</p> - -<p>The form of the active stomach soon after -food has been taken is shown in outline in -Figure 1. Since the several parts of the stomach<span class="pagenum" id="Page_307">[Pg 307]</span> -are to be mentioned frequently, it will be well to -recall them here in their relations to the outline. -The larger, cardiac part of the organ lies to the -left of a line through <i>w x</i>. Into it the œsophagus -opens through the cardiac sphincter, or -cardia, at <i>c</i>. The pyloric part, which includes -all of the stomach situated at the right of a line -<i>w x</i>, is closed by the pylorus at <i>p</i>. This part -has two divisions: the antrum at the right of the -line <i>y z</i>, and the preantral part of the pyloric -portion, or middle region of the stomach, between -the lines <i>w x</i> and <i>y z</i>. The lesser curvature -corresponds approximately to the anterior -border of the shadow <i>c w p</i>; the greater curvature -to the more extensive sweep, <i>c p</i>, along the -posterior border.</p> - -<div class="figcenter illowp100" id="illus-345" style="max-width: 43.75em;"> - <img src="images/illus-345.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 1.</span></div> -</div> - -<p>The wall of the cat’s stomach consists of -three coats, but as this paper deals only with the -functions of the muscular coat, that alone will -be described. The gastric muscular fibres are<span class="pagenum" id="Page_308">[Pg 308]</span> -disposed in three sets: an outer longitudinal -layer, a middle circular layer, and a set of inner -oblique fibres. The longitudinal fibres continue -those of the œsophagus, and, radiating over the -cardiac end, become more marked along the -curvatures than on the front and back surfaces. -Over the antrum they lie in a thick, uniform -layer. The circular fibres form a complete -investment, and are arranged in rings at -right angles to the curved axis of the stomach. -Towards the pyloric end they become denser and -stronger, and at the pylorus form a thick bundle, -the pyloric sphincter. Separating the antrum -from the rest of the stomach, at <i>y z</i>, is a special -thickening of the circular fibres, called by the -early writers the “transverse band,” and described -by Hofmeister and Schütz as the “sphincter antri -pylorici.” The oblique fibres start from the left -of the cardiac orifice and pass as two strong -bands along the anterior part of the dorsal and -ventral surfaces, giving off fine fasciculi to the -circular musculature; towards the antrum they -gradually disappear.</p> - -<p>The musculature of the stomach consists of -smooth muscle fibres, the chief physiological -characteristics of which are slowness of contraction, -rhythmic alternation of contraction -and relaxation, and a very great tonicity, or -power of prolonged contraction. The action of<span class="pagenum" id="Page_309">[Pg 309]</span> -these muscles in the process of gastric digestion -is now to be considered.</p> - - -<h4><span class="smcap">The Normal Movements of the -Stomach</span></h4> - -<p>Since the time of Haller the chief contributors -to the knowledge of the mechanics of -the stomach have been Beaumont, Hofmeister -and Schütz, and Rossbach.</p> - -<p>Beaumont’s famous investigations on Alexis -St. Martin are recorded in almost all general -works on physiology. Through a gastric fistula -he introduced a thermometer-tube and observed -how it was affected by the motions of the -stomach. His conclusions are as follows: “The -circular or transverse muscles contract progressively -from left to right. When the impulse -arrives at the <i>transverse band</i>, this is excited -to a more forcible contraction, and closing -upon the alimentary matter and fluids contained -in the pyloric end, prevents their regurgitation. -The muscles of the pyloric end, now contracting -upon the contents detained there, separate and -expel some portion of the chyme.... After -the contractile impulse is carried to the pyloric -extremity, the circular band and all the transverse -muscles become relaxed, and a contraction commences -in a reversed direction, from right to<span class="pagenum" id="Page_310">[Pg 310]</span> -left, and carries the contents again to the splenic -extremity to undergo similar revolutions.”</p> - -<p>In close accord with Beaumont’s description -of the activities of the human stomach are the -records of the investigations on the stomach of -dogs by Hofmeister and Schütz. They removed -the stomach from the body and placed it -in a moist chamber, kept at body-heat and -covered with glass. Under such conditions -the organ remained active for from sixty to -ninety minutes. A typical movement is described -by these observers as composed of two phases. -In the first phase a constriction of the circular -fibres, deeper on the greater curvature, starts a few -centimetres from the cardia and passes towards -the pylorus. As the constriction proceeds it -increases in strength until a maximum is reached -about two centimetres in front of the antrum. -This annular contraction, called by Hofmeister -and Schütz the “preantral constriction,” closes -the first phase. Immediately thereafter the -strong sphincter antri pylorici, or transverse -band, contracts. Now, while the preantral constriction -is relaxing, the sphincter antri pylorici -tightens still more, and the antrum is shut off -from the rest of the stomach. As soon as this -has occurred a general contraction of the muscles -of the antrum follows. Relaxation begins at the -sphincter antri pylorici and progresses slowly<span class="pagenum" id="Page_311">[Pg 311]</span> -towards the pylorus; it is sometimes accompanied -by an antiperistaltic movement.</p> - -<p>Although Rossbach also used dogs, his results -vary considerably from those of Hofmeister -and Schütz. This discrepancy is possibly accounted -for by a difference in method, for -Rossbach left the stomach in the body. The -dogs were treated with morphia and curare, and -the abdomen was then widely opened, so that the -movements could be clearly seen. When the -stomach was full Rossbach saw deep constrictions -begin near the middle and pass in waves -to the pylorus. At first these movements were -weak; later, however, they became more vigorous. -The fundus remained in tonic contraction -about its contents and took no part in the -peristalsis.</p> - -<p>Before attempting to explain the difference -in the records of these observers I shall give an -account of what may be seen in a cat by use of -bismuth subnitrate and the Röntgen rays.</p> - -<p>1. <i>Movements of the pyloric part.</i>—Within -five minutes after a cat has finished a meal of -bread, there is visible near the duodenal end of -the antrum a slight annular contraction which -moves peristaltically to the pylorus; this is followed -by several waves recurring at regular intervals. -Two or three minutes after the first -movement is seen very slight constrictions ap<span class="pagenum" id="Page_312">[Pg 312]</span>pear -near the middle of the stomach, and pressing -deeper into the greater curvature, course slowly -towards the pyloric end. As new regions enter -into constriction, the fibres just previously contracted -become relaxed, so that there is a true -moving wave, with a trough between two crests. -When a wave swings round the bend in the pyloric -part the indentation made by it deepens; -and as digestion goes on the antrum elongates and -the constrictions running over it grow stronger, -but until the stomach is nearly empty they do -not entirely divide the cavity. After the antrum -has lengthened, a wave takes about thirty-six -seconds to move from the middle of the stomach -to the pylorus. At all periods of digestion the -waves recur at intervals of almost exactly ten -seconds. So regular is this rhythm that many -times I have been able to determine within two -or three seconds when a minute had elapsed -simply by counting six similar phases of the -undulations as they passed a given point. It -results from this rhythm that when one wave is -just beginning several others are already running -in order before it. Between the rings of constriction -the stomach is bulged out, as shown -in the various outlines in Figures 2, 3, 4, and 5. -The number of waves during a single period of -digestion is larger than might possibly at first -be supposed. In a cat that finished eating<span class="pagenum" id="Page_313">[Pg 313]</span> -fifteen grams of bread at 10.52 <span class="allsmcap">A.M.</span>, the waves -were running regularly at 11.00 o’clock. The -stomach was not free from food until 6.12 <span class="allsmcap">P.M.</span> -During that time the cat was fastened to the -holder at intervals of half an hour, and the waves -were always observed following one another in -slow and monotonous succession. At the rate -of three hundred and sixty an hour, approximately -two thousand six hundred waves passed -over the antrum during that single digestive -period.</p> - -<p>From the above review it will be manifest -that my observations of the movements of the -pyloric part agree closely with those of Rossbach, -but differ considerably from the harmonious -results of the work of Beaumont, and Hofmeister -and Schütz. Beaumont’s methods, however, -may be justly criticised on the ground that the -thermometer-tube which he held in the stomach -was wholly unlike food and very liable to bring -about unwonted contractions in so sensitive an -organ as the stomach. Further, the movements -observed by Hofmeister and Schütz, as Ewald -has pointed out, may easily have resulted from -the abnormal stimulus due to lack of blood—a -potent cause of peristalsis. And it will be -shown later that the accounts given by these -investigators describe very well the actions of -the stomach when stimulated by an unusual<span class="pagenum" id="Page_314">[Pg 314]</span> -irritant. In this connection it may be added -that since the publication of the preliminary -notice of my work, Roux and Balthazard, using -the Röntgen rays, have published the results of -observations on the stomachs of the dog and -man similar to those thus far described in this -paper.</p> - -<p>The fact that my observations and those of -Roux and Balthazard were conducted under -normal conditions, and that the conditions of -Rossbach’s experiments were more nearly normal -than those of the other observers mentioned, -warrants the conclusion that the pyloric part -has a more important function than that of -merely expelling the contents of the stomach -into the intestines. After summarising the -description given by Hofmeister and Schütz, -Ewald, for <i>a priori</i> reasons, declares: “I cannot -accept this view. The plain fact that the pyloric -portion secretes a strongly digesting fluid containing -pepsin and hydrochloric acid proves it -to be an important part for the peptonising -function of the stomach.” The account of the -remarkable manner in which the pyloric portion -performs this function must be deferred until -the movements of other parts of the stomach -have been considered.</p> - -<p>2. <i>Movements of the pyloric sphincter.</i>—Rossbach -mars his otherwise careful work by de<span class="pagenum" id="Page_315">[Pg 315]</span>claring -that the pylorus is tightly closed during -the whole digestive period of from four to eight -hours, and that then the sphincter relaxes and -the peristaltic waves empty the stomach. That -this is not the normal action of the sphincter -has been shown by several observers. Hirsch -watched dogs with duodenal fistulas and saw -food come from the stomach at intervals of one-fourth -of a minute to several minutes. Roux -and Balthazard maintain that in dogs food enters -the duodenum at the completion of each -wave of constriction. Observations on the cat, -however, do not support their view, but agree -rather with the statement of Hirsch.</p> - -<p>In cats fed with bread mixed with subnitrate -of bismuth, ten or fifteen minutes elapse after the -first constriction in the antrum before any food -can be seen in the duodenum. When food does -appear it is spurted through the pylorus and -shoots along the intestine for two or three -centimetres. Not every constriction-wave forces -food from the antrum. On one occasion, about -an hour after the movements began, three consecutive -waves were seen, each of which squirted -food into the duodenum. The pylorus remained -closed against the next eight waves, opened for -the ninth, but closed once more against the -tenth and eleventh. For each of the four -succeeding waves the sphincter relaxed, but<span class="pagenum" id="Page_316">[Pg 316]</span> -blocked the food brought by three constrictions -that followed; and in this irregular way the -food continued passing from the stomach. Near -the end of gastric digestion, when the constrictions -are very deep, it may be that the -pylorus opens for every wave.</p> - -<p>When a hard bit of food reaches the pylorus, -the sphincter closes tightly and remains closed -longer than when the food is soft. This action -of the sphincter was shown by giving with the -regular food of the cat a dry, hard pellet of -equal parts of starch paste and bismuth subnitrate -about the size of a pea. The food itself -contained merely enough bismuth to throw a -dim shadow, near the centre of which the pellet -could be clearly seen as a dark object. The -continual passing of the contraction-waves -finally brought the little ball to the pylorus. -When it arrived there, five grams of bismuth -subnitrate were introduced into the stomach -through a tube in the œsophagus. This was -done in order that the food passing into the -intestines after the ball came to the pylorus -might be distinguished from that which had -gone on before. By kneading the stomach the -bismuth was distributed, as shown by the uniformly -black shadow. The pellet could still -be seen near the end of the antrum when the -constrictions passed over it. Now, although the<span class="pagenum" id="Page_317">[Pg 317]</span> -waves continued to run regularly, the very black -food did not gather in the intestines in sufficient -amount to be recognised until forty-two minutes -after it had been introduced. And when, finally, -the food did show itself in the intestines, its -shadow contrasted strongly with that of the food -which had already passed on. The slowness of -the expulsion is not to be regarded as wholly -due to the hard mass. No doubt the kneading -of the stomach mixed the contents of different -parts of the organ and brought to the pylorus -food not yet sufficiently digested to be passed -by that selective sphincter. But this does not -explain the whole delay. Food similar to that -given here, except that it contained no hard -particles, has usually been seen as small masses -in the intestines within fifteen minutes after being -swallowed. A part of the delay was evidently, -therefore, caused by the hard pellet. Further -evidence on this point was secured when, on -one occasion, the sphincter was seen to open -only seven times in twenty minutes following the -arrival of a hard particle of food at the pylorus. -The conclusion may therefore be drawn that -hard morsels keep the pylorus closed and hinder -the passage of the food into the duodenum.</p> - -<p>3. <i>Activity of the cardiac portion.</i>—The -part played by the fundus apparently has not -hitherto been properly appreciated. It has been<span class="pagenum" id="Page_318">[Pg 318]</span> -regarded as the place for peptic digestion, or -as a passive reservoir for food; but it is in fact -a most interestingly active reservoir.</p> - -<div class="figcenter illowp75" id="illus-356" style="max-width: 43.75em;"> - <img src="images/illus-356.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 2.</span></div> -</div> - -<p><span class="pagenum" id="Page_319">[Pg 319]</span></p> - - -<div class="figcenter illowp75" id="illus-357" style="max-width: 43.75em;"> - <img src="images/illus-357.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 3.</span></div> -</div> - -<div class="figcenter illowp75" id="illus-358" style="max-width: 43.75em;"> - <img src="images/illus-358.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 4.</span></div> -</div> - -<div class="figcenter illowp100" id="illus-359" style="max-width: 62.5em;"> - <img src="images/illus-359.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 5.</span> -<p class="hang"><span class="smcap">Figure 5.</span>—Figures 2, 3, 4, and 5 present outlines of the shadow -of the contents of the stomach cast on a fluorescent screen by the -Röntgen rays. The drawings were made by tracing the outline of -the shadow on tissue paper laid upon the fluorescent surface, and -are about one-half the actual size. They show the change in the -appearance of the stomach at intervals for half an hour, from the -time of eating until the stomach is nearly empty.</p> -</div> -</div> - -<p>The action of the cardiac portion will be best -understood by comparing the appearances the -stomach presents at various stages in a digestive -period. In order to show these stages I care<span class="pagenum" id="Page_320">[Pg 320]</span>fully -made a set of three tracings of the outlines -of the stomach as soon as possible after a -cat had finished eating, and another set of three -every half hour thereafter, until the contents had -disappeared (Figs. 2, 3, 4, and 5). These tracings -were made by placing white tissue paper over<span class="pagenum" id="Page_321">[Pg 321]</span> -the fluorescent screen, and drawing with a thick -lead pencil, easily seen, as much of the boundary<span class="pagenum" id="Page_322">[Pg 322]</span> -of the stomach as I could at the end of each -expiration. Between the times for making the -drawings the cat was allowed to rest quietly on -a mat, but care was taken to lay her in the same -position on the holder for every drawing. The -drawings of each set were afterwards fastened -over one another, so that the lines coincided as -closely as possible. Another piece of tissue -paper was then put over these, and all four -sheets were laid on an illuminated pane of glass. -It was thus easy to get a composite tracing -which, considering the movement imparted to -the stomach by respiration, and the dimness of -the shadows in the later stages of digestion, -probably represents more exactly than any -single drawing the outline of the stomach for -each successive period.</p> - -<p>A comparison of these drawings shows that -as digestion proceeds the antrum appears gradually -to elongate and acquire a greater capacity, -and that the constrictions make deeper indentations -in it. But when the fundus has lost most -of its contents, the longitudinal and circular -fibres of the antrum contract to make it again -shorter and smaller. Its change of form, however, -compared with the rest of the stomach, -is slight.</p> - -<p>The first region to decrease markedly in size -is the preantral part of the pyloric portion. The<span class="pagenum" id="Page_323">[Pg 323]</span> -peristaltic undulations, caused by the circular -fibres, start at the beginning of this portion, and -gradually, by their rhythmic recurrence, press -some of the contents into the antrum. As the -process continues, the smooth muscle fibres with -their remarkable tonicity contract closely about -the food that remains, so that the middle region -comes to have the shape of a tube (Figs. 3 and 4—1.30 -<span class="allsmcap">P.M.</span> to 2.30 <span class="allsmcap">P.M.</span>), with the rounded fundus -at one end and the active antrum at the other. -Along the tube very shallow constrictions may -be seen following one another to the pylorus.</p> - -<p>At this juncture the longitudinal fibres which -cover the fundus like radiating fingers, and the -circular and oblique fibres reaching in all directions -about this spherical region, begin to -contract. Thus the contents of the fundus are -squeezed into the tubular portion. This process, -accompanied by a slight shortening of the -tube, goes on until the shadow cast by the -fundus is almost wholly obliterated (Fig. 5—5.30 -<span class="allsmcap">P.M.</span>).</p> - -<p>The waves of constriction moving along the -tubular portion press the food onward as fast as -they receive it from the contracting fundus, and -when the fundus is at last emptied they sweep -the contents of the tube into the antrum (Fig. 5—5.00 -<span class="allsmcap">P.M.</span> to 6.00 <span class="allsmcap">P.M.</span>). Here the operation -is continued by the deeper constrictions till,<span class="pagenum" id="Page_324">[Pg 324]</span> -finally (in this instance at 6.12 <span class="allsmcap">P.M.</span>), with the -exception of a slight trace of food in the fundus, -nothing is to be seen in the stomach at all.</p> - -<p>The food in the fundus may possibly be -slightly affected by the to-and-fro movements -of the diaphragm in respiration. With normal -breathing the upper border of the cardiac portion -swings through about one centimetre; with -dyspnœa, or deep breathing, through one and a -half or two centimetres. Since the lower border -does not move so much, the contents are gently -pressed, and then released from pressure, at -each respiration. The pyloric portion is moved -very little by the diaphragm, the oscillation -being less than a half centimetre.</p> - -<p>Moritz has pointed out the value of an organ -like the stomach for holding the bulk of the food -and serving it out a little at a time, so that the -intestines may not become congested during -their digestive and absorptive processes. All -of the advantages supposed to be thus secured -to the intestines may be claimed also for the -stomach itself. For the preceding description -indicates, and experiments to be described later -prove, that the stomach is composed of two -physiologically distinct portions: the busy antrum, -over which during digestion constriction-waves -are running in continuous rhythm; and -the cardiac part, which is an active reservoir,<span class="pagenum" id="Page_325">[Pg 325]</span> -pressing out its contents a little at a time as the -antral mechanism is ready to receive them.</p> - - -<h4><span class="smcap">The Movements of the Stomach in -Vomiting</span></h4> - -<p>The appearance of the stomach during vomiting -has been studied particularly by Openchowski. -He says that when an emetic is given -there follows a quivering of the stomach-wall, -which, beginning near the pylorus, shows itself -later in the antral and middle regions of the -stomach. The quivering afterwards passes into -a contraction, most strongly marked in the -antral part, since the peristaltic waves running -down to the antrum from above are continually -growing deeper. At the same time the fundus -expands spherically. The increased contraction -in the pyloric part drives the contents towards -the more dilated portion, and thence they -are forced into the œsophagus by abdominal -pressure.</p> - -<p>The same phenomena occur when a cat is -given apomorphine hypodermatically. First the -upper circular muscles relax and become so -flaccid that the slightest movement of the -abdomen changes the form of the fundus. Then -there are apparently irregular twitchings of the -fundus wall. Soon a deep constriction starts -about three centimetres below the cardia and,<span class="pagenum" id="Page_326">[Pg 326]</span> -growing in strength, moves towards the pylorus. -When it reaches the transverse band the constriction -tightens and holds fast, while a wave -of contraction sweeps over the antrum. Another -similar constriction follows. In the interval the -transverse band relaxes slightly, but tightens -again when the second wave reaches it. Perhaps -a dozen such waves pass; then a firm -contraction at the beginning of the antrum completely -divides the gastric cavity into two parts. -This same division of the stomach into two parts -at the transverse band is to be seen when -mustard is given. Now, although the waves are -still running over the antrum, the whole preantral -part of the stomach is fully relaxed. A flattening -of the diaphragm and a quick jerk of the -abdominal muscles, accompanied by the opening -of the cardia, now force the contents of the -fundus into the œsophagus. As the spasmodic -contractions of the abdominal muscles are repeated, -the gastric wall again tightens around -the contained food. Antiperistalsis I have seen -only once; then, while the cat was retching, a -constriction started at the pylorus and ran back, -over the antrum, completely obliterating the -antral cavity.</p> - -<p>It will be recalled that the principal difference -between the movements of the stomach and -their effects as described by Beaumont, and Hof<span class="pagenum" id="Page_327">[Pg 327]</span>meister -and Schütz on the one hand, and Rossbach, -Roux and Balthazard, and myself on the -other hand, is that the former observed constrictions -completely dividing the stomach at the -transverse band, and the antrum then squeezing -its contents into the intestines; whereas the latter -have seen the constrictions moving forward as -narrowing rings, but not separating the gastric -cavity into two parts.</p> - -<p>With the exception of peristalsis in the -antrum, the gastric movements at the beginning -of emesis are almost exactly the same as those -Beaumont, and Hofmeister and Schütz, declare -to be the normal contractions of the stomach. -Their observations were made, however, when -the organ was subjected to unnatural stimulation. -In the excised stomach, observed by Hofmeister -and Schütz, not only were all nervous connections -severed, but likewise all flow of blood -to the organ was entirely stopped, and the cutting -off of the blood supply is regarded as one of the -most powerful predisposing causes of peristaltic -action. The thermometer-tube used by Beaumont -was an irritant to the stomach, as he himself -admits. “If the bulb of the thermometer,” -he writes, “be suffered to be drawn down to the -pyloric extremity, and retained there for a short -time, or if the experiments be repeated too -frequently, it causes severe distress and a sen<span class="pagenum" id="Page_328">[Pg 328]</span>sation -like cramp, or spasm, which ceases on -withdrawing the tube, but leaves a sense of -soreness and tenderness at the pit of the -stomach.” Moritz also noticed that a rubber -sound introduced into the human stomach -proved to be a source of irritation. It seems -reasonable to suppose, therefore, that these observers -did not see the normal movements, but -the actions resulting from abnormal irritation.</p> - - -<h4><span class="smcap">The Effect of the Movements of the -Stomach on the Food</span></h4> - -<p>In my first observations on the active -stomach a bulging of the stomach-wall was to -be seen in front of the passing waves. But as -food did not immediately appear in the intestine, -and as, after the pylorus relaxed, the gastric -contents did not diminish rapidly enough to -allow the supposition that all of the food -squeezed forward by the waves was immediately -forced through the pylorus, it was assumed that -a part, at least, of the food under pressure was -forced back towards the cardia through the -constriction-ring. This inference was stated in -the preliminary notice of my work. Roux and -Balthazard also observed the passage of the undulations -over the pyloric part, but state merely -that the function of the constrictions is the -propulsion of food into the intestine, without<span class="pagenum" id="Page_329">[Pg 329]</span> -mentioning what must be regarded as a very -important function; namely, the mixing effect -of the waves.</p> - -<p>Most writers have agreed that the result of -the active and passive movements of the stomach -is to force the contents hither and thither, thus -mixing them and the gastric juice together. -Two observers, Beaumont and Brinton, have attempted -to explain the manner of the mixing. -Beaumont, after noting how the thermometer-tube, -used by him to indicate the gastric motions, -was affected, describes the circulation of the food -as follows: “The bolus as it enters the cardia -turns to the left, passes the aperture, descends -into the splenic extremity, and follows the -great curvature towards the pyloric end. It -then returns, in the course of the small curvature, -makes its appearance again at the aperture, -in its descent into the great curvature, to perform -similar revolutions.” Brinton bases his -theory of the circulation of the food on an -analogy between the movement of a constriction -over the stomach and the passage of a septum -with a central perforation along the interior of a -cylinder full of liquid. The result in both cases, -he declares, must be a peripheral current of -advance, and a central current of return. Thus -in the stomach there would be peripheral currents -from the cardia along the walls of the<span class="pagenum" id="Page_330">[Pg 330]</span> -stomach to the pylorus, where they would unite -and run as an axial current back to the cardia.</p> - -<p>Certain <i>a priori</i> objections may be urged -against each of these conclusions. In the first -place Beaumont’s observations were made on a -subject having a gastric fistula, and the adhesions -between the stomach and the abdominal wall -would prevent the fundus from acting quite -normally in relation to its contents. Beaumont’s -conclusions, furthermore, are based on the -movements of a thermometer-tube introduced -through the fistula, and on the recognition of -particles of food which he had seen before as -they passed the fistulous opening: the first -method, as has been shown, made the conditions -in the stomach more abnormal than they -were previously; the second gave uncertain -knowledge of the course of the food when out -of the observer’s sight. Brinton’s hypothesis -states the probable movements of fluid contents -acted on by a passing constriction. But it may -be objected that the conditions assumed by him -do not exist in all parts of the stomach. For -not only is there no peristalsis visible in the -fundus, but with the usual food the fundus -contents are not liquid. Moreover, the constrictions -at the beginning of the pyloric portion -are very slight and move slowly. The food in -front of them is, accordingly, not under much<span class="pagenum" id="Page_331">[Pg 331]</span> -greater pressure than the food behind them. -The axial current which might result, therefore, -could not be strong enough to go far into the -cardiac portion.</p> - -<p>It is easily possible to test experimentally -the validity of these two theories by watching -the action of pieces of food which throw a black -shadow in a dimly outlined stomach. For this -purpose little paste pellets of bismuth subnitrate, -with starch enough to keep the form, were -given with the customary meal. These pellets, -it was found, did not break up in the stomach -during the gastric digestion of soft bread. Several -times I have been fortunate in getting two -of the little balls in the axis of the stomach and -about a centimetre apart. As the constriction-wave -approached them, both moved forward, -but not so rapidly as the wave. Now when the -constriction overtook the first ball, the ball -moved backward through the constricted ring, -in the direction of least resistance. The wave -then overtook the second ball, and it also passed -backward to join its fellow. At the approach -of the next wave they were both pushed forward -once more, only to be again forced backward, -one at a time, through the narrow orifice. As -the waves recurred in their persistent rhythm, -the balls were seen to be making progress—an -oscillating progress—towards the pylorus;<span class="pagenum" id="Page_332">[Pg 332]</span> -for they went forward each time a little farther -than they retreated. This to-and-fro movement -of the pellets was much more marked in the -antrum, where the waves were deep, than in the -middle region. On different occasions from -nine to twelve minutes have elapsed while the -balls were passing from where the waves first -affected them to the pylorus; which means that -on the way they were moved back and forth by -more than a half hundred constrictions.</p> - -<p>If the pylorus does not relax, it is evident -that a wave approaching it pushes the food into -a blind, elastic pouch, the only exit from which -is through the advancing constricted ring. The -constrictions are deeper near the end of the -antrum, and the rings are small; consequently, -the food is squirted back through them with -considerable violence. As has been noted, the -pylorus opens less frequently for a while after a -solid piece of food comes to it. In such a case -the slow driving waves squeeze the hard morsel -and the soft food about it up to the sphincter, -only to have the whole mass shoot back, sometimes -half-way along the antrum. Over and -over again the process is repeated till the -sphincter at last opens and allows the more fluid -parts to pass. Hofmeister and Schütz, and -Moritz have disclaimed any selective action of the -pylorus, and declare that solids are driven from<span class="pagenum" id="Page_333">[Pg 333]</span> -the pylorus to the fundus by antiperistalsis. -The action of the pylorus which I have seen, -however, is more like that described by the -earlier investigators; for during digestion there -was no antiperistalsis, and the sphincter, separating -the fluids from the solids, caused the solids -to remain and undergo a tireless rubbing. -Frequently, when several of these balls have -been given at the same time, they have all been -seen in the antrum after the stomach was otherwise -empty. Here they remain to be softened -in time by the juices, or to be forced through the -pylorus later, for solids do pass into the intestine. -Thus when the teeth neglect their work -the stomach attempts to perform their function; -the relative inefficiency of the gastric method of -grinding and its interference with the normal -gastric activities point an obvious hygienic -moral.</p> - -<p>During the process of digestion the food in -the cardiac portion gives no sign of currents. -Balls which lie in the fundus immediately after -the food is ingested keep their relative positions -until the cardiac portion begins to contract, and -then move very slowly towards the antrum. -Moreover, the food in the fundus of a cat has -the same mushy appearance when examined -after gastric peristalsis had been active for an -hour and a half that it had when ingested. The<span class="pagenum" id="Page_334">[Pg 334]</span> -contents of the antrum, on the other hand, look -quite different and have the consistency of thick -soup. The inactivity of the food in the fundus -can also be proved by feeding first five grams -of bread and bismuth, then five grams without -bismuth, and finally five grams again with -bismuth in it. The stomach contents are thus -arranged in two dark layers along the curvatures, -with a light layer between. Tracings -made on tissue paper show that ten minutes -after peristalsis commenced the stratification -had entirely disappeared in the pyloric part, but -that an hour and twenty minutes thereafter the -layers were still clearly visible in the cardiac -region.</p> - -<p>The value of the circulation of the food, as -described by Beaumont and Brinton, lay in the -supposition that the contents of the stomach -were thus brought near to the secreting gastric -wall, and that the gastric juice could thus more -readily exert its action. Although my observations -do not support their theories of mixing -currents running throughout the stomach, they -still show that the pyloric portion is an admirable -device for bringing all of the food under -the influence of the glandular secretions of that -region. For, when a constriction occurs, the -secreting surface enclosed by the ring is brought -close around the food lying within the ring in<span class="pagenum" id="Page_335">[Pg 335]</span> -the axis of the stomach. As this constriction -passes on, fresh areas of glandular tissue are -continuously pressed in around the narrow orifice. -And also, as the constriction passes on, -a thin stream of gastric contents is continuously -forced back through the orifice, and thus past the -mouths of the glands. The result of this ingenious -mechanism is that every part of the secreting -surface of the pyloric portion is brought -near to every bit of food, before the latter leaves -the stomach, a half hundred times or more, as -evidence by the moving ball.</p> - - -<h4><span class="smcap">Salivary Digestion in the Stomach</span></h4> - -<p>The absence of movement in the fundus -would seem to give the food during its stay there -little opportunity to become mixed with the -gastric juices, and thus to undergo peptic digestion. -The truth of this supposition can easily -be proved experimentally by feeding a slightly -alkaline meal, and later testing the chemical -reaction of the contents of various parts of the -stomach. A cat which had been without food -for fifteen hours was given eighteen grams of -mushy bread made slightly alkaline with sodium -carbonate. One hour and a half after the cat -had finished eating she was killed, and the -stomach laid bare by opening the abdomen. A -very small hole was then made through the wall<span class="pagenum" id="Page_336">[Pg 336]</span> -in the fundus region, and another similar hole -was made into the antrum. By means of a -glass pipette food was extracted first from the -periphery of the fundus; this food was slightly -acid. The cleaned pipette was then introduced -two and a half centimetres into the fundus contents, -and the food thus extracted gave the -original alkaline reaction. Specimens of the -liquid contents of the antral and middle regions, -taken from various depths, were all strongly -acid. A dog killed an hour and three-quarters -after eating showed similar differences between -the reactions of the food in the fundus and the -food in the pyloric portion. So, as a matter of -fact, the food does not become acid at a uniform -rate in all parts of the stomach, as would -be the case if Beaumont’s and Brinton’s theories -of mixing currents were true. Moreover, if the -facts accorded with their notions, the saliva, -which ceases to act in the presence of more than -0.003 per cent free hydrochloric acid, and is -destroyed when the percentage of acid proteids -is large, would manifestly have its service as a -ferment limited to the relatively short time during -which the stomach contents, in the process -of thorough mixing, were reaching that degree -of acidity. There is, however, no movement of -food in the fundus, and the alkaline food received -from the œsophagus remains alkaline in this<span class="pagenum" id="Page_337">[Pg 337]</span> -region for a considerable period. The nutriment, -therefore, if well chewed and thus mixed -with saliva, can undergo salivary digestion in -the fundus for a considerable period without -interference by the acid gastric juice.<a id="FNanchor_32" href="#Footnote_32" class="fnanchor">[32]</a></p> - -<p>From all these observations the conclusion -must be that the fundus acts as a reservoir for -the food, in which the digestion of sugars and -starches may take place; and that the pyloric -portion with its simple but marvellous peristaltic -mechanism, by a single process, triturates the -food, brings it near to the active glands, stirs it -thoroughly with their secretions, and expels the -products into the intestines.</p> - - -<h4><span class="smcap">The Inhibition of Stomach Movements -during Emotion</span></h4> - -<p>Early in the research a marked unlikeness -was noticed in the action of the stomachs of male -and female cats. The peristalsis seen with only -a few exceptions in female cats failed to appear -in most of the males, although both had received -exactly the same treatment. Along with this difference -was a very striking difference in behaviour<span class="pagenum" id="Page_338">[Pg 338]</span> -when bound to the holder; the females would -lie quiet, mewing occasionally, but purring as -soon as they were gently stroked. The males, -on the contrary, would fly into a violent rage, -struggle to be loose from their fastenings, bite -at everything near their heads, cry loudly, and -resist all attempts to quiet them. On account -of this difference only female cats were used for -some time, and the significance at first attributed -to the action of the males was almost forgotten -when the following incident recalled it -and suggested that the excitement caused the -suspension of the stomach movements. On -October 23, 1897, a male cat was fed at 12.00, -but was not placed on the holder till ninety -minutes later. The waves were passing at the -rate of six a minute. The cat fell into a rage -and the waves suddenly stopped.</p> - -<p>A few days later an observation on a female -with kittens explained the absence of gastric -movements in the males. While the peristaltic -undulations were coursing regularly over the cat’s -stomach, she suddenly changed from her peaceful -sleepiness, began to breathe quickly, and -struggled to get loose. As soon as the change -took place, the movements in the stomach -entirely disappeared; the pyloric portion relaxed -and presented a smooth, rounded outline. -I continued observing, and stroked the cat reas<span class="pagenum" id="Page_339">[Pg 339]</span>suringly. -In a moment she became quiet and -began to purr. As soon as this happened the -movements commenced again in the stomach; -first a few constrictions were visible near the end -of the antrum, then a few near the sharp bend -in the lesser curvature, and finally the waves -were running normally from their habitual starting-place. -By holding the cat’s mouth closed -between the thumb and last three fingers, and -covering her nostrils with the index finger, she -could be kept from breathing. At the first sign -of discomfort the fingers were removed. This -experiment was repeated a great many times on -different cats, and invariably the evidence of -distress was accompanied by a total suspension -of the motor activities of the stomach and a -relaxation of the antral fibres.</p> - -<p>No amount of kneading or compression of -the abdomen with the fingers, short of making -the cat angry, would cause the waves to stop; -so that the cat’s movements, in themselves, -were not the source of the inhibition. And -since expressions of strong feeling on the part -of the animal always accompanied cessation of -the constriction-waves, the inhibition was probably -due to nervous influence. It has long -been common knowledge that violent emotions -interfere with the digestive process, but that the -gastric motor activities should manifest such<span class="pagenum" id="Page_340">[Pg 340]</span> -extreme sensitiveness to nervous conditions is -surprising.</p> - - -<h4><span class="smcap">Summary</span></h4> - -<p>1. By mixing a harmless powder, subnitrate -of bismuth, with the food, the movements of the -stomach can be seen by means of the Röntgen -rays.</p> - -<p>2. The stomach consists of two physiologically -distinct parts: the pyloric part and the -fundus. Over the pyloric part, while food is -present, constriction-waves are seen continually -coursing towards the pylorus; the fundus is an -active reservoir for the food and squeezes out -its contents gradually into the pyloric part.</p> - -<p>3. The stomach is emptied by the formation, -between the fundus and the antrum, of a tube -along which constrictions pass. The contents -of the fundus are pressed into the tube and the -tube and antrum slowly cleared of food by the -waves of constriction.</p> - -<p>4. The food in the pyloric portion is first -pushed forward by the running wave, and then -by pressure of the stomach-wall is returned -through the ring of constriction; thus the food -is thoroughly mixed with gastric juice, and is -forced by an oscillating progress to the pylorus.</p> - -<p>5. The food in the fundus is not moved by -peristalsis, and consequently it is not mixed with<span class="pagenum" id="Page_341">[Pg 341]</span> -the gastric juice; salivary digestion can therefore -be carried on in this region for a considerable -period without being stopped by the acid -gastric juice.</p> - -<p>6. The pylorus does not open at the approach -of every wave, but only at irregular intervals. -The arrival of a hard morsel causes the sphincter -to open less frequently than normally, thus -materially interfering with the passage of the -already liquefied food.</p> - -<p>7. Solid food remains in the antrum to be -rubbed by the constrictions until triturated, or -to be softened by the gastric juice, or later -it may be forced into the intestine in the solid -state.</p> - -<p>8. The constriction-waves have, therefore, -three functions: the mixing, trituration, and -expulsion of the food.</p> - -<p>9. At the beginning of vomiting, the gastric -cavity is separated into two parts by a constriction -at the entrance to the antrum; the cardiac -portion is relaxed, and the spasmodic contractions -of the abdominal muscles force the food -through the opened cardia into the œsophagus.</p> - -<p>10. The stomach movements are inhibited -whenever the cat shows signs of anxiety, rage, -or distress.</p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_342">[Pg 342]</span></p> - - -<h3 class="nobreak" id="THE_MOVEMENTS_OF_THE_INTESTINES">THE MOVEMENTS OF THE INTESTINES -STUDIED BY MEANS OF -THE RÖNTGEN RAYS<a id="FNanchor_33" href="#Footnote_33" class="fnanchor">[33]</a><br /> - -<small><span class="smcap">By W. B. Cannon</span></small><br /> - -<small><i>From the Laboratory of Physiology in the Harvard Medical School</i></small><br /> - -<small>Extracts from <i>American Journal of Physiology</i>, 1902</small></h3></div> - - -<h4><span class="smcap">Introduction</span></h4> - -<p>The investigation of intestinal movements -has been beset by the same difficulties that -characterised the investigation of the gastric -mechanism. Pathological subjects or animals -subjected to the disturbing action of drugs and -anæsthetics and of serious operations have been -the only sources of our knowledge. A considerable -difference of opinion as to the nature of -the normal movements in the intestines has -resulted from observations made under these -necessary abnormal conditions. The slowly -advancing peristaltic wave and the <i>Pendelbewegung</i>, -or swaying movement, described by -Ludwig, have been regarded as true physiological -processes. Concerning antiperistalsis and<span class="pagenum" id="Page_343">[Pg 343]</span> -the swiftly running vermicular contraction, observers -are not so nearly in agreement. The -activity of the large intestine has been described -as simply peristalsis of a slower rate than that -seen in the small intestine.</p> - -<p>The best known of the intestinal movements -is the normal peristaltic wave. This wave is -slow, having a rate of about two centimetres -per minute, is regular, and by most observers -is said to move always in one direction. The -progress of the contraction, as suggested by -Nothnagel’s experiments, and as clearly stated -by Mall and by Bayliss and Starling, is dependent -upon a local reflex. According to Mall, when -an object stimulates the mucosa there occurs -above the point of stimulation a constriction -which forces the object downward; and as -it moves downward new regions immediately -above the mass are by this reflex brought into -constriction, and thus the wave and its stimulus -advance together. “At the same time,” Mall -states, “a sucking force, due to active dilatation -below the body, may have a tendency to drag -it down.” In what manner an active dilatation -of the intestinal wall may occur so as to produce -a “sucking force” he does not make -wholly clear. Bayliss and Starling, in describing -normal peristalsis in the intestine, state that -the contractions above the bolus increase until<span class="pagenum" id="Page_344">[Pg 344]</span> -there is a strong tonic constriction. This passes -the bolus onward, and as it advances the ring -of constriction follows it. While the bolus is -passing down, the gut above it is traversed by -waves running as far as the constricted ring. -These observers state the law of intestinal peristalsis -thus: “Local stimulation of the gut produces -excitation above and inhibition below the -excited spot.”</p> - -<p>The pendulum movements are characterised -by a gentle swaying motion of the coils, and are -accompanied by rhythmical contractions of the -intestinal wall. They continue with undiminished -force after paralysis of the local nervous -mechanism by nicotine or cocaine; they have -been called, therefore, myogenic or myodromic -contractions. Observers have described them -variously as shortenings and narrowings of the -gut, rhythmically repeated at nearly the same -intestinal circumference; as alternating to-and-fro -movements of the long axis without changes -in the lumen; as local or extensive periodic -contractions and relaxations mainly of the circular -musculature; and as waves involving both -muscular coats of the intestine, and travelling -normally from above downward at a rapid rate -(2 to 5 cm. per second). They have been seen -in the dog, and in the rabbit and cat. In the -cat Bayliss and Starling noticed that when the<span class="pagenum" id="Page_345">[Pg 345]</span> -lumen of the gut was distended by a rubber -balloon, there appeared rhythmical contractions, -which nearly always were most marked at about -the middle of the balloon; <i>i. e.</i>, the region of -greatest tension. This form of constriction, -which, as my observation shows, is an indication -of the manner in which the rhythmical contraction -acts in the cat’s intestine, Bayliss and Starling -seem to have regarded with slight attention, -since it did not accord with the law of peristalsis.</p> - -<p>The swift vermicular wave may pass the -whole length of the intestine in about a minute. -It is often seen just after death, as well as in -pathological states such as intestinal anæmia or -hyperæmia, and when the bowel contains gases -and organic acids from decomposing food. -Starling is inclined to regard this type of intestinal -activity as an exaggeration of the rhythmic -type; Mall, on the other hand, places it in -a class by itself, and declares that its service -is to rid the intestine rapidly of irritating substances. -Nothnagel, who designates this form -of movement with the term <i>Rollbewegung</i>, thinks -it is transitional between a physiological and a -pathological activity.</p> - -<p>The existence of antiperistalsis has been so -much questioned that it will be considered in a -special section of this paper, where my observations -may be conveniently introduced.</p> - -<p><span class="pagenum" id="Page_346">[Pg 346]</span></p> - -<p>The common understanding of the manner -in which food passes through the intestinal -canal is that the chyme ejected from the stomach -is pressed downward by a peristalsis, which -passes slowly over a part or all of the small intestine. -The peristaltic waves of the colon are -supposed to constitute an independent group, -similar to those of the small intestine, but -weaker and slower. Movements of the food -other than the uninterrupted advance have been -mentioned by some observers. Starling states -that the effect of the pendulum movement is -to mix the contents of the intestine and bring -them into intimate contact with the mucous -membrane. Grützner writes that he has been -brought “by strange and peculiar observations” -to believe that the fluid contents of the -small intestine move irregularly forward, then -forward and back, then perhaps remain quiet -for some time, only to pass backward for a long -distance, and finally to move forward steadily to -the end. In this manner the food is mixed and -brought into contact with the absorbing walls. -The to-and-fro shiftings of the food Grützner -ascribed to advancing and retrograde contractions -of the intestinal musculature, and he -argued that even circular constrictions must -force the liquid contents away in both directions. -To support his contention, Grützner<span class="pagenum" id="Page_347">[Pg 347]</span> -introduced mercury into the intestine and observed -it with the Röntgen rays. After noting -a backward and forward movement of the mercury -he dismissed the method, saying, “Many -a flash must come from the Röntgen tube before -the <i>normal</i> movement of the intestinal contents -is made entirely clear by this method.”</p> - -<p>The following account is a summary of many -repeated observations on different animals, and -is a contribution to a clear understanding of the -normal movements of the intestines and their -contents.</p> - - -<h4><span class="smcap">The Movements of the Small Intestine</span></h4> - -<p>When the food has been distributed through -the intestine so as to present the appearance -shown in Figure 1, a noticeable feature in most -or all of the loops is the total absence of movement. -If the animal remains quiet, however, -only a few moments elapse before peculiar -motions appear in one or another of the loops, -or perhaps in several, and last for some time. -These motions consist in a sudden division of -one of the long, narrow masses of food into -many little segments of nearly equal size; then -these segments are again suddenly divided and -the neighbouring halves unite to make new segments, -and so on, in a manner to be more fully -described. I have called this process the rhyth<span class="pagenum" id="Page_348">[Pg 348]</span>mic -segmentation of the intestinal contents. -Further observation reveals peristalsis here and -there, and under certain circumstances the -typical swaying movements may be seen. All -these phenomena are -now to be considered -in detail.</p> - - -<div class="figleft illowp50" id="illus-386" style="max-width: 37em;"> - <img src="images/illus-386.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 1.</span>—Appearance of food -in the intestines 5¾ hours after -eating. This and other radiographs -reduced two-thirds.</div> -</div> - - -<p><i>Rhythmic segmentation -of the intestinal -contents.</i>—This is by -far the most common -and the most interesting -mechanical process -to be seen in the small -intestine. The nature -of the process may -best be understood by -referring to the diagram -in Figure 2. A -string-like mass of food -is seen lying quietly in -one of the intestinal loops (line 1, Fig. 2). Suddenly -an undefined activity appears in the mass, -and a moment later constrictions at regular intervals -along its length cut it into little ovoid -pieces. The solid string is thus quickly transformed, -by a simultaneous sectioning, into a -series of uniform segments. A moment later -each of these segments is divided into two par<span class="pagenum" id="Page_349">[Pg 349]</span>ticles, -and immediately after the division neighbouring -particles (as <i>a</i> and <i>b</i>, line 2, Fig. 2) rush -together, often with the rapidity of flying shuttles, -and merge to form new segments (as <i>c</i>, line -3, Fig. 2). The next moment these new segments -are divided, and neighbouring particles -unite to make a third series, and so on. At -the time of the second segmentation (line 3, -Fig. 2) the end particles are left small. Observation -shows that these small pieces are not redivided. -The end piece at A simply varies in -size with each division; at one moment it is left -small, at the next moment it is full size from the -addition of a part of the nearest segment, and a -moment later is the small bit left after another -division. The end piece at B (probably the rear -of the mass) shoots away when the end mass is -divided, and is swept back at each reunion to<span class="pagenum" id="Page_350">[Pg 350]</span> -make the large end mass again, only to be shot -away and swept onward with each recurrence of -the constrictions. Thus the process of repeated -segmentation continues, with the little particles -flitting towards each other and the larger segments -shifting to and fro, commonly for more -than half an hour without cessation. From the -beginning to the end of a period of segmentation -the food is seen to have changed its position -in the abdomen to only a slight extent; -whether this change is a passing of the food -along the loop, or a movement of the loop -itself, it is impossible to tell from the shadows -on the screen. The change of position, however, -is much less conspicuous than the lively -division and redivision which the mass suffers so -many times from the busy, shifting constrictions.</p> - -<div class="figcenter illowp100" id="illus-387" style="max-width: 43.75em;"> - <img src="images/illus-387.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 2.</span>—Diagram representing the process of rhythmic segmentation. -Lines 1, 2, 3, 4 indicate the sequence of appearances -in the loop. The dotted lines mark the regions of division. The -arrows show the relation of the particles to the segments they -subsequently form.</div> -</div> - -<p>From this typical form of rhythmic segmentation -there are several variations. Sometimes, -and especially when the mass of food is thick, -the constrictions do not make complete divisions -and are so far apart that the intermediate -portions are relatively large. Moreover, the -constrictions do not take place in the middle of -each portion, but near one end; thus each -portion is constricted, not into halves, but into -thirds. If a little pointer is placed at the middle -of a segment, when the segments are completely -divided into halves, in a few seconds the pointer<span class="pagenum" id="Page_351">[Pg 351]</span> -will be in the middle of the clear space between -two segments; but in a few seconds more the -first phase will return and the pointer will again -be indicating a segment,—two operations intervene -between similar phases. When, however, -the portions are constricted into thirds, the indicator -shows it, since three operations intervene -between similar phases. The manner of these -changes is made clearer by reference to the -diagram in Figure 3. That each portion is constricted -into three pieces is proved also by -watching the gradual reduction of the portion -at the left end of line 1 through lines 2 and 3, -and also in the gradual formation of a full-sized -portion at the right end of lines 2, 3, and 4. -When food undergoing this process is watched, -it appears to be affected by a series of constrictions, -each of which starts at one end of the -mass and marches through to the other end, -leaving its impress at short intervals along the -length. The progression of the dotted lines -from right to left in <i>a</i>, <i>b</i>, <i>c</i>, and <i>d</i>, etc., Fig. 3, -gives a notion of these advancing constrictions.</p> - -<p>Another variation of the segmentation is -shown in Figure 4. In this type there are evidently -divisions and subdivisions, <i>i.e.</i>, one more -operation between the appearance and the reappearance -of the same phase than is present in -the simple division of the small segments in a<span class="pagenum" id="Page_352">[Pg 352]</span> -long string of food (Fig. 2). This form of -segmentation is fairly typical for the constrictions -seen in food advancing through the intestine. -Sometimes the divisions occur in the middle of -a long string of food and leave the ends wholly -unaffected.</p> - -<div class="figright illowp60" id="illus-390" style="max-width: 18.75em;"> - <img src="images/illus-390.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 3.</span>—Diagram showing the relations -of the portions when they are constricted -into three pieces. The dotted lines indicate -regions of constriction; the arrows indicate -the relationship of the pieces to the -portions they subsequently form.</div> -</div> - -<p>A remarkable feature in the segmentation of -the food is the rapidity with which the changes -take place. -The simplest -way of estimating -the rate of -division is to -count, not the -number of -times the partition -of the food -recurs in the -same place, -but the number -of different -sets of segments observed in a given period. -Thus in Figure 4 the appearances of lines 1, 2, -3, 4, etc., would be counted, and not merely lines -1, 4, etc. Repeated observations on different -animals have shown that the most common -rate of division in long, thin chains of food -varies between twenty-eight and thirty times in -a minute; <i>i. e.</i>, there is a change from one set of<span class="pagenum" id="Page_353">[Pg 353]</span> -segments to another set every two seconds, and -a return of the same phase every four seconds. -In some cases the rate is as low as twenty-three -times per minute. The larger masses seem to -be associated with a slower segmentation; the -operations indicated in Figure 3, for example, -occurred from eighteen to twenty-one times in a -minute, so that the same phase reappeared only -once in eight or nine seconds. The segmentation -frequently continues for more than half -an hour; in one instance it was seen to persist -with only three short periods of inactivity for -two hours and twenty-two minutes. At the -rate of thirty segmentations per minute it is -clear that a slender string of food may commonly -undergo division into small particles -more than a thousand times while scarcely -changing its position in the intestine.</p> - -<p>I have seen once, in a cat only lightly etherised, -the exterior of an intestine which was -dividing the food as above described. An hour -and a half after a meal of salmon the anæsthetic -was given, the abdomen opened, and the flaps -raised so as to form walls. Warm salt solution -was then poured into the abdominal cavity, and -the floating coils left covered with the transparent -omentum. The gastric peristaltic waves -were running regularly; on the intestine there -were visible at various places during the period<span class="pagenum" id="Page_354">[Pg 354]</span> -of observation regions of constriction which had -the appearance shown in Figure 3, except that -the rings were relatively nearer together. New -rings of constriction took place on the same side -of all the bulging parts at the margin of the -constricted portion (<i>cf.</i> dotted lines, Fig. 3). As -new rings occurred the old relaxed, but apparently -with tardiness, for the contents gurgled as -if forced through the narrowed lumen. The -constrictions recurred irregularly and at much -longer intervals than in the normal animal. The -contracted rings were pale and bloodless.</p> - -<p>The effect of the process of rhythmic segmentation -proves it an admirable mechanism. -The food over and over again is brought into -closest contact with the intestinal walls by the -swift kneading movement of the muscles. -Thereby not only is the undigested food intimately -mixed with the digestive juices, but the -digested food is thoroughly exposed to the organs -of absorption. Mall has shown that contraction -of the intestinal wall has the effect of -pumping the blood from the submucous venous -plexus into the radicles of the superior mesenteric -vein, and thus materially aids the intestinal -circulation. Moreover, lacteals loaded with fat -will in a few moments become empty unless -the intestine is slit lengthwise, so that the muscles -cannot exert compression. The rhythmic<span class="pagenum" id="Page_355">[Pg 355]</span> -constrictions, therefore, both propel the blood in -the portal circulation and act like a heart in promoting -the flow of lymph in the lacteals. This -single movement with its several results is an excellent -example of bodily economy; the repeated -constrictions, as already shown, thoroughly churn -the food and digestive fluids together, and also -plunge the absorbing mucosa into the very -midst of the food masses: but not only are the -processes of digestion and absorption favoured -by these movements; they also, by compression -of the veins and lacteals of the intestinal -wall, serve to deport through blood and lymph -channels the digested and absorbed material.</p> - -<p><i>Peristalsis.</i><a id="FNanchor_34" href="#Footnote_34" class="fnanchor">[34]</a>—The phenomena of peristalsis -and segmentation are usually combined in some -manner while the food passes through the small -intestine. Peristalsis is observed normally in -two forms: as a slow advancing of the food for -a short distance in a coil, and as a rapid movement -sweeping the food without pause through -several turns of the gut. The latter form is<span class="pagenum" id="Page_356">[Pg 356]</span> -frequently seen when the food is carried on from -the duodenum; and it may readily be produced -in other parts of the small intestine by giving an -enema of soapsuds.</p> - -<div class="figleft illowp35" id="illus-394" style="max-width: 18.75em;"> - <img src="images/illus-394.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 4.</span>—Diagram -showing combined peristalsis and segmentation.</div> -</div> - -<p>When a mass of food has been subjected for -some time to the segmenting activity of the -intestine, the separate segments, instead of -being again divided, may suddenly begin to -move slowly along the loop in which they lie. -That this movement is not a -swinging of the coil as a whole, -but a peristaltic advance of separate -rings of its circular musculature, -is made probable by the fact -that the succeeding segments follow -along the same path their -predecessors have taken. The -advance of the little pieces may -continue for seven or eight centimetres, -when finally the front piece stops or meets -other food. Then all the succeeding pieces are -swept one by one into the accumulating mass, -which at last lies stretched along the intestine, a -solid string manifesting no sign of commotion.</p> - -<p>Another form of slow peristalsis is frequently -observed when the food is pushed forward, not -in small divisions, but as a large lump. The -relatively long string of food is first crowded into -an ovoid form as the forward movement begins,<span class="pagenum" id="Page_357">[Pg 357]</span> -and as it is collecting thus, it seems at the last -to be suddenly formed into a more rounded -ball, as if the mass were pulled or pushed together -at the two ends. The next moment it is -indented in the middle by a circular constriction -(as shown in Fig. 4, line 2), which spreads it in -both directions along the loop. The trailing -portion (<i>a</i>) is next cut in two, and the severed -part sometimes flies back over its course about -a centimetre. Now the whole mass is swept -together again and slightly forward as shown in -line 4, Fig. 4, and the segmenting process is -repeated. At stage 3, Fig. 4, a constriction -sometimes appears around the middle of the -advanced portion (<i>b</i>). Thus, with many halts -and interruptions, the food slowly advances.</p> - -<p>A slight variation of the movement just described -is observed when the amount of food is -greater and extends farther along the intestine. -Under such circumstances, as the mass moves forward, -constrictions appear just in front of the rear -end, which separate it from the main body, and -cause it to shoot backward sometimes through -the distance of a centimetre. The main body -meanwhile is not disturbed. No sooner has the -rear section been shot away than it is swept forward -again into union with the rest of the food, -and the whole mass then advances until another -interfering constriction repeats the process.</p> - -<p><span class="pagenum" id="Page_358">[Pg 358]</span></p> - -<p><i>Rhythmic segmentation and the pendulum -movement.</i>—There is little doubt that the segmentation -of the food which I have seen is due -to an activity of the intestinal musculature similar -to that which causes the so-called pendulum -movement. This activity, as already noted, is -rhythmic, and, although accounts differ, analytical -methods prove that it involves both the -longitudinal and the circular layers of muscle. -Observations of the effect of the rhythmic contractions -upon the food show that the action of -the circular fibres is most prominent. It is -probable, however, that the longitudinal fibres -also play an important part in the process of -segmentation. Examination of Figure 2 makes -clear that in line 2 the regions of constriction -appear between the regions of constriction in -line 3; before <i>c</i> can be formed, therefore, the -constriction between <i>a</i> and <i>b</i> must relax. Contraction -of the longitudinal fibres between two -segments would help to enlarge the constricted -lumen of the gut. It seems probable that, as -the constrictions on either side of <i>c</i> occur, the -longitudinal fibres between them contract; almost -simultaneously the constriction between -<i>a</i> and <i>b</i> relaxes, and the two particles are thus -brought swiftly together. A similar process -naturally would take place for each of the shifting -segments. Thus the function of the longi<span class="pagenum" id="Page_359">[Pg 359]</span>tudinal -muscles would be to contract between -new rings of constriction and thereby aid in -relaxing the former ring between them. During -my one observation of the segmenting process, -as seen on the surface of the intestine, I could -not be sure that the distance between neighbouring -segments was shortened as the constriction -relaxed; that activity of the -longitudinal fibres is present, -however, is indicated by observations -of Raiser on the intestines -of the rabbit and the cat. -Raiser observed the outer surface -of the coils, and describes -the normal movement as an -alternate contraction and relaxation -of single divisions of the -longitudinal fibres; he notes -that these short divisions shift. -But whether they shift in alternation with the -shifting circular constrictions, as seems probable, -is an interesting point not yet determined.</p> - - -<div class="figright illowp30" id="illus-397" style="max-width: 18.75em;"> - <img src="images/illus-397.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 5.</span>—Tracing -showing segmentation of chyme in the duodenum. This -and other tracings reduced two-thirds.</div> -</div> - -<p>Bayliss and Starling state that the swaying -pendulum movements are essentially due to -peristaltic waves recurring in the same place -and running rapidly downward. This form of -the movements I have seen only once. At this -time about 90 c.c. of soapy water had been injected. -This procedure has the effect of exag<span class="pagenum" id="Page_360">[Pg 360]</span>gerating -in every particular the movements of -the small intestine. In this instance a broad -constriction appeared about the middle of a -long string of food and persisted there while -it spread down the gut. As the contraction -spread, the gut swayed slowly to and fro before it. -Then there was a relaxation, followed by a recurrence -of the constriction in the same place, -a spreading of the contraction, and a swinging -of the loop just as before. This phenomenon -was repeated again and again, till finally the -string was divided and the forward piece pushed -through a tortuous course to the colon.</p> - -<p><i>The course of the food in the small intestine.</i>—Chyme -is not forced from the stomach by -every wave that passes over the antrum, but -only at intervals. When the pylorus relaxes, the -food, moved towards the pylorus under considerable -pressure, is squirted along the duodenum for -two centimetres or more. Careful watching of -this food shows that usually it lies for some time -in the curve of the duodenum until additions have -been made to it from the stomach, and a long, -thin string of food is formed. While it is resting -in this place it is exposed to the outpouring -of the bile and pancreatic juices. All at once -the string becomes segmented (see Fig. 5) and -the process of rhythmic segmentation continues -several minutes, thoroughly mixing the intes<span class="pagenum" id="Page_361">[Pg 361]</span>tinal -digestive juices with the chyme. In this -region the alternate positions of the segments -are sometimes far apart, and the to-and-fro -movements of the particles may be a relatively -extensive and very energetic swinging. Finally -the little segments unite into a single mass, or -form in groups, and begin to move forward. -The peristalsis here, as already mentioned, is -much more rapid than the normal peristalsis -elsewhere in the small intestine. The masses, -once started, go flying along, turning curves, -whisking hither and thither in the loops, moving -swiftly and continuously forward. After passing -on in this rapid manner for some distance -the food is collected in thicker and longer strings, -resembling the strings seen characteristically in -the other loops. Towards the end of digestion -the small masses shot out from the stomach, -after a few segmentations, may move on in the -rapid course without being accumulated in a -larger mass until the swift movement ceases.</p> - -<p>During the first stages of digestion in the -cat’s small intestine the food usually lies chiefly -on the right side of the abdomen; during the -last stages the loops on the left side contain -the greater amount of food. In these loops -the food remains sometimes for an hour or more -with no sign of movement. All at once a mass -begins to show irregular depressions and eleva<span class="pagenum" id="Page_362">[Pg 362]</span>tions -along its length, and then suddenly it is -divided, at first partially, later completely, into -many little equal parts, and these repeatedly -undergo division and reunion, division and reunion, -over and over again, in the manner -described above as rhythmic segmentation. -After a varying length of time the activity -wanes and the little segments are carried forward -individually and later brought together, -or join and move on as a single body, or they -may reunite and lie quietly for some time without -further change. Thus by a combined -process of kneading and peristaltic advance the -food is brought to the ileocæcal valve to enter -the large intestine. Records from ten different -animals show that salmon does not appear in -the small intestine until an hour or an hour and -a half after the food is eaten. Inasmuch as five -or six hours elapse after eating before this food -begins to be seen in the colon, it is evident that -the chyme takes four to five hours to pass the -length of the small intestine. It is interesting -to note that the operations are considerably -shortened if the meal has consisted of bread and -milk.</p> - - -<h4><span class="smcap">The Competence of the Ileocæcal Valve</span></h4> - -<p>The ileocæcal valve in the cat is situated -three or four centimetres from the blind end of<span class="pagenum" id="Page_363">[Pg 363]</span> -the cæcum. Its position is usually marked in -shadows of the food in the colon by a slight -indentation, towards which masses about to enter -the colon are ordinarily directed from a point -somewhat distant in the small intestine (see -Fig. 6).</p> - -<p>Regarding the competence of the ileocæcal -valve many observations have been made. -Grützner has reviewed the evidence bearing on -the question and concludes that the valve is not -competent, least of all for liquids. He declares -that as soon as liquids or thin fluid masses appear -in the upper part of the colon they pass -in many instances into the small intestine the -moment that the pressure on the colon side -rises slightly. If the colon contains a solid or -a thick, mushy mass, the passage towards the -small intestine is scarcely possible, because -every increase of pressure in the large intestine -must force the two lips of the valve together -and close it.</p> - -<p>The importance of the competence of the -ileocæcal valve under normal conditions cannot -be appreciated until the function of the first -part of the colon is considered. In order that -this part of the intestinal mechanism may perform -its service, the competence of the valve -for the food which enters the colon from the -ileum should be perfect. As a matter of fact,<span class="pagenum" id="Page_364">[Pg 364]</span> -such is the case. Not only does the activity of -the colon prove this statement, but the failure -of every attempt to drive the food in the colon -back through the valve into the ileum confirms -the proof. Again and again I have tried, by -manipulation through the abdominal wall, to -press the normal contents of the colon downward -with sufficient force to cause them to return -to the small intestine, but without success. -The valve held perfectly.</p> - - -<h4><span class="smcap">The Movements of the Large Intestine</span></h4> - -<p>When the large intestine is full, palpation -through the abdominal wall demonstrates that -the material in the lower descending colon and -in the sigmoid flexure is usually composed of -hard, incompressible lumps, while that in the -ascending and transverse colon and the cæcum -is soft, permitting the walls of the gut to be -easily pushed together. The condition of the -contents in these two regions seems to indicate -a rough division of the large intestine into two -parts, and the mechanical activities of these two -parts verify the differentiation. In the descending -colon the material is very slowly advanced -by rings of tonic constrictions (see Fig. 7); in -the ascending and transverse colon and in the -cæcum by far the most common movement is -an antiperistalsis.</p> - -<p><span class="pagenum" id="Page_365">[Pg 365]</span></p> - -<p><i>Antiperistalsis in the colon.</i>—The colon of -cats which have been without food for a day -usually contains enough gas to make the position -of the gut distinguishable with the fluorescent -screen (see Fig. 1). The first food to -enter the colon from the small intestine is carried -by antiperistaltic waves into the cæcum -(Fig. 1), and all new food as it enters is also -affected by these waves. Thus the contents of -the colon, instead of being driven immediately -toward the rectum by slow peristalsis, as is the -general opinion, are first repeatedly pushed -toward the cæcum by an antiperistaltic action.</p> - -<p>These antiperistaltic waves follow one after -another like the peristaltic waves of the stomach -(see Figs. 5, 6, and 10). They begin either on -the more advanced portion of the food in the -colon (when only a small amount is present), or -at the nearest tonic constriction, which is usually -at the turn between the transverse and descending -colon (Figs. 7 and 8.) The waves rarely -run continuously for a long time. When the -colon is full, it is usually quiet. The first sign -of activity is an irregular undulation of the -walls, then very faint constrictions passing along -the gut towards the cæcum. These constrictions -may first appear only on the ascending colon. -As they continue coursing over the intestine -they become deeper and deeper, until there is<span class="pagenum" id="Page_366">[Pg 366]</span> -a marked bulging between successive constrictions. -When the waves have thus become -more prominent, they are seen to start near the -end of the transverse colon and pass without -interruption to the end of the cæcum. After -these deepest waves have been running for a -few minutes the indentations grow gradually -less marked, until at last they are so faint as to -be hardly discernible. The final waves are -sometimes to be observed only at the end of -the transverse colon.</p> - -<p>Such a period of antiperistalsis lasts from -two to eight minutes, with an average duration -of four or five minutes. The periods recur at -varying lengths of time; in one instance a period -began at 1.38 <span class="allsmcap">P.M.</span> and was repeated at 2.06, -2.34, 2.55, 3.15, and at 3.36, when the observation -ceased; in another instance a period -began at 2.43 <span class="allsmcap">P.M.</span>, and was repeated at 2.57 -and at intervals of from ten to fifteen minutes -thereafter while the animal was being watched. -The waves have nearly the same rate of recurrence -as those in the stomach; about five and -a half waves pass a given point in a minute, <i>i. e.</i>, -eleven waves in two minutes. This rate has -proved fairly constant in different cats and at -different stages in the process of digestion; in -one case, however, the waves passed at the rate -of nine in two minutes.</p> - -<p><span class="pagenum" id="Page_367">[Pg 367]</span></p> - -<p>The stimulating effect of rectal injections on -the movements of the small intestine has already -been noted. Enemata have also pronounced -stimulating action on the antiperistalsis of the -colon. Usually the almost immediate result of -a rectal injection of warm water is the appearance -of deep antiperistaltic waves, which often -continue running for a long period. In one -case, after an injection of 50 c.c. of warm water, -the waves followed one another with monotonous -regularity during an observation lasting -an hour and twenty minutes. The manner in -which this antiperistaltic mechanism affects -nutrient enemata introduced into the bowel will -be discussed in the section devoted to the -question of antiperistalsis.</p> - -<p>These constrictions passing backward over -the colon do not force the normal contents -back through the valve into the small intestine -again. I have seen hundreds of such constrictions, -and only twice have there been exceptions -to this rule,—once under normal conditions, -when a small mass slipped back into the ileum, -and at another time when a large amount of -water had been introduced into the colon. The -importance of the competence of the ileocæcal -valve is now apparent; indeed, antiperistalsis -in the colon gives new meaning and value to the -location of a valve at the opening of the ileum.<span class="pagenum" id="Page_368">[Pg 368]</span> -For, inasmuch as the valve is normally competent, -the constrictions repeatedly coursing -towards it force the food before them into a blind -sac. The effect on the food must be the same -as the effect seen in the stomach when the -pylorus remains closed before the advancing -waves. The food is pressed forward by the -approach of each constriction; but since it cannot -go onward in the blind sac, and is, moreover, -subjected to increasing pressure as the -constriction comes nearer, it is forced into the -only way of escape, <i>i. e.</i>, away from the cæcum -through the advancing constricted ring. About -twenty-five waves affect every particle of food -in the colon in this manner during each normal -period of antiperistalsis. The result must be -again a thorough mixing of the contents and a -bringing of these contents into close contact -with the absorbing wall—a process which has -already been variously repeated many times in -the stomach and in the small intestine.</p> - -<p>Two other movements have been observed -in the ascending colon, but they are rare appearances. -The first of these was a serial sectioning -of the contents noticed in an animal -given castor oil with the food. A constriction -separated a small segment in the cæcum; another -constriction then cut off a segment just -above the first, and with the disappearance of<span class="pagenum" id="Page_369">[Pg 369]</span> -the first constriction the two separated segments -united. A third segmentation took place -above the second, and the changes occurred -again. Thus the whole mass was sectioned -from one end to the other; and no sooner was -that finished than the process began again and -was repeated several times. A slight modification -of this movement was observed in a colon -containing very little food. The mass was -pressed and partially segmented in the manner -characteristic of the small intestine, and was -thus again and again spread along the ascending -colon, and each time swept back into a -rounded form by antiperistalsis. The second -of the two movements mentioned above consisted -in a gentle kneading of the contents. -This was caused by broad constrictions appearing, -relaxing, appearing, relaxing, over and -over again, in the same place. When several of -these regions were active at the same time, -they gave the food in the colon the appearance -of a restless undulatory mass. Once a constriction -occurred and remained permanently in one -place, while the bulging parts on either side of -it pulsated alternately, at the rate of about -eighteen times in a minute, with the regularity -of the heart-beat. Although these phenomena -are somewhat striking, they are not usual, and -are in no way so important as the antiperistalsis.</p> - -<p><span class="pagenum" id="Page_370">[Pg 370]</span></p> - -<p><i>The changes when food enters the colon.</i>—The -passage of food through the ileocæcal -valve seems to stimulate the colon to activity. -As food is nearing the ileocæcal valve the large -intestine is usually quiet and relaxed (Fig. 6, -4.00), though occasionally indefinite movements -are to be observed; and sometimes just before -the food reaches the end of the ileum the circular -fibres of the colon in the region of the -valve contract strongly, so that a deep indentation -is present there. The indentation may -persist several minutes; it disappears as the -muscles relax just previous to the entrance of -the food. The food is moved slowly along the -ileum and is pushed through the valve into the -colon. The moment it has entered a strong -contraction takes place all along the cæcum and -the beginning of the ascending colon, pressing -some of the food onward, and a moment later -deep antiperistaltic waves (Fig. 6, 4.03) sweep -down from the transverse colon and continue -running until the cæcum is again normally full, -<i>i. e.</i>, for two or three minutes.</p> - - -<div class="figright illowp50" id="illus-409" style="max-width: 34.375em;"> - <img src="images/illus-409.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 6.</span>—Tracings showing -changes when food enters the colon -and also the first tonic constriction. -4.00, the colon relaxed as food approaches -in the ileum. 4.03, the -colon contracted and traversed by -antiperistaltic waves after the food -has entered.</div> -</div> - -<p><i>The appearance of tonic constrictions.</i>—It has -already been noted that as the food accumulates -in the ascending colon it is at first confined to -this region by antiperistaltic waves. With further -accessions, however, the contents naturally -must be pressed more and more into the trans<span class="pagenum" id="Page_371">[Pg 371]</span>verse -and descending colon. In the early stages -of this accumulation, while the food lies chiefly -in the ascending colon, the only activity of the -muscular walls is the antiperistalsis. As the -contents extend along the intestine a deep constriction -appears near the advancing end and -nearly separates a globular mass from the main -body of the food (Fig. 6). The contents of the -large intestine progress -farther and -farther from the -cæcum; meanwhile -new tonic constrictions -appear which -separate the contents -into a series -of globular masses. -And as the number -of these divisions increases -they take a -position farther from the cæcum, so that they are -present chiefly in the descending colon (Fig. 7). -Raiser has recorded a similar appearance in the -terminal portion of the rabbit’s colon, in which -deep circular constrictions separate the scybalous -masses. He maintains that these masses are -pushed onward by the constrictions. Comparing -tracings made at rather long intervals (forty-five -minutes), I found that the rings disappear<span class="pagenum" id="Page_372">[Pg 372]</span> -from the transverse colon, and then are present -with the waste material in the descending colon. -Thus in the cat also these rings, which seem with -short observation to be remaining in one position, -are in reality moving slowly away from the -cæcum, pushing the hardening -contents before -them. The contents at -this stage are no longer -fluid, and consequently -they must offer considerable -resistance to a force -pushing them through the -colon. It is an advantage -to have this pultaceous -substance propelled in -divisions rather than in -a uniformly cylindrical -mass, since the fibres -along the length of the -mass are thereby rendered -effective. Such are -the functions of the persistent -rings; they form the waste matter into -globular masses at the end of the transverse -colon and slowly push these masses onward.</p> - -<div class="figleft illowp40" id="illus-410" style="max-width: 28.125em;"> - <img src="images/illus-410.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 7.</span>—Radiograph -showing the region of tonic constrictions (descending -colon) and the region of antiperistalsis (transverse -and ascending colon).</div> -</div> - -<p>In the transverse colon, which is free from -the slowly moving rings, the antiperistaltic -waves have full sway. In the region of the<span class="pagenum" id="Page_373">[Pg 373]</span> -tonic rings an infrequent or even a slowly periodic -relaxation and contraction are often to be -observed. These changes seem to take place -in all the rings at about the same time. Once -I saw antiperistaltic waves running over the -uppermost of four segments, but since the -rings on either side of the segment held tightly, -the waves had merely the effect of churning the -material of the segment and did not move it -onward. Inasmuch as the material in these -segments at first is soft, so that the segments -are easily compressible, while the fæcal masses -which are the final result are relatively hard and -dry, it follows that even within the confines of -these persistent rings some absorption is taking -place.</p> - - -<p><span class="smcap">Defecation</span></p> - -<p>The process of clearing the colon is a process -of repeated reduction of the amount of -material present. Figure 8 (3.11) is a radiograph -showing the food in the colon at 3.11 <span class="allsmcap">P.M.</span> -About 3.25, with a slow, sweeping movement, -the gut swung around so that the ascending -colon was lying in the position of the last half -of the transverse colon, and the transverse colon -had taken the position of the descending part -(Fig. 8, 3.25). At the same time the tonic constrictions -disappeared and were replaced by a -strong, broad contraction of the circular mus<span class="pagenum" id="Page_374">[Pg 374]</span>cle, -tapering the contents off on either side in -two cones. The region of strongest contraction -was apparently drawn downward with the rest -of the gut by a shortening of the descending -colon. As the intestine swung around, more -material was forced into the rectum, and when -the swinging of the intestine stopped, the constriction -which divided the lumen passed slowly -downward, and with the aid of the muscles surrounding -the abdominal cavity, pushed the separated -mass out of the canal.<a id="FNanchor_35" href="#Footnote_35" class="fnanchor">[35]</a> After the terminal -mass had thus been pushed out, the colon with -the remainder of its contents returned to nearly -its former position (Fig. 8, 3.46). About two -hours afterward this remnant had been spread -throughout the length of the large intestine by -means of the slowly moving rings. Figure 7 is a -radiograph of the same colon pictured in Figure -8; the radiograph was taken at 11.50 <span class="allsmcap">A.M.</span>, and -at 12.15 <span class="allsmcap">P.M.</span> the material in the lower descending -colon was forced out in the manner above -described. Within three hours the remaining -portion had been spread into the evacuated region, -as shown in Figure 8, 3.11. The manner -in which the material is spread from the region -of the antiperistaltic waves into the region of -the slowly advancing rings presents a problem. -During normal living new food constantly arriving -in the colon must force the old contents -forward just as the later parts of a meal force -forward the earlier parts; there is no doubt,<span class="pagenum" id="Page_375">[Pg 375]</span> -however, that most of the contents of the -cæcum and the ascending colon may be passed -onward even during starvation. The emptying<span class="pagenum" id="Page_376">[Pg 376]</span> -of these regions, according to my observations, -is never complete; for after considerable time -has elapsed and the large intestine is cleared -and dilated with gas, some substance is still -to be detected in the cæcum and clinging to -the walls of the ascending colon. The only -activities manifested here are the antiperistaltic -waves and the strong tonic contraction of the -whole circular musculature shown in Figure 6. -It is clear that the latter activity would serve to -press into the transverse colon a considerable -portion of the contents of the ascending colon, -and the remnant seen clinging to the walls would -be the part not thus pressed forward.</p> - -<div class="figcenter illowp100" id="illus-414" style="max-width: 75em;"> - <img src="images/illus-414.jpg" alt="" /> - <div class="caption"> -<span class="smcap">Figure 8.</span>—Two radiographs and a tracing showing the changes taking place in -defecation. 3.11, material in the colon. 3.25, colon carried downward and terminal -mass separated. 3.46, after defecation, when the colon returns to former -position. Defecation occurred at 3.27.</div> -</div> - -<p>Twice I have seen appearances which might -account for the emptying of the first portion of -the large intestine in a more thorough manner -than that above described. At one time, without -apparent stimulation, strong tonic contraction -occurred along the entire length of the -ascending colon, which forced the contents almost -wholly into the transverse portion. This -action seemed merely an exaggerated form of -that observable after food passes the ileocæcal -valve (see Fig. 6). At another time, after a -mass of food had passed through the ileocæcal -valve, after the ascending colon had contracted -generally and the antiperistaltic waves had -coursed over it in the usual manner, a deep<span class="pagenum" id="Page_377">[Pg 377]</span> -constriction appeared at the valve and ran upward -without relaxation nearly the length of the -ascending colon, pushing the contents before it. -For an instant the wave paused; then the constriction -relaxed and the food returned towards -the cæcum. These observations indicate that -either a general contraction of the wall of the -large intestine or a true peristalsis may be effective -in pressing waste matter from the region -where antiperistalsis is the usual activity into the -region where the slowly advancing rings may -carry it on to evacuation (see Fig. 7).</p> - - -<h4><span class="smcap">The Question of Antiperistalsis</span></h4> - -<p>In 1894 Grützner published an observation -and made an assumption about which there has -since been much controversy. He maintained -that when normal salt solution, holding in suspension -hair, powdered charcoal, or starch -grains, is injected into the rectum, it is carried -upward into the small intestine and may even -enter the stomach. These experiments have -been repeated by several observers. Some -have confirmed Grützner’s results; others have -failed, after using most careful methods, to find -any evidence of the passage of the injected -material back to the stomach, and they have -declared that the apparent success was due to -carelessly allowing the food of the animal to<span class="pagenum" id="Page_378">[Pg 378]</span> -become contaminated with the test materials, so -that these were introduced into the stomach -by way of the mouth. That antiperistalsis does -not occur in the small intestine seems to be -proved by Mall’s experiment of reversing a -portion, sewing it in place, and then finding that -the food does not pass the reversed region, but -collects at the upper end. Sabbatani and Fasola -reversed stretches of small intestine of varying -length, and found that the reversed portions -allowed fluids to pass, but that the persistence -of the physiological direction of movement -caused an accumulation of undigested food in -the region of the upper suture. However a -portion of the intestine lay in relation to the -rest, it always manifested the normal peristalsis. -Many other observers working directly on -the intestine confirm this testimony and state -that the progress of the constriction-rings is -always downward, and that antiperistalsis is not -physiological. In 1898, however, Grützner took -his stand again in favour of a backward movement -in the intestines, and in a somewhat metaphysical -manner argued that peristalsis and -antiperistalsis belong to each other just as relaxation -of muscle is related to contraction. He -assumed that as the contents are advanced by -slow peristalsis, so are they returned by a similar -movement in the opposite direction, and he<span class="pagenum" id="Page_379">[Pg 379]</span> -mentions several pathological cases (fistula of -intestine) to substantiate the assumption.</p> - -<p>By means of the X-rays it is possible to see -just what takes place when a fluid is injected -into the rectum. For the purpose of determining -how nutrient enemata are received and acted -upon in the intestines, I have introduced thin, -fluid masses in large and small amounts, and -thick, mushy masses in large and small amounts, -in different animals. The enemata consisted of -100 c.c. of milk, one egg, ten to fifteen grams -of bismuth subnitrate, and two grams of starch -to hold the bismuth powder in suspension. To -make the thick enema all these were stirred -together and boiled to a soft mush; to make the -thin enema all the parts were boiled together -except the egg, which was added after the boiled -portion was cooled. The small amount injected -was 25 c.c.; the large amount almost 90 c.c., -about the capacity of the large intestine when -removed from the body. The animals were -given first a cleansing injection, and after this -was effective the nutrient material was introduced. -In order to make sure of the observation, -a control radiograph was first taken to -show no bismuth food present, and other radiographs -taken at varying intervals after the injection -to record the course the food was following.</p> - -<p><span class="pagenum" id="Page_380">[Pg 380]</span></p> - -<div class="figcenter illowp100" id="illus-420" style="max-width: 75em;"> - <img src="images/illus-420.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 9.</span>—- Radiographs showing that after a large nutrient enema (about 90 c.c.) has been given the food -is forced more and more from the large into the small intestine. The enema was introduced at about -1.40 <span class="allsmcap">P.M.</span> At 3.00 segmentation was occurring in many loops. -</div></div> - - -<p><span class="pagenum" id="Page_381">[Pg 381]</span></p> - -<p>These experiments show that when small -amounts of nutrient fluid are introduced they -lie first in the descending colon. In every instance -antiperistaltic waves are set going by the -injection, and the material is thereby carried to -the cæcum. When large amounts are injected -they stop for a moment in the region between -the transverse and descending colon, as if a -constriction existed there. Then a considerable -amount of the fluid passes the point, and antiperistaltic -waves carry it to the cæcum. In any -case the repeated passing of the waves seems to -have the effect of promoting absorption, for in -the region where these waves continue running, -the shadows become gradually more dim, and -finally the bismuth appears to be only on the intestinal -walls; in other regions, <i>e. g.</i> in the descending -colon, the shadows retain their original -intensity. Small injections have never in my -experience been forced even in part into the -small intestine; but with the larger amounts, -whether fluid or mushy, the radiographs show -many coils of the small intestine containing the -bismuth food.</p> - -<p>The passage of the injected material beyond -the ileocæcal valve is probably due entirely to -antiperistalsis in the colon,—a factor unknown -to both Grützner and his opponents. The valve, -which is thoroughly competent for food coming -normally from the small intestine into the large,<span class="pagenum" id="Page_382">[Pg 382]</span> -is curiously incompetent for a substance, even -of the consistency of thick cream, introduced -in large amount by rectum. When the valve -first permits the food to enter the ileum, the -fluid pours through and appears suddenly as -a winding mass occupying several loops of the -intestine (Fig. 9, 1.50, about ten minutes after -the injection). The mass is continuous from -the valve to the other end; antiperistalsis is -therefore not visible in the small intestine under -the circumstances of this experiment. The -antiperistaltic waves of the colon, however, continue -running; the transverse and ascending -colon are thus almost emptied, and the small intestine -more and more filled with food (Fig. 9, -2.15 and 3.00). After a short time the typical -segmenting movements can be seen in the loops, -busily separating the food into small masses, -and over and over again dividing and redividing -them.</p> - -<p>I have never seen food material pass back -from the colon so far as the stomach; but once, -about ten minutes after an injection of 100 c.c. -of warm water, the cat retched and vomited a -clear fluid resembling mixed water and mucus. -In the fluid were two intestinal worms still alive.</p> - -<p>The importance of the mechanism by which -nutrient enemata are passed backward in the -intestine is evident. In the colon the nutrient<span class="pagenum" id="Page_383">[Pg 383]</span> -material is worked over by the antiperistaltic -waves, intimately mixed with whatever digestive -juices may be present, and exposed to the -organs of absorption in that region. If the enemata -are large, the digestive and absorptive -processes are by no means confined to the -colon, but may take place along extensive surfaces -of the small intestine. I have repeatedly -seen rhythmic segmentation active throughout -many loops of the small intestine, thus exposing -the injected food to the same mixing and absorbing -processes as affect the nutriment which -has come through the stomach in a normal -manner.</p> - - -<h4><span class="smcap">The Effect of Emotions and Sleep</span></h4> - -<p>Observations on the stomach of the cat -showed that the peristalsis is inhibited whenever -the animal manifests signs of anxiety, rage, -or distress. Since the extrinsic innervation of a -large part of the intestinal tract is the same as -that of the stomach, it is of interest to note the -effect of emotional states on the movements of -the intestines. Esselmont, in a study of the -dog’s intestine, noted constantly after signs of -emotion a marked increase of activity lasting for -only a few moments. Fubini also observed that -fear occasioned more rapid peristalsis. There -is no doubt that many emotional states are a<span class="pagenum" id="Page_384">[Pg 384]</span> -strong stimulus to peristalsis, but it is equally -true that other emotional states inhibit peristalsis. -In the cat the same conditions which stop the -movements of the stomach stop also the movements -of the intestines.</p> - - -<div class="figleft illowp45" id="illus-424" style="max-width: 31.25em;"> - <img src="images/illus-424.jpg" alt="" /> - <div class="caption"><span class="smcap">Figure 10.</span>—Tracings showing -the effect of excitement -on antiperistalsis in -the colon.</div> -</div> - - -<p>The female cats used in these observations -ordinarily lie quietly on the holder and make -no demonstration. Sometimes, however, with -only a little premonitory -restlessness, the cat suddenly -flies into a rage, -lashing her tail from side -to side, pulling and jerking -with every limb, and -biting at everything near -her head. During such -excitement, and for some -moments after the animal -becomes pacified again, -the movements, both of the large and small intestine, -entirely cease. Such violence of excitement -is not necessary to cause the movements -to stop; a cat which was restless and continually -whining while confined to the holder -showed no signs of intestinal movements during -any period of observation (one period -lasted more than an hour), although the changes -in the distribution of the food observable from -one period to the next proved that movements<span class="pagenum" id="Page_385">[Pg 385]</span> -were going on during the quiet intermissions. -In another cat, uneasy and fretful for fifty minutes, -no activity was seen; then she became quiet -for several minutes, and peristalsis of the small -intestine appeared.</p> - -<p>When the segmentation process in the small -intestine is stopped by excitement the segments -unite and the series of parts returns to the form -of a solid string. The change occurring in the -large intestine when the antiperistalsis is inhibited -by excitement is shown in Figure 10. The tonic -constrictions in the descending colon are apparently -not affected by emotional states, for they -do not seem to relax in the excitement which -causes the movements to cease.</p> - -<p>By holding the mouth and nostrils closed, or -by pressing between the rami of the jaw, the -breathing may be stopped. As soon as the cat -shows distress from lack of breath every form -of intestinal movement stops.</p> - -<p>The statement is sometimes made in text-books -of physiology that the gastric and intestinal -mechanisms cease to act during sleep. It is -worthy of note that nearly all the animals curled -up and slept during the time between observations; -nevertheless, the progress of the food -through the intestines continued. The statement -is also made that at night, even without -sleep, the intestines are almost entirely at rest;<span class="pagenum" id="Page_386">[Pg 386]</span> -that this is their normal time for repose. I have -seen both large and small intestines actively at -work, however, from half past nine until half -past ten o’clock at night.</p> - - -<h4><span class="smcap">Summary</span></h4> - -<p>1. Bismuth subnitrate, 10 to 33 per cent, -mixed with the food renders the movement of -the intestinal contents, and thereby the movements -of the intestinal walls, visible on the -fluorescent screen.</p> - -<p>2. The activity most commonly seen in the -small intestine is the simultaneous division of -the food in a coil into small segments, and a -rhythmic repetition of the segmentation each -time applied to the new segments formed from -parts of those just divided. In the cat this -rhythmic segmentation may proceed at the rate -of thirty divisions per minute. The effects of the -constrictions causing the segmentation are the -mixing of the food and the digestive juices, -the bringing of the digested food into contact -with the absorbing mechanisms, and the emptying -of the venous and lymphatic radicles of their -contents by compression of the intestinal wall.</p> - -<p>3. Peristalsis is usually combined with segmentation. -As the food is advancing, interfering -constrictions often separate the rear end of the -mass from the main body. The separation is<span class="pagenum" id="Page_387">[Pg 387]</span> -momentary, however; the rear end is swept into -union with the main body again, and the whole -mass is pushed onward until another constriction -repeats the changes.</p> - -<p>4. The ileocæcal valve is thoroughly competent -for food entering the colon from the -ileum.</p> - -<p>5. The usual movement of the transverse -and ascending colon and the cæcum is an -antiperistalsis. This recurs in periods about -every fifteen minutes, and each period lasts commonly -about five minutes; the waves recur during -a period at the rate usually of eleven waves -in two minutes. This antiperistalsis gives new -significance to the ileocæcal valve; for the food, -now in a closed sac, is thoroughly churned and -mixed by the constrictions running towards the -cæcum, and again exposed to absorbing walls -without any interference with the processes in -the small intestine.</p> - -<p>6. As soon as new food enters the large -intestine a strong general contraction takes place -along the cæcum and ascending colon, forcing -some of the food onward; a moment later -antiperistaltic waves begin to pass.</p> - -<p>7. With the accumulation of material in the -transverse colon, deep tonic constrictions appear -one after another and carry the material -into the descending colon, leaving the trans<span class="pagenum" id="Page_388">[Pg 388]</span>verse -and ascending portions free for the antiperistaltic -waves.</p> - -<p>8. In emptying the large intestine the -material in the lower descending colon is first -carried out by combined peristalsis and pressure -of abdominal muscles; the remainder of the -material is then spread into the evacuated region, -and this region is again cleared; the second remainder -may be similarly affected. In normal -life the new food arriving in the colon must -force forward the old contents of the ascending -and transverse colon.</p> - -<p>9. The observations have revealed no evidence -of antiperistalsis in the small intestine, -but since the ileocæcal valve will allow nutrient -material under pressure to pass backward, the -antiperistalsis of the large intestine may force -into the small intestine a considerable portion -of a large nutrient enema. Segmentation in -the small intestine affects such an enema precisely -as it affects food which has passed normally -through the stomach.</p> - -<p>10. Signs of emotion, such as fear, distress, -or rage, are accompanied by a total cessation of -the movements of both large and small intestines. -The movements continue in the cat both -during sleep and at night.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_389">[Pg 389]</span></p> - -<h3 class="nobreak" id="THE_BATTLE_CREEK_LABORATORIES">THE BATTLE CREEK LABORATORIES<br /> - -<small>THE MAMMOTH SANITARIUM AND THE -LARGE ADOPTED FAMILY -OF DR. AND MRS. J. H. KELLOGG</small></h3> -</div> - -<div class="blockquot"> - -<p>[A report of one experiment has been selected from -<i>Modern Medicine</i> relative to the work of the laboratories connected -with the Battle Creek Sanitarium because it relates to -the effect of cooking and mastication upon food in illustration -of the statement of Dr. Campbell pertaining to these aids to -digestion. Much more evidence could be had from the Sanitarium -reports, but sufficient has already been given herewith -from various authoritative sources to justify our claims of the -great importance of mouth-treatment in human nutrition.</p> - -<p>It may be said here, however, that the trial of thorough -mouth-work as an aid to digestion, which has been in progress -at the Sanitarium for more than a year, and which has finally -been accepted and prescribed as the first requirement of the -treatment of patients, is of the utmost significance. This is, -by far, the largest sanitarium in the world, having some hundreds -of physicians, nurses, and other attachés, and treating -many thousands of patients annually. The “cure” is based -upon natural methods of recuperation, and while all of the -staff, both medical and surgical, are fully equipped diplomatists, -and whereas the organisation has a legally and professionally -accepted medical school of its own, so-called medicines -are rarely used, and never except as antidotes to specific -poisons. Nature is assisted by scientific means to do the -curing, and now that an economic nutrition to relieve the -exhausted system of the patient from all possible strain -through ample mouth-treatment of food, as intended by the -anatomical, dental, and chemical plan on which man is constructed, -has been tried and accepted as a fundamental principle -of the institution, it gives a practical indorsement of the -claims set forth in “Glutton or Epicure,” and in this present<span class="pagenum" id="Page_390">[Pg 390]</span> -book, and declares that they are of greatest importance in -securing health and efficiency.</p> - -<p>The Battle Creek Sanitarium is a philanthropic and -humanitarian institution operating under a perpetual charter -which compels the use of all the profits gained to foster the -spread of the humanitarian work. More than sixty branches -of the parent institution have been established in or near large -cities in different parts of the world, under the title of The -American Medical Missionary Association, and each of these -branches conducts a life-saving business on Good Samaritan -principles. The organisation started its medical missionary -work some thirty-seven years ago, with almost no capital and -only one patient, in a small two-storey frame house, in the -then small village of Battle Creek, Michigan. The incorporators -were religious enthusiasts who believed that Christianity -should be expressed in works as much as in faith, in -curing the sick and healing the wounded, and thus preparing -the unfortunate for the reception of moral and spiritual -inspiration.</p> - -<p>The best evidence that this scheme of procedure to attain -the ultimate end was a good one is shown by the success -of the institution in its growth from such small beginning to -the immense proportions of the present time, with one of its -buildings nearly a thousand feet in length and five storeys -in height and numerous other buildings radiating from the -main one and scattered about it in a finely wooded park. -Fire came and destroyed the old building and all its contents, -but yet it was soon rebuilt, and the concern goes on growing -and growing, because the foundation principle of the institution -is the beautiful Golden Rule, and the method of treatment -employed is taken from the open book of Nature.</p> - -<p>While the organisation was primarily based upon a special -religious creedal enthusiasm, it has become so broadly altruistic -as to suggest a return to original Christianity as defined -in the Sermon on the Mount. In such Christian expression -honest agnostics, born Buddhists, and the tolerant of all the -different Christian creeds may join and say amen!</p> - -<p>One of the splendid results of an economic nutrition, -attained by following the natural requirements and impulses, -is the curing of many diseases, among them several forms of -constipation. The writer has a genuine admiration for the<span class="pagenum" id="Page_391">[Pg 391]</span> -spirit that is the motive power of the Battle Creek Sanitarium -and firm belief in the Christianity demonstrated in the work, -especially in the private experiment of Dr. and Mrs. Kellogg, -with their family of adopted waifs. Twenty-four children of -unfortunate parents, waifs so unfortunate in their attractability -as to be hopelessly neglected, have been gathered under this -sheltering roof and are showing their mettle and gratitude by -splendid behaviour and brilliant accomplishment in a manner -that any proud parent might approve. To miss any opportunity -to express gratitude to Dr. and Mrs. Kellogg for giving -us such a splendid example of the true meaning of practical -Christianity would be showing symptoms of the worst form of -constipation; viz., constipation of appreciation and affection.—<span class="smcap">Horace -Fletcher.</span>]</p> -</div> - -<hr class="chap x-ebookmaker-drop" /> - -<h3 class="hang">EXPERIMENTAL INVESTIGATION OF -THE INFLUENCE OF MASTICATION -AND COOKING OF FOOD, ETC., IN -THE LABORATORIES OF THE BATTLE -CREEK, MICHIGAN, SANITARIUM, -UNDER THE DIRECTION OF -DR. J. H. KELLOGG</h3> - - -<p class="center small">From <i>Modern Medicine</i></p> - - -<p>The table clearly shows the effect of cooking -and the effect of mastication upon the salivary -digestion of food. Column 1 shows the results -obtained after an ordinary test meal consisting -of 1½ ounces of water biscuit to 8 ounces of -water; column 2, 1½ ounces of water biscuit -ground fine, mixed with water and swallowed -without chewing; column 3, test meal consist<span class="pagenum" id="Page_392">[Pg 392]</span>ing -of 1½ ounces of raw wheat flour and 8 -ounces of water; column 4, test meal consisting -of 1½ ounces of unground pearled wheat -with 8 ounces of water.</p> - -<table class="standard" summary=""> -<tr> -<th class="tdc"></th> -<th class="tdc">Water biscuit, well chewed.</th> -<th class="tdc">Water biscuit, not chewed.</th> -<th class="tdc">Raw flour.</th> -<th class="tdc">Raw wheat.</th> -</tr> -<tr> -<td class="tdc_br"></td> -<td class="tdc_br">1</td> -<td class="tdc_br">2</td> -<td class="tdc_br">3</td> -<td class="tdc">4</td> -</tr> -<tr> -<td class="tdc_br">Total acidity (A)</td> -<td class="tdc_br">0.142</td> -<td class="tdc_br">0.140</td> -<td class="tdc_br">0.204</td> -<td class="tdc">0.136</td> -</tr> -<tr> -<td class="tdl_br">Calculated acidity (A´)</td> -<td class="tdc_br">0.156</td> -<td class="tdc_br">0.132</td> -<td class="tdc_br">0.186</td> -<td class="tdc">0.128</td> -</tr> -<tr> -<td class="tdl_br">Total chlorine (T)</td> -<td class="tdc_br">0.296</td> -<td class="tdc_br">0.284</td> -<td class="tdc_br">0.332</td> -<td class="tdc">0.272</td> -</tr> -<tr> -<td class="tdl_br">Free HCl (H)</td> -<td class="tdc_br">0.050</td> -<td class="tdc_br">0.028</td> -<td class="tdc_br">0.056</td> -<td class="tdc">0.052</td> -</tr> -<tr> -<td class="tdl_br">Combined chlorine (C)</td> -<td class="tdc_br">0.106</td> -<td class="tdc_br">0.104</td> -<td class="tdc_br">0.130</td> -<td class="tdc">0.076</td> -</tr> -<tr> -<td class="tdl_br">Fixed chlorides (F)</td> -<td class="tdc_br">0.114</td> -<td class="tdc_br">0.152</td> -<td class="tdc_br">0.146</td> -<td class="tdc">0.144</td> -</tr> -<tr> -<td class="tdl_br">Maltose (M)</td> -<td class="tdc_br">1.088</td> -<td class="tdc_br">0.272</td> -<td class="tdc_br">0.000</td> -<td class="tdc">0.000</td> -</tr> -<tr> -<td class="tdl_br">Dextrine and soluble starch (D)</td> -<td class="tdc_br">0.812</td> -<td class="tdc_br">0.548</td> -<td class="tdc_br">0.300</td> -<td class="tdc">0.448</td> -</tr> -<tr> -<td class="tdc_br">COEFFICIENTS</td> -<td class="tdc_br"></td> -<td class="tdc_br"></td> -<td class="tdc_br"></td> -<td class="tdc"></td> -</tr> -<tr> -<td class="tdl_br">Digestion of albumin (<i>a</i>)</td> -<td class="tdc_br">0.82</td> -<td class="tdc_br">0.97</td> -<td class="tdc_br">1.00</td> -<td class="tdc">1.00</td> -</tr> -<tr> -<td class="tdl_br">Digestion of starch (<i>b</i>)</td> -<td class="tdc_br">0.71</td> -<td class="tdc_br">0.42</td> -<td class="tdc_br">0.00</td> -<td class="tdc">0.00</td> -</tr> -<tr> -<td class="tdl_br">Salivary activity (<i>c</i>)</td> -<td class="tdc_br">1.17</td> -<td class="tdc_br">1.11</td> -<td class="tdc_br">1.14</td> -<td class="tdc">1.37</td> -</tr> -<tr> -<td class="tdc_br">Fermentation (<i>x</i>)</td> -<td class="tdc_br">5.00</td> -<td class="tdc_br">11.00</td> -<td class="tdc_br">6.00</td> -<td class="tdc">6.00</td> -</tr> -<tr> -<td class="tdc_brb">Chlorine liberation (<i>m</i>)</td> -<td class="tdc_brb">0.80</td> -<td class="tdc_brb">0.70</td> -<td class="tdc_brb">0.85</td> -<td class="tdc_bb">0.71</td> -</tr> -</table> - -<p>Several points of interest are to be noted -in the above table, the first and most conspicuous -of which is the fact that the saliva did not -act at all upon the raw flour and raw wheat, as -shown by the total absence of maltose in the -cases represented in columns 3 and 4. The -small amount of dextrine and soluble starch -shown was, perhaps, already present in the raw<span class="pagenum" id="Page_393">[Pg 393]</span> -grain, but this point I have not investigated. It -is clear, however, that no sugar was produced -when raw starch was taken, whereas the amount -of sugar produced after the ordinary test meal -was more than 1 gram in each 100 c.c. of stomach -fluid; in other words, the stomach fluid -contained more than one per cent of sugar without -taking into account the amount which had -been absorbed.</p> - -<p>The figures for maltose in column 2 represent -a test meal in which little or no saliva was -mixed with the test meal, the food being swallowed -without chewing, indicating very slight -action of the saliva, the amount of maltose -found in the stomach fluid being but a trifle -more than one-fourth the amount obtained after -an ordinary test meal. The amount of soluble -starch and dextrine was less than half the normal -amount in the case of the raw flour, and -but little more in the case of the raw wheat.</p> - -<p>Another point of interest is the increased -amount of lactic acid found in the test meal -taken without chewing, represented in column 2. -The coefficient of fermentation which represents -the number of milligrams of lactic acid (as expressed -in terms of HCl) found in 100 c.c. of -stomach fluid was more than double that found -after the same kind of test breakfast properly masticated, -represented in column 1. The results<span class="pagenum" id="Page_394">[Pg 394]</span> -of this experiment distinctly associate acid fermentation -with imperfect mastication and imperfect -salivary digestion.</p> - -<p>Another fact noted in a comparative study -of the results of the analysis of over 5000 stomach -fluids, which very strongly confirms this -idea, is that starch conversion is usually complete -in cases of apepsia, while lactic acid is -conspicuous by its absence. In nearly all cases -of apepsia which I have encountered, numbering -about forty cases in all, the most delicate -tests for lactic acid have failed to show its presence -except in the most minute quantities; in -most cases it was entirely absent.</p> - -<p>There are a number of other points of interest -in the above table in addition to those -which relate particularly to starch digestion. -One of the most noteworthy of these is the fact -that the digestion of albumen was not unfavourably -influenced by the neglect to masticate the -food, the coefficient of digestion, in fact, being -raised from .82 to .97. This coefficient is a -qualitative and not a quantitative index. The -higher coefficient indicates a more perfect elaboration -of proteids and a close approach to an -absolutely perfect proteid digestion.</p> - -<p>Another fact of perhaps even greater interest -has relation to the digestion of albumen -when the wheat was eaten raw, in the form of<span class="pagenum" id="Page_395">[Pg 395]</span> -either flour or wheat. The coefficient of proteid -digestion in both cases, as shown in columns -3 and 4, was 1.00, indicating perfect elaboration -of the albuminoids. From this it appears that -raw gluten, or the proteids of wheat, is digested -more perfectly when taken in a raw state than -when cooked, the very opposite of which we -have seen to be true of starch. The digestion -of raw starch may take place in the intestines, -by the action of the pancreatic juice, but cannot -take place in the stomach, for the reason -that the saliva has not the power to penetrate -the cellulose envelope of the starch granule, -and hence cannot digest raw starch.</p> - -<p>This fact coincides in a most interesting -manner with the biological fact that man is -by nature a frugivorous animal. In the process -of ripening, the starch of fruits undergoes -a hydration similar to that which takes place in -cooking and in pancreatic digestion, whereby -the insoluble starch is converted into soluble -starch, dextrine, and sugar. This explains, also, -why well-ripened fruit may be eaten raw with -impunity, while unripe fruit and farinaceous -food of all sorts require cooking. In his diet, -man, like his nearest relative, the monkey, being -naturally a frugivorous animal, may eat fruits -in the state in which Nature has provided them; -but when he introduces other natural products<span class="pagenum" id="Page_396">[Pg 396]</span> -into his bill of fare, he must adopt artificial -means for securing the preparation for digestion -which Nature makes in the ripening process -of fruits.</p> - -<p>The coefficient of chlorine liberation (<i>m</i>) is -very nearly uniform, indicating that the mastication -of food and the cooking of food have little -influence upon this digestive function.</p> - -<p>The coefficient of salivary activity (<i>c</i>) was -determined independently for each test breakfast. -Its practical uniformity indicates that there -was no essential change in the character or quality -of the saliva to account for the differences -shown by the totals in relation to the stomach -digestion of starch.</p> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="DR_EDWARD_HOOKER_DEWEY_AND_THE">DR. EDWARD HOOKER DEWEY AND THE -“NO BREAKFAST PLAN”</h3> -</div> - - -<div class="blockquot"> - -<p>The “No Breakfast Plan,” evolved from the long experimental -experience of Dr. Dewey, to secure much needed rest -for the stomach and intestines, is described in a book bearing -that title which can be had direct from the author by addressing -him at his home, Meadville, Penn., U. S. A.</p> - -<p>“No Breakfast” is, evidently, a misnomer, but means, in -the present application, an appetite <i>earned</i> after arising from -sleep. The writer, for instance, often begins work so early in -the morning that by the time the ordinary breakfast is ready -he has already done a fair day’s work.</p> - -<p>The writer has no reported details of the work of Dr. -Dewey to add to this volume. In “Glutton or Epicure” -full appreciation of this Esculapian Luther is expressed and -extracts of his writings are reprinted. In fighting for more -than forty years for the principle of less abuse of the tired<span class="pagenum" id="Page_397">[Pg 397]</span> -body of man, Dr. Dewey has rendered a service that some -time will be reckoned very great; and while there is no -scientific report of the good doctor’s work to call for introductory -comment, it would be equally unhealthy to miss an -opportunity to express gratitude for what he has done for us -all.</p> -</div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="PROFESSOR_JAFFA_AND_THE_FRUITARIANS">PROFESSOR JAFFA AND THE FRUITARIANS</h3> -</div> - - -<div class="blockquot"> - -<p>Professor Jaffa, too, of the University of California, has -been doing most valuable service in testing the usefulness of -fruits and nuts as human foods. He generously furnished the -author with elaborate tables of his results, covering several -years of observation, showing low nitrogen possibilities similar -to those demonstrated by the writer and his colleagues at -Cambridge and Yale. These have since been published, and -relating to special kinds of foods, as they do, suggest a wide -range of choice among the fruits of earth; but the collected -evidence of this book shows that human nutrition is best -served when the appetite, being kept at normal, is allowed to -make selection from the whole range of nutritious products -furnished by good Mother Nature.</p> -</div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h3 class="nobreak" id="DR_H_P_ARMSBY">DR. H. P. ARMSBY</h3> -</div> - - -<div class="blockquot"> - -<p>In the Oct. 16th, 1903, number of <i>Science</i>, also, is an interesting -article by Dr. H. P. Armsby on the heat values and -muscular energy values of different food elements and their isodynamic -replacement of each other under various conditions.—<span class="smcap">Horace -Fletcher.</span>]</p> -</div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_399">[Pg 399]</span></p> - -<h3 class="nobreak" id="Explanation_of_The_A_B_C">Explanation of The A. B. C. -Life Series<br /> - - -<small>THE ESSENTIALS AND SEQUENCE IN LIFE</small></h3> -</div> - -<p>It would seem a considerable departure -from the study of menticulture as advised -in the author’s book, “Menticulture,” to -jump at once to an investigation of the -physiology and psychology of nutrition of -the body and then over to the department -of infant and child care and education as -pursued in the <i>crêche</i> and in the kindergarden; -but as a matter of fact, if study -of the causation of human disabilities and -misfortunes is attempted at all, the quest -leads naturally into all the departments of -human interest, and first into these primary -departments.</p> - -<p>The object of this statement is to -link up the different publications of the -writer into a chain of consistent suggestions -intended to make life a more simple<span class="pagenum" id="Page_400">[Pg 400]</span> -and agreeable problem than many of us -too indifferent or otherwise inefficient and -bad fellow-citizens make of it.</p> - -<p>It is not an altogether unselfish effort -on the part of the author of the A. B. C. -Life Series to publish his findings. In the -consideration of his own mental and physical -happiness it is impossible to leave out -environment, and all the units of humanity -who inhabit the world are part of his and -of each other’s environment.</p> - -<p>It would be rank presumption for any -person, even though gifted with the means -to circulate his suggestions as widely as -possible, and armed with the power to -compel the reading of his publications, -to think that any suggestions of his could -influence any considerable number of his -fellow-citizens of the world, or even of his -own immediate neighbourhood, to accept -or follow his advice relative to the management -of their lives and of their communal -and national affairs; but while the -general and complete good of humanity -should be aimed at in all publications, -one’s immediate neighbours and friends<span class="pagenum" id="Page_401">[Pg 401]</span> -come first, and the wave of influence -spreads according to the effectiveness of -the ideas suggested in doing good; that -is, in altering the point of view and conduct -of people so as to make them a better -sympathetic environment.</p> - -<p>For instance, the children of your -neighbours are likely to be the playmates -of your own children, and the children of -degenerate parents in the slum district -of your city will possibly be the fellow-citizen -partners of your own family. Again, -when it is known that right or wrong nutrition -of the body is the most important -agent in forming character, in establishing -predisposition to temperance or intemperance -of living, including the desire for -intoxicating stimulants, it is revealed to -one that right nutrition of the community -as a whole is an important factor in his -own environment, as is self-care in the -case of his own nourishment.</p> - -<p>The moment a student of every-day -philosophy starts the study of problems -from the A. B. C. beginning of things, -and to shape his study according to an<span class="pagenum" id="Page_402">[Pg 402]</span> -A. B. C. sequence, each cause of inharmony -is at once traced back to its first expression -in himself and then to causes -influenced by his environments.</p> - -<p>If we find that the largest influences -for good or bad originate with the right -or wrong instruction of children during -the home training or kindergarden period -of their development, and that a dollar -expended for education at that time is -worth more for good than whole bancs -of courts and whole armies of police to -correct the effect of bad training and bad -character later in life, it is quite logical -to help promote the spread of the kindergarden -or the kindergarden idea to include -all of the children born into the world, -and to furnish mothers and kindergarden -teachers with knowledge relative to the -right nutrition of their wards which they -can themselves understand and can teach -effectively to children.</p> - -<p>If we also find that the influence of the -kindergarden upon the parents of the infants -is more potent than any other which -can be brought to bear upon them, we see<span class="pagenum" id="Page_403">[Pg 403]</span> -clearly that the way to secure the widest -reform in the most thorough manner is -to concentrate attention upon the kindergarden -phase of education, advocate its -extension to include even the last one of -the children, beginning with the most -needy first, and extending the care outward -from the centre of worst neglect to -finally reach the whole.</p> - -<p>Experience in child saving so-called, -and in child education on the kindergarden -principle, has taught the cheapest -and the most profitable way to insure -an environment of good neighbours and -profit-earning citizens; and investigation -into the problem of human alimentation -shows that a knowledge of the elements of -an economic nutrition is the first essential -of a family or school training; and also -that this is most impressive when taught -during the first ten years of life.</p> - -<p>One cannot completely succeed in the -study of menticulture from its A. B. C. -beginning and in A. B. C. sequence without -appreciation of the interrelation of -the physical and the mental, the personal<span class="pagenum" id="Page_404">[Pg 404]</span> -and the social, in attaining a complete -mastery of the subject.</p> - -<p>The author of the A. B. C. Life -Series has pursued his study of the -philosophy of life in experiences which -have covered a great variety of occupations -in many different parts of the world -and among peoples of many different -nations and races. His first book, “Menticulture,” -dealt with purging the mind -and habits of sundry weaknesses and deterrents -which have possession of people -in general in some degree. He recognised -the depressing effect of anger and -worry and other phases of <i>fearthought</i>. -In the book “Happiness,” which followed -next in order, <i>fearthought</i> was shown to be -the unprofitable element of forethought. -The influence of environment on each -individual was revealed as an important -factor of happiness, or the reverse, by -means of an accidental encounter with a -neglected waif in the busy streets of -Chicago during a period of intense -national excitement incident to the war -with Spain, and this led to the publication<span class="pagenum" id="Page_405">[Pg 405]</span> -of “That Last Waif; or, Social Quarantine.” -During the time that this last -book was being written, attention to the -importance of right nutrition was invited -by personal disabilities, and the experiments -described in “Glutton or Epicure; -or, Economic Nutrition” were begun and -have continued until now.</p> - -<p>In the study of the latter, but most -important factor in profitable living, circumstances -have greatly favoured the -author, as related in his latest book, -“The A. B.-Z. of Our Own Nutrition.”</p> - -<p>The almost phenomenal circulation of -“Menticulture” for a book of its kind, -and a somewhat smaller interest in the -books on nutrition and the appeal for -better care of the waifs of society, showed -that most persons wished, like the author, -to find a short cut to happiness by -means of indifference to environment, -both internal and external, while habitually -sinning against the physiological -dietetic requirements of Nature. In smothering -worry and guarding against anger the -psychic assistance of digestion was stimu<span class="pagenum" id="Page_406">[Pg 406]</span>lated -and some better results were thereby -obtained, but not the best attainable -results.</p> - -<p>Living is easy and life may be made -constantly happy by beginning right; and -the right beginning is none other than -the careful feeding of the body. This -done there is an enormous reserve of -energy, a naturally optimistic train of -thought, a charitable attitude towards -everybody, and a loving appreciation of -everything that God has made. Morbidity -of temperament will disappear from an -organism that is economically and rightly -nourished, and death will cease to have -any terrors for such; and as <i>fear</i> of death -is the worst depressant known, many of -the <i>worries</i> of existence take their everlasting -flight from the atmosphere of the -rightly nourished.</p> - -<p>The wide interest now prevalent in -the subjects treated in The A. B. C. Life -Series is evidenced by the scientific, military, -and lay activity in connection with -the experiments at the Sheffield Scientific -School of Yale University and elsewhere,<span class="pagenum" id="Page_407">[Pg 407]</span> -as related in the “A. B.-Z. of Our Own -Nutrition” and in “The New Glutton or -Epicure” of the series.</p> - -<p>The general application is more fully -shown, however, by the indorsement of -the great Battle Creek Sanitarium, which -practically studies all phases of the subject, -from health conservation and child -saving to general missionary work in -social reform.</p> - -<p class="psig"> -HORACE FLETCHER.</p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_409">[Pg 409]</span></p> - -<h2 class="nobreak" id="Index">Index</h2> -</div> - - -<ul class="index"> -<li class="ifrst">A</li> - -<li class="indx">A. B. C. Life Series, the, xxiv, <a href='#Page_15'>15</a>, <a href='#Page_47'>47</a>;</li> -<li class="isub1">explanation of, <a href='#Page_399'>399</a>-407</li> - -<li class="indx">Abdominal glands, the, <a href='#Page_189'>189</a>, <a href='#Page_190'>190</a></li> - -<li class="indx">—— muscles, the, <a href='#Page_326'>326</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">—— wall, the, <a href='#Page_364'>364</a></li> - -<li class="indx">Abernethy biscuit, <a href='#Page_131'>131</a></li> - -<li class="indx">Acid reaction, of food, <a href='#Page_269'>269</a></li> - -<li class="indx">Acids, stimulating properties of, <a href='#Page_270'>270</a>;</li> -<li class="isub1">supplement weak action in the stomach, <a href='#Page_270'>270</a>;</li> -<li class="isub1">special relation to the pancreas of, <a href='#Page_270'>270</a></li> - -<li class="indx">Addison, Joseph, upon the work of Luigi Cornaro, <a href='#Page_28'>28</a></li> - -<li class="indx">Adenoids, largely dietetic in origin, <a href='#Page_148'>148</a>-152, <a href='#Page_156'>156</a></li> - -<li class="indx">Afferent nerves, special duty of the peripheral terminations of, <a href='#Page_184'>184</a>-185</li> - -<li class="indx">Agriculture, U. S. Department of, <a href='#Page_37'>37</a></li> - -<li class="indx">Albumen, digestion of, <a href='#Page_394'>394</a></li> - -<li class="indx">Albuminoids, the, <a href='#Page_395'>395</a></li> - -<li class="indx">Albuminous foods, minimum amount of, <a href='#Page_74'>74</a>, <a href='#Page_78'>78</a></li> - -<li class="indx">Alcoholic beverages, explanation of the use of, <a href='#Page_252'>252</a></li> - -<li class="indx">Algarroba bean, the, <a href='#Page_124'>124</a></li> - -<li class="indx">Alimentary canal, the, <a href='#Page_13'>13</a>, <a href='#Page_14'>14</a>, <a href='#Page_15'>15</a>, <a href='#Page_40'>40</a>;</li> -<li class="isub1">pabulum derived from, <a href='#Page_40'>40</a>, <a href='#Page_92'>92</a>, <a href='#Page_117'>117</a>;</li> -<li class="isub1">Professor Pawlow’s conclusions concerning, <a href='#Page_186'>186</a>;</li> -<li class="isub1">experimental investigation of the pathology and therapeutics of, <a href='#Page_248'>248</a>, <a href='#Page_260'>260</a>, <a href='#Page_273'>273</a>, <a href='#Page_275'>275</a>, <a href='#Page_276'>276</a>, <a href='#Page_277'>277</a></li> - -<li class="indx">Alimentation, human, study of, <a href='#Page_13'>13</a>;</li> -<li class="isub1">theory of, <a href='#Page_180'>180</a></li> - -<li class="indx">Alkalies, the, <a href='#Page_278'>278</a>, <a href='#Page_279'>279</a>, <a href='#Page_280'>280</a>, <a href='#Page_281'>281</a>, <a href='#Page_282'>282</a></li> - -<li class="indx">Alkaline reduction, <a href='#Page_33'>33</a>, <a href='#Page_34'>34</a>, <a href='#Page_35'>35</a>, <a href='#Page_36'>36</a>, <a href='#Page_44'>44</a></li> - -<li class="indx">—— saliva, <a href='#Page_33'>33</a>;</li> -<li class="isub1">its quantity increased by mastication, <a href='#Page_96'>96</a>, <a href='#Page_102'>102</a>, <a href='#Page_146'>146</a></li> - -<li class="indx">Alkalinisation, <a href='#Page_92'>92</a></li> - -<li class="indx">Altruism, placed upon a business basis, xxiv</li> - -<li class="indx">American Medical Missionary Association, the, <a href='#Page_390'>390</a></li> - -<li class="indx">—— Medical Missionary Cause, the, xxiii</li> - -<li class="indx">—— Physiological Society, the, <a href='#Page_68'>68</a></li> - -<li class="indx">Anderson, Dr. William G., <a href='#Page_54'>54</a>, <a href='#Page_87'>87</a>, <a href='#Page_88'>88</a></li> - -<li class="indx">Anger, causes indigestion, <a href='#Page_7'>7</a></li> - -<li class="indx">Animal economy, <a href='#Page_40'>40</a></li> - -<li class="indx">—— food, necessitates less thorough mastication than vegetable, <a href='#Page_67'>67</a>, <a href='#Page_99'>99</a>-100, <a href='#Page_173'>173</a>;</li> -<li class="isub1">influenced less than vegetable by cooking, <a href='#Page_118'>118</a></li> - -<li class="indx">—— organism, the efficiency of, <a href='#Page_58'>58</a></li> - -<li class="indx">Anthropoid apes, <a href='#Page_115'>115</a>, <a href='#Page_116'>116</a></li> - -<li class="indx">Antiperistalsis, <a href='#Page_326'>326</a>, <a href='#Page_333'>333</a>, <a href='#Page_342'>342</a>, <a href='#Page_345'>345</a>, <a href='#Page_364'>364</a>;</li> -<li class="isub1">in the colon, <a href='#Page_365'>365</a>-370;</li> -<li class="isub1">the question of, <a href='#Page_377'>377</a>-383, <a href='#Page_384'>384</a>, <a href='#Page_385'>385</a>, <a href='#Page_387'>387</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">Antiperistaltic waves, <a href='#Page_365'>365</a>, <a href='#Page_367'>367</a>, <a href='#Page_373'>373</a>, <a href='#Page_374'>374</a>, <a href='#Page_376'>376</a>, <a href='#Page_381'>381</a>, <a href='#Page_383'>383</a>, <a href='#Page_387'>387</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">Antrum, the, <a href='#Page_307'>307</a>, <a href='#Page_308'>308</a>, <a href='#Page_311'>311</a>, <a href='#Page_315'>315</a>, <a href='#Page_322'>322</a>, <a href='#Page_323'>323</a>, <a href='#Page_326'>326</a>, <a href='#Page_327'>327</a>, <a href='#Page_333'>333</a>, <a href='#Page_334'>334</a>, <a href='#Page_336'>336</a>, <a href='#Page_340'>340</a>, <a href='#Page_341'>341</a>, <a href='#Page_360'>360</a></li> - -<li class="indx">Apepsia, <a href='#Page_394'>394</a> -<span class="pagenum" id="Page_410">[Pg 410]</span></li> - - -<li class="indx">Appendicitis, relationship between diet and, <a href='#Page_141'>141</a></li> - -<li class="indx">Appendix, the, cause of catarrh of, <a href='#Page_141'>141</a></li> - -<li class="indx">Appetite, demands proteid when wanted, xxxii;</li> -<li class="isub1">knows what to do and when to do it, xxxiii;</li> -<li class="isub1">most important factor in digestion, <a href='#Page_6'>6</a>;</li> -<li class="isub1">a perfect indicator, <a href='#Page_6'>6</a>;</li> -<li class="isub1">a creature of the mind, <a href='#Page_7'>7</a>;</li> -<li class="isub1">the caprices of, <a href='#Page_7'>7</a>;</li> -<li class="isub1">easily comprehended, how to read, <a href='#Page_8'>8</a>, <a href='#Page_9'>9</a>, <a href='#Page_12'>12</a>;</li> -<li class="isub1">an indicator of what the body requires, <a href='#Page_20'>20</a>;</li> -<li class="isub1">will close the valve when enough is eaten, <a href='#Page_20'>20</a>;</li> -<li class="isub1">striking effect of insalivation upon, <a href='#Page_50'>50</a>;</li> -<li class="isub1">fully understood, prevents intemperance in eating or drinking, <a href='#Page_95'>95</a>;</li> -<li class="isub1">sooner satisfied with thorough mastication, <a href='#Page_137'>137</a>;</li> -<li class="isub1">the first and mightiest exciter of the secretory nerves of the stomach, <a href='#Page_210'>210</a>;</li> -<li class="isub1">is juice, <a href='#Page_213'>213</a>;</li> -<li class="isub1">Dr. Pawlow’s experiment showing value of, <a href='#Page_226'>226</a>;</li> -<li class="isub1">its initial impulse may originate in the stomach, <a href='#Page_244'>244</a>;</li> -<li class="isub1">in the rich and in the poor, <a href='#Page_252'>252</a>-253;</li> -<li class="isub1">care should be taken of, <a href='#Page_254'>254</a>;</li> -<li class="isub1">physicians most often called on to restore, <a href='#Page_254'>254</a>;</li> -<li class="isub1">remarkable how little attention is paid to, <a href='#Page_255'>255</a>;</li> -<li class="isub1">bitters increase, <a href='#Page_263'>263</a>, <a href='#Page_265'>265</a>;</li> -<li class="isub1">the strongest of all stimuli to the digestive glands, <a href='#Page_263'>263</a>;</li> -<li class="isub1">connection between gastric juice and, <a href='#Page_265'>265</a>.</li> - -<li class="indx">—— earned, a preliminary necessity of easy digestion, <a href='#Page_180'>180</a></li> - -<li class="indx">——, false, <a href='#Page_6'>6</a>, <a href='#Page_9'>9</a>, <a href='#Page_29'>29</a>, <a href='#Page_75'>75</a></li> - -<li class="indx">——, normal, <a href='#Page_6'>6</a></li> - -<li class="indx">“Appetite juice,” the, <a href='#Page_213'>213</a>, <a href='#Page_228'>228</a>, <a href='#Page_258'>258</a>, <a href='#Page_259'>259</a>, <a href='#Page_260'>260</a></li> - -<li class="indx">Apples, <a href='#Page_169'>169</a></li> - -<li class="indx">Appreciation, attention necessary to create, <a href='#Page_7'>7</a>;</li> -<li class="isub1">necessary to stimulate flow of digestive juices, <a href='#Page_7'>7</a>, <a href='#Page_12'>12</a></li> - -<li class="indx">Armsby, Dr. H. P., on the heat values and muscular energy values of different food elements, <a href='#Page_397'>397</a></li> - -<li class="indx">Asiatics, the, consume smaller proportion of proteids, <a href='#Page_82'>82</a></li> - -<li class="indx">Asparagus, <a href='#Page_93'>93</a></li> - -<li class="indx">Astrup, E., <a href='#Page_126'>126</a></li> - -<li class="indx">Athletes, reason for training, <a href='#Page_22'>22</a></li> - -<li class="indx">Attention, necessary to create appreciation, <a href='#Page_7'>7</a>;</li> -<li class="isub1">how to command, <a href='#Page_8'>8</a>, <a href='#Page_9'>9</a>, <a href='#Page_12'>12</a></li> - -<li class="indx">Atwater, Prof. W. O., <a href='#Page_54'>54</a>;</li> -<li class="isub1">on the daily proteid requirement, <a href='#Page_76'>76</a></li> - -<li class="indx">—— Respiration Apparatus, the, <a href='#Page_57'>57</a></li> - -<li class="indx">Australians, the, <a href='#Page_118'>118</a>, <a href='#Page_129'>129</a>, <a href='#Page_163'>163</a></li> - - -<li class="ifrst">B</li> - -<li class="indx">Bache Fund, the, <a href='#Page_69'>69</a></li> - -<li class="indx">Bacteria, the action in the intestines of, <a href='#Page_39'>39</a>, <a href='#Page_117'>117</a></li> - -<li class="indx">Bacterial digestion, <a href='#Page_40'>40</a></li> - -<li class="indx">—— flora, the, examination of, <a href='#Page_26'>26</a></li> - -<li class="indx">Bacteriology, advances of, <a href='#Page_248'>248</a>, <a href='#Page_249'>249</a></li> - -<li class="indx">Bailey, <a href='#Page_128'>128</a></li> - -<li class="indx">Balthazard, experiments of, <a href='#Page_314'>314</a>, <a href='#Page_315'>315</a>, <a href='#Page_327'>327</a>, <a href='#Page_328'>328</a></li> - -<li class="indx">Baltimore, Md., <a href='#Page_68'>68</a></li> - -<li class="indx">Barling, Gilbert, <a href='#Page_141'>141</a></li> - -<li class="indx">Barrett, Robert, <a href='#Page_47'>47</a></li> - -<li class="indx">Bayliss, experiments of, <a href='#Page_343'>343</a>, <a href='#Page_344'>344</a>, <a href='#Page_345'>345</a>, <a href='#Page_359'>359</a></li> - -<li class="indx">Batter pudding, <a href='#Page_98'>98</a></li> - -<li class="indx">Battle Creek, Michigan, <a href='#Page_390'>390</a></li> - -<li class="indx">—— Laboratories, the, <a href='#Page_389'>389</a>-391;</li> -<li class="isub1">experimental investigation of the influence of mastication and cooking of food, etc., in, <a href='#Page_391'>391</a>-396</li> - -<li class="indx">—— Sanitarium, the, xvii, xxiii, xxvii;</li> -<li class="isub1">described, <a href='#Page_389'>389</a>-391</li> - -<li class="indx">Bayert, <a href='#Page_123'>123</a></li> - -<li class="indx">Beans, <a href='#Page_95'>95</a>, <a href='#Page_132'>132</a> -<span class="pagenum" id="Page_411">[Pg 411]</span></li> - -<li class="indx">Beaumont, experiments of, <a href='#Page_305'>305</a>, <a href='#Page_309'>309</a>, <a href='#Page_310'>310</a>, <a href='#Page_313'>313</a>, <a href='#Page_326'>326</a>, <a href='#Page_327'>327</a>, <a href='#Page_329'>329</a>, <a href='#Page_330'>330</a>, <a href='#Page_334'>334</a>, <a href='#Page_336'>336</a></li> - -<li class="indx">Beef, <a href='#Page_100'>100</a></li> - -<li class="indx">Benedict, Prof. Francis G., <a href='#Page_54'>54</a></li> - -<li class="indx">Berlin, <a href='#Page_56'>56</a>, <a href='#Page_65'>65</a></li> - -<li class="indx">Berne, Switzerland, <a href='#Page_284'>284</a></li> - -<li class="indx">Betel, chewing, <a href='#Page_103'>103</a>, <a href='#Page_128'>128</a></li> - -<li class="indx">Beverages, mastication in the preparation of, <a href='#Page_123'>123</a></li> - -<li class="indx">Bidder and Schmidt, experiments of, <a href='#Page_202'>202</a>, <a href='#Page_204'>204</a>, <a href='#Page_231'>231</a>;</li> -<li class="isub1">conditions for success, <a href='#Page_204'>204</a>-206</li> - -<li class="indx">Bile, the, <a href='#Page_360'>360</a></li> - -<li class="indx">Bitters, therapeutic influence of, <a href='#Page_262'>262</a>, <a href='#Page_265'>265</a>;</li> -<li class="isub1">increase the appetite, <a href='#Page_263'>263</a>, <a href='#Page_264'>264</a>, <a href='#Page_265'>265</a></li> - -<li class="indx">Blondlot, experiments of, <a href='#Page_181'>181</a>, <a href='#Page_182'>182</a>, <a href='#Page_277'>277</a></li> - -<li class="indx">Blood, the, toxins absorbed into, <a href='#Page_40'>40</a>;</li> -<li class="isub1">influence of the contraction of the masticatory muscles on local circulation of, <a href='#Page_107'>107</a>, <a href='#Page_148'>148</a>, <a href='#Page_149'>149</a>, <a href='#Page_278'>278</a>, <a href='#Page_355'>355</a></li> - -<li class="indx">—— elements, the, <a href='#Page_41'>41</a></li> - -<li class="indx">Blumfield, Dr. Joseph, <a href='#Page_26'>26</a></li> - -<li class="indx">Body, the, considered as an engine, <a href='#Page_4'>4</a>, <a href='#Page_23'>23</a>;</li> -<li class="isub1">derives its necessary energy from food, <a href='#Page_72'>72</a>;</li> -<li class="isub1">burdened by excess of food, <a href='#Page_73'>73</a></li> - -<li class="indx">Boer War, the, <a href='#Page_11'>11</a></li> - -<li class="indx">Bolting food, <a href='#Page_35'>35</a>, <a href='#Page_36'>36</a>, <a href='#Page_134'>134</a>, <a href='#Page_135'>135</a>, <a href='#Page_138'>138</a>, <a href='#Page_140'>140</a></li> - -<li class="indx">Bolus, the, <a href='#Page_329'>329</a>, <a href='#Page_343'>343</a>, <a href='#Page_344'>344</a></li> - -<li class="indx">Boston Society of Medical Sciences, the, <a href='#Page_342'>342</a></li> - -<li class="indx">Bouillon, <a href='#Page_266'>266</a></li> - -<li class="indx">Bowditch, Dr. Prof. Henry Pickering, xxiv, xxv, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a>, <a href='#Page_70'>70</a>, <a href='#Page_284'>284</a>, <a href='#Page_285'>285</a>, <a href='#Page_287'>287</a>, <a href='#Page_306'>306</a></li> - -<li class="indx">Bowel, the, liable to suffer, <a href='#Page_140'>140</a>, <a href='#Page_345'>345</a></li> - -<li class="indx">“Bracer,” a, why required, <a href='#Page_20'>20</a></li> - -<li class="indx">Braun and Grützner, experiments of, <a href='#Page_278'>278</a></li> - -<li class="indx">Bread, <a href='#Page_78'>78</a>, <a href='#Page_98'>98</a>, <a href='#Page_99'>99</a>, <a href='#Page_132'>132</a>, <a href='#Page_137'>137</a>, <a href='#Page_143'>143</a>, <a href='#Page_171'>171</a>, <a href='#Page_270'>270</a>, <a href='#Page_271'>271</a>, <a href='#Page_274'>274</a>, <a href='#Page_275'>275</a></li> - -<li class="indx">Brinton, experiments of, <a href='#Page_329'>329</a>, <a href='#Page_330'>330</a>, <a href='#Page_334'>334</a>, <a href='#Page_336'>336</a></li> - -<li class="indx">British Guiana, <a href='#Page_124'>124</a></li> - -<li class="indx">—— Medical Association, the, <a href='#Page_27'>27</a>, <a href='#Page_48'>48</a>, <a href='#Page_91'>91</a>, <a href='#Page_92'>92</a></li> - -<li class="indx">“British Medical Journal,” the, <a href='#Page_141'>141</a></li> - -<li class="indx">Bronchitis, <a href='#Page_144'>144</a>, <a href='#Page_146'>146</a></li> - -<li class="indx">Broth, strong, <a href='#Page_268'>268</a></li> - -<li class="indx">Brown bread, <a href='#Page_43'>43</a></li> - -<li class="indx">Brussels, <a href='#Page_68'>68</a></li> - -<li class="indx">Buccal digestion, <a href='#Page_8'>8</a></li> - -<li class="indx">—— nerves, the, <a href='#Page_194'>194</a></li> - -<li class="indx">Bushmen, the, <a href='#Page_118'>118</a>, <a href='#Page_123'>123</a></li> - -<li class="indx">Butter, <a href='#Page_43'>43</a>, <a href='#Page_100'>100</a></li> - - -<li class="ifrst">C</li> - -<li class="indx">Cabbage, why indigestible, <a href='#Page_99'>99</a></li> - -<li class="indx">Cæcum, the, <a href='#Page_140'>140</a>, <a href='#Page_141'>141</a>, <a href='#Page_363'>363</a>, <a href='#Page_364'>364</a>, <a href='#Page_365'>365</a>, <a href='#Page_366'>366</a>, <a href='#Page_368'>368</a>, <a href='#Page_370'>370</a>, <a href='#Page_371'>371</a>, <a href='#Page_372'>372</a>, <a href='#Page_375'>375</a>, <a href='#Page_376'>376</a>, <a href='#Page_377'>377</a>, <a href='#Page_381'>381</a>, <a href='#Page_387'>387</a></li> - -<li class="indx">Cake, <a href='#Page_132'>132</a></li> - -<li class="indx">California, University of, <a href='#Page_90'>90</a>, <a href='#Page_397'>397</a></li> - -<li class="indx">Calm, easy to cultivate, <a href='#Page_7'>7</a></li> - -<li class="indx">Cambridge, England, xxxi, <a href='#Page_26'>26</a>, <a href='#Page_47'>47</a>, <a href='#Page_49'>49</a></li> - -<li class="indx">—— tests, the, <a href='#Page_47'>47</a>, <a href='#Page_69'>69</a></li> - -<li class="indx">—— University, England, xxv, <a href='#Page_26'>26</a>, <a href='#Page_53'>53</a>, <a href='#Page_68'>68</a>, <a href='#Page_91'>91</a></li> - -<li class="indx">Campbell, Dr. Harry, <a href='#Page_8'>8</a>, <a href='#Page_12'>12</a>;</li> -<li class="isub1">on the importance of mastication, <a href='#Page_92'>92</a>-179, <a href='#Page_389'>389</a></li> - -<li class="indx">Cancer, produced by inefficient mastication, <a href='#Page_138'>138</a></li> - -<li class="indx">Cane-sugar, changed to grape-sugar, <a href='#Page_21'>21</a>, <a href='#Page_169'>169</a></li> - -<li class="indx">Cannon, Dr. W. B., <a href='#Page_7'>7</a>, <a href='#Page_12'>12</a>;</li> -<li class="isub1">on “Swallowing and Movements of the Stomach and Intestines,” <a href='#Page_284'>284</a>-300; -<span class="pagenum" id="Page_412">[Pg 412]</span></li> -<li class="isub1">on the “Movements of the Stomach Studied by means of the Röntgen Rays,” <a href='#Page_301'>301</a>-341;</li> -<li class="isub1">on the “Movements of the Intestines Studied by Means of the Röntgen Rays,” <a href='#Page_342'>342</a>-388</li> - -<li class="indx">Carbohydrate foods, <a href='#Page_78'>78</a>, <a href='#Page_79'>79</a>, <a href='#Page_80'>80</a>, <a href='#Page_85'>85</a>, <a href='#Page_86'>86</a>, <a href='#Page_89'>89</a></li> - -<li class="indx">Cardia, the, ideas of early writers concerning, <a href='#Page_303'>303</a>, <a href='#Page_304'>304</a>, <a href='#Page_325'>325</a>, <a href='#Page_326'>326</a>, <a href='#Page_328'>328</a>, <a href='#Page_329'>329</a></li> - -<li class="indx">Cardiac sphincter, the, <a href='#Page_307'>307</a></li> - -<li class="indx">Carelessness, the sin of, xvii</li> - -<li class="indx">Carnegie, Andrew, xxxv</li> - -<li class="indx">—— Institution, the, <a href='#Page_53'>53</a></li> - -<li class="indx">Carnivora, the, do not masticate, <a href='#Page_97'>97</a>, <a href='#Page_161'>161</a></li> - -<li class="indx">Cassava root, <a href='#Page_124'>124</a></li> - -<li class="indx">Cat, the, experiments upon, <a href='#Page_289'>289</a>-293, <a href='#Page_299'>299</a>, <a href='#Page_303'>303</a>, <a href='#Page_307'>307</a>, <a href='#Page_311'>311</a>, <a href='#Page_312'>312</a>, <a href='#Page_315'>315</a>, <a href='#Page_320'>320</a>, <a href='#Page_322'>322</a>, <a href='#Page_325'>325</a>, <a href='#Page_333'>333</a>, <a href='#Page_335'>335</a>, <a href='#Page_337'>337</a>-339, <a href='#Page_341'>341</a>, <a href='#Page_344'>344</a>, <a href='#Page_353'>353</a>, <a href='#Page_359'>359</a>, <a href='#Page_361'>361</a>, <a href='#Page_365'>365</a>, <a href='#Page_366'>366</a>, <a href='#Page_372'>372</a>, <a href='#Page_382'>382</a>, <a href='#Page_383'>383</a>-386, <a href='#Page_388'>388</a></li> - -<li class="indx">Catarrh of the appendix, caused by inefficient mastication, <a href='#Page_141'>141</a></li> - -<li class="indx">Cauliflower, <a href='#Page_99'>99</a></li> - -<li class="indx">“Cause and Prevention of Decay in Teeth, the,” Wallace’s, <a href='#Page_161'>161</a></li> - -<li class="indx">Cavendish lecture, Sir Frederick Treves’s, <a href='#Page_140'>140</a></li> - -<li class="indx">Cell, a, determination of the metabolism of, <a href='#Page_40'>40</a></li> - -<li class="indx">Cellulose, <a href='#Page_117'>117</a>, <a href='#Page_170'>170</a></li> - -<li class="indx">Cereals, <a href='#Page_78'>78</a>, <a href='#Page_84'>84</a>, <a href='#Page_146'>146</a></li> - -<li class="indx">Ceylon, <a href='#Page_128'>128</a></li> - -<li class="indx">Cheese, <a href='#Page_43'>43</a>, <a href='#Page_95'>95</a>;</li> -<li class="isub1">when indigestible, <a href='#Page_100'>100</a>, <a href='#Page_137'>137</a></li> - -<li class="indx">Chemical excitants, the, <a href='#Page_268'>268</a></li> - -<li class="indx">—— secretion, <a href='#Page_259'>259</a></li> - -<li class="indx">Chemistry, organic, <a href='#Page_62'>62</a></li> - -<li class="indx">——, physical, <a href='#Page_62'>62</a></li> - -<li class="indx">Chewing, length of time necessary for, xxxii</li> - -<li class="indx">Chicken bone, <a href='#Page_166'>166</a></li> - -<li class="indx">Chigin, Dr., experiments by, <a href='#Page_214'>214</a>, <a href='#Page_216'>216</a>, <a href='#Page_282'>282</a></li> -<li class="indx">Children, early feeding of, <a href='#Page_130'>130</a>-132, <a href='#Page_143'>143</a>;</li> -<li class="isub1">defective mastication in, <a href='#Page_148'>148</a>;</li> -<li class="isub1">feeding of, <a href='#Page_262'>262</a></li> - -<li class="indx">Children’s Aid Society, the, xxv, <a href='#Page_68'>68</a></li> - -<li class="indx">Chimpanzee, the, <a href='#Page_115'>115</a></li> - -<li class="indx">China, <a href='#Page_82'>82</a></li> - -<li class="indx">Chittenden, Prof. R. H., conducting the experiments at Yale, xvii, <a href='#Page_5'>5</a>;</li> -<li class="isub1">emphasises the want of exact knowledge of nutrition, <a href='#Page_53'>53</a>, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a>;</li> -<li class="isub1">the Yale test, <a href='#Page_69'>69</a>-91.</li> - -<li class="indx">Chop bone, <a href='#Page_166'>166</a></li> - -<li class="indx">Chyme, the, <a href='#Page_346'>346</a>, <a href='#Page_360'>360</a>, <a href='#Page_362'>362</a></li> - -<li class="indx">Circulation, the, stimulated by mastication, <a href='#Page_96'>96</a>, <a href='#Page_103'>103</a>, <a href='#Page_157'>157</a></li> - -<li class="indx">Cocoa-nut, <a href='#Page_137'>137</a></li> - -<li class="indx">Coffee, <a href='#Page_132'>132</a></li> - -<li class="indx">Cole, Sidney W., <a href='#Page_47'>47</a>;</li> -<li class="isub1">his paper upon the isolation of the tryptophane element of the proteid molecule, <a href='#Page_47'>47</a></li> - -<li class="indx">Colon, the, <a href='#Page_363'>363</a>, <a href='#Page_364'>364</a>;</li> -<li class="isub1">antiperistalsis in, <a href='#Page_365'>365</a>-370;</li> -<li class="isub1">changes when food enters, <a href='#Page_370'>370</a>, <a href='#Page_371'>371</a>, <a href='#Page_372'>372</a>;</li> -<li class="isub1">process of clearing, <a href='#Page_373'>373</a>-377, <a href='#Page_381'>381</a>, <a href='#Page_382'>382</a>, <a href='#Page_384'>384</a>, <a href='#Page_387'>387</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">Comminution, <a href='#Page_98'>98</a>, <a href='#Page_100'>100</a>, <a href='#Page_101'>101</a></li> - -<li class="indx"><i>Commonwealth</i>, the S. S., <a href='#Page_69'>69</a></li> - -<li class="indx">Condiments, influence of, <a href='#Page_261'>261</a>, <a href='#Page_265'>265</a></li> - -<li class="indx">Constipation, cannot exist, <a href='#Page_43'>43</a></li> - -<li class="indx">Constriction, waves of, <a href='#Page_323'>323</a>, <a href='#Page_340'>340</a>, <a href='#Page_341'>341</a></li> - -<li class="indx">Cooked flesh, requires mastication, <a href='#Page_97'>97</a>, <a href='#Page_174'>174</a></li> - -<li class="indx">Cooking, influences vegetable more than mineral food, <a href='#Page_118'>118</a>;</li> -<li class="isub1">effect of, <a href='#Page_389'>389</a>, <a href='#Page_391'>391</a>-396</li> - -<li class="indx">Cornaro, Luigi, reformed manner of living of, ix;</li> -<li class="isub1">his autobiography, x, xvi, xvii;</li> -<li class="isub1">Dr. Van Someren’s paper upon his theory of living, <a href='#Page_26'>26</a>-46;</li> -<li class="isub1">his treatise on the “Sure and Certain Method -of Attaining a Long and Healthful Life,” <a href='#Page_28'>28</a>; -<span class="pagenum" id="Page_413">[Pg 413]</span></li> - - -<li class="isub1">Addison’s comments upon his work, <a href='#Page_28'>28</a>, <a href='#Page_92'>92</a></li> - -<li class="indx">Craving for food, <a href='#Page_256'>256</a></li> - -<li class="indx">Cream, experiments with, <a href='#Page_38'>38</a>-39, <a href='#Page_43'>43</a></li> - -<li class="indx">Cuba, xiv, <a href='#Page_70'>70</a></li> - -<li class="indx">Curr, E. M., <a href='#Page_125'>125</a>, <a href='#Page_129'>129</a></li> - - -<li class="ifrst">D</li> - -<li class="indx">Dastre, Dr. Prof. A., <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a></li> - -<li class="indx">Day, experiments of, <a href='#Page_337'>337</a></li> - -<li class="indx">Defecation, <a href='#Page_373'>373</a>-377</li> - -<li class="indx">Deglutition, Magendie’s theory of, <a href='#Page_284'>284</a>, <a href='#Page_285'>285</a>;</li> -<li class="isub1">movements of, <a href='#Page_285'>285</a>;</li> -<li class="isub1">divided into three parts, <a href='#Page_285'>285</a>;</li> -<li class="isub1">Falk’s and Kronecker’s theory of, <a href='#Page_286'>286</a>;</li> -<li class="isub1">the X-ray method in the study of, <a href='#Page_287'>287</a>-295;</li> -<li class="isub1">phenomena of œsophageal, <a href='#Page_298'>298</a>-300</li> - -<li class="indx">—— reflex, the, <a href='#Page_287'>287</a></li> - -<li class="indx">Dental caries, causation of, <a href='#Page_161'>161</a></li> - -<li class="indx">Dewey, Dr. Edward Hooker, and the “No Breakfast Plan,” <a href='#Page_396'>396</a>, <a href='#Page_397'>397</a></li> - -<li class="indx">De Witt, Assistant Surgeon, Lieut. Wallace, in command of soldiers in the Yale investigation, xiii, <a href='#Page_70'>70</a></li> - -<li class="indx">Dextrine, <a href='#Page_170'>170</a>, <a href='#Page_171'>171</a>, <a href='#Page_392'>392</a>, <a href='#Page_393'>393</a>, <a href='#Page_395'>395</a></li> - -<li class="indx">Diaphragm, the, <a href='#Page_324'>324</a>, <a href='#Page_326'>326</a></li> - -<li class="indx">Diet, best manner and system of, xiii;</li> -<li class="isub1">the optimum, xxxi;</li> -<li class="isub1">minimum, <a href='#Page_74'>74</a>;</li> -<li class="isub1">the anthropoid stage, <a href='#Page_116'>116</a>;</li> -<li class="isub1">the pre-cooking human stage, <a href='#Page_117'>117</a>;</li> -<li class="isub1">the pre-agricultural cooking period, <a href='#Page_118'>118</a>;</li> -<li class="isub1">the early agricultural age, <a href='#Page_119'>119</a>;</li> -<li class="isub1">the late agricultural period, <a href='#Page_120'>120</a>;</li> -<li class="isub1">for children, <a href='#Page_130'>130</a>-132;</li> -<li class="isub1">relationship between appendicitis and, <a href='#Page_141'>141</a></li> - -<li class="indx">Dietary Ten Commandments, <a href='#Page_5'>5</a></li> - -<li class="indx">Dietetics, precepts of, <a href='#Page_272'>272</a></li> -<li class="indx">Digestion, appetite the most important factor in, <a href='#Page_6'>6</a>;</li> -<li class="isub1">the true chemical end-point of, <a href='#Page_10'>10</a>-11;</li> -<li class="isub1">effect of the mental state upon, <a href='#Page_74'>74</a>, <a href='#Page_145'>145</a>;</li> -<li class="isub1">psychic influence in, <a href='#Page_180'>180</a>;</li> -<li class="isub1">the phenomena in, <a href='#Page_251'>251</a>;</li> -<li class="isub1">thorough mouth-work as an aid to, <a href='#Page_389'>389</a></li> - -<li class="indx">Digestion-ash, the, what it should be like, <a href='#Page_10'>10</a>-11, <a href='#Page_14'>14</a>;</li> -<li class="isub1">should not be unclean, <a href='#Page_24'>24</a>;</li> -<li class="isub1">in experiments, <a href='#Page_38'>38</a>-39, <a href='#Page_42'>42</a>, <a href='#Page_43'>43</a>, <a href='#Page_47'>47</a>, <a href='#Page_51'>51</a>, <a href='#Page_79'>79</a>, <a href='#Page_83'>83</a>, <a href='#Page_84'>84</a>, <a href='#Page_85'>85</a>, <a href='#Page_94'>94</a></li> - -<li class="indx">Digestive activity, stopped by anger and worry, <a href='#Page_7'>7</a></li> - -<li class="indx">—— canal, the. <i>See</i> Alimentary canal, the</li> - -<li class="indx">—— glands, the, analogy between the innervation mechanism of the salivary glands and, <a href='#Page_188'>188</a>-190;</li> -<li class="isub1">appetite the strongest of all stimuli to, <a href='#Page_263'>263</a>, <a href='#Page_280'>280</a>, <a href='#Page_282'>282</a></li> - -<li class="indx">—— juices, the, <a href='#Page_7'>7</a>;</li> -<li class="isub1">appreciation necessary to stimulate flow of, <a href='#Page_7'>7</a>, <a href='#Page_12'>12</a>, <a href='#Page_96'>96</a>;</li> -<li class="isub1">mastication brings the food into intimate contact with, <a href='#Page_98'>98</a>;</li> -<li class="isub1">quantity of, <a href='#Page_267'>267</a>;</li> -<li class="isub1">relation of milk to the secretion of, <a href='#Page_274'>274</a>, <a href='#Page_383'>383</a>, <a href='#Page_386'>386</a></li> - -<li class="indx">Digitalis, <a href='#Page_281'>281</a></li> - -<li class="indx">Diphtheria, <a href='#Page_149'>149</a></li> - -<li class="indx">Disease, caused by indiscretions in eating, x, xxxi;</li> -<li class="isub1">follows disobedience, <a href='#Page_29'>29</a></li> - -<li class="indx">Disobedience, disease follows, <a href='#Page_29'>29</a></li> - -<li class="indx">Distention, <a href='#Page_144'>144</a></li> - -<li class="indx">Distress, effect of, <a href='#Page_388'>388</a></li> - -<li class="indx">Dog, the experiments upon, <a href='#Page_181'>181</a>, <a href='#Page_194'>194</a>-211, <a href='#Page_212'>212</a>-246, <a href='#Page_249'>249</a>, <a href='#Page_254'>254</a>, <a href='#Page_258'>258</a>, <a href='#Page_263'>263</a>, <a href='#Page_279'>279</a>, <a href='#Page_280'>280</a>, <a href='#Page_285'>285</a>, <a href='#Page_292'>292</a>, <a href='#Page_293'>293</a>, <a href='#Page_297'>297</a>, <a href='#Page_298'>298</a>, <a href='#Page_299'>299</a>, <a href='#Page_303'>303</a>, <a href='#Page_310'>310</a>, <a href='#Page_311'>311</a>, <a href='#Page_313'>313</a>, <a href='#Page_314'>314</a>, <a href='#Page_315'>315</a>, <a href='#Page_336'>336</a>, <a href='#Page_344'>344</a></li> - -<li class="indx">Dolomites, the, <a href='#Page_26'>26</a></li> - -<li class="indx">Drinking, too much, xix, <a href='#Page_95'>95</a></li> - -<li class="indx">Dry food, <a href='#Page_97'>97</a></li> - -<li class="indx">Dunn, Miss Eva, <a href='#Page_122'>122</a> -<span class="pagenum" id="Page_414">[Pg 414]</span></li> - -<li class="indx">Duodenum, the, <a href='#Page_303'>303</a>, <a href='#Page_315'>315</a>, <a href='#Page_356'>356</a>, <a href='#Page_360'>360</a></li> - -<li class="indx">Dyspepsia, dangers of, xv;</li> -<li class="isub1">might cease to exist, <a href='#Page_35'>35</a></li> - - -<li class="ifrst">E</li> - -<li class="indx">Eat, how to, <a href='#Page_19'>19</a></li> - -<li class="indx">Eating, too much, ix;</li> -<li class="isub1">indiscretions of, x, xix, xxix, <a href='#Page_29'>29</a>, <a href='#Page_95'>95</a>, <a href='#Page_135'>135</a>;</li> -<li class="isub1">too fast, <a href='#Page_20'>20</a>;</li> -<li class="isub1">systematic inattention to, <a href='#Page_259'>259</a>, <a href='#Page_260'>260</a>;</li> -<li class="isub1">English have made a cult of, <a href='#Page_261'>261</a></li> - -<li class="indx">Economic nutrition. <i>See</i> Nutrition, economic</li> - -<li class="indx">Efferent nerves, <a href='#Page_184'>184</a>, <a href='#Page_185'>185</a></li> - -<li class="indx">Efficiency, human, the measure of, xxx;</li> -<li class="isub1">research into causes for, <a href='#Page_54'>54</a></li> - -<li class="indx">Eggs, experiments with, <a href='#Page_38'>38</a>, <a href='#Page_43'>43</a>, <a href='#Page_78'>78</a>, <a href='#Page_95'>95</a>, <a href='#Page_100'>100</a>, <a href='#Page_137'>137</a>, <a href='#Page_277'>277</a></li> - -<li class="indx">“Encyclopædia Britannica,” the, <a href='#Page_27'>27</a></li> - -<li class="indx">Enemata, the, <a href='#Page_367'>367</a>, <a href='#Page_379'>379</a>, <a href='#Page_380'>380</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">Energy, the minimum transformation of, <a href='#Page_59'>59</a></li> - -<li class="indx">——, potential, <a href='#Page_59'>59</a></li> - -<li class="indx">Engine, an, the body considered as, <a href='#Page_4'>4</a>, <a href='#Page_23'>23</a></li> - -<li class="indx">English, the, have made a cult of the art of eating, <a href='#Page_261'>261</a></li> - -<li class="indx">Emetic, an, <a href='#Page_325'>325</a></li> - -<li class="indx">Emotion, inhibition of stomach movements during, <a href='#Page_337'>337</a>;</li> -<li class="isub1">effect of, <a href='#Page_383'>383</a>-384, <a href='#Page_388'>388</a></li> - -<li class="indx">Empiricism, medical practice largely based upon, <a href='#Page_52'>52</a></li> - -<li class="indx">Esquimaux, the, <a href='#Page_118'>118</a>, <a href='#Page_123'>123</a>, <a href='#Page_125'>125</a>, <a href='#Page_126'>126</a></li> - -<li class="indx">Esselmont, experiments of, <a href='#Page_383'>383</a></li> - -<li class="indx">Evolution, Nature’s plan of, xi</li> - -<li class="indx">Ewald, experiments of, <a href='#Page_313'>313</a>, <a href='#Page_314'>314</a></li> - -<li class="indx">Excess, habitual, confirmed by experiments, ix</li> - -<li class="indx">Excrements. <i>See</i> Digestion-ash, the</li> - -<li class="indx">Excretia. <i>See</i> Digestion-ash, the</li> - -<li class="indx">Exercise, necessity of, xxix</li> - - -<li class="ifrst">F</li> - -<li class="indx">Fæces, the, <a href='#Page_374'>374</a>. <i>See also</i> Digestion-ash</li> - -<li class="indx">Falk, Dr., <a href='#Page_284'>284</a>;</li> -<li class="isub1">theory of deglutition of, <a href='#Page_286'>286</a></li> - -<li class="indx">Fallopius, on the functions of the stomach, <a href='#Page_302'>302</a></li> - -<li class="indx">Farinaceous food, <a href='#Page_395'>395</a></li> - -<li class="indx">Fasola, experiments of, <a href='#Page_378'>378</a></li> - -<li class="indx">Fat, potatoes need not produce, <a href='#Page_21'>21</a>, <a href='#Page_78'>78</a>, <a href='#Page_79'>79</a>, <a href='#Page_80'>80</a>, <a href='#Page_85'>85</a>, <a href='#Page_86'>86</a>, <a href='#Page_95'>95</a>, <a href='#Page_98'>98</a>, <a href='#Page_100'>100</a>;</li> -<li class="isub1">experiments upon, <a href='#Page_271'>271</a>, <a href='#Page_272'>272</a>, <a href='#Page_274'>274</a></li> - -<li class="indx">Faucial tonsils, the, influence of mastication upon, <a href='#Page_148'>148</a></li> - -<li class="indx">Fear, effect of, <a href='#Page_388'>388</a></li> - -<li class="indx">Fearthought, <a href='#Page_404'>404</a></li> - -<li class="indx">Featherman, <a href='#Page_123'>123</a></li> - -<li class="indx">Fibrin, <a href='#Page_276'>276</a></li> - -<li class="indx">Flesh food, reduction of craving for, <a href='#Page_50'>50</a></li> - -<li class="indx">Fletcher, Horace, Dr. Van Someren’s comments upon the case of, <a href='#Page_30'>30</a>-31;</li> -<li class="isub1">his experiments confirmed by Marckwald, <a href='#Page_46'>46</a>;</li> -<li class="isub1">Sir Michael Foster’s comments, <a href='#Page_48'>48</a>;</li> -<li class="isub1">the Cambridge tests, <a href='#Page_49'>49</a>-52;</li> -<li class="isub1">the Middletown test, <a href='#Page_54'>54</a>-55, <a href='#Page_60'>60</a>;</li> -<li class="isub1">the Yale test, <a href='#Page_75'>75</a>-91</li> - -<li class="indx">Flour, <a href='#Page_132'>132</a>, <a href='#Page_392'>392</a>, <a href='#Page_393'>393</a>, <a href='#Page_395'>395</a></li> - -<li class="indx">Food, mal-assimilation of, x;</li> -<li class="isub1">length of time for chewing, xxxii;</li> -<li class="isub1">Dr. Kellogg’s estimate of amount habitually used, xxxiv;</li> -<li class="isub1">mouth-treatment of, <a href='#Page_5'>5</a>;</li> -<li class="isub1">how to masticate and swallow, <a href='#Page_8'>8</a>, <a href='#Page_9'>9</a>, <a href='#Page_31'>31</a>, <a href='#Page_32'>32</a>;</li> -<li class="isub1">actual process of mastication described, <a href='#Page_32'>32</a>-34;</li> -<li class="isub1">important bearing upon the economy of the body of its treatment in the mouth, <a href='#Page_48'>48</a>-49;</li> -<li class="isub1">its function to supply material from which the body derives necessary energy, <a href='#Page_72'>72</a>;</li> -<li class="isub1">any excess an incubus, <a href='#Page_72'>72</a>-73;</li> -<li class="isub1">classified under three heads, <a href='#Page_78'>78</a>; -<span class="pagenum" id="Page_415">[Pg 415]</span></li> -<li class="isub1">in excess,produces a large amount of unnecessary work, <a href='#Page_80'>80</a>;</li> -<li class="isub1">its nutritive value determined by the thoroughness of its digestion, <a href='#Page_79'>79</a>;</li> -<li class="isub1">softness of, <a href='#Page_129'>129</a>;</li> -<li class="isub1">mastication tends to reduce amount of, <a href='#Page_136'>136</a>;</li> -<li class="isub1">should be eaten with interest and enjoyment, <a href='#Page_252'>252</a>;</li> -<li class="isub1">passionate craving for, <a href='#Page_256'>256</a>;</li> -<li class="isub1">its nutritive value should be considered rather than taste, <a href='#Page_261'>261</a>;</li> -<li class="isub1">the acid reaction of, <a href='#Page_269'>269</a>;</li> -<li class="isub1">relative nutritive values of different, <a href='#Page_275'>275</a>, <a href='#Page_276'>276</a>;</li> -<li class="isub1">experiments upon the utilisation of, <a href='#Page_275'>275</a>;</li> -<li class="isub1">effect of the movements of the stomach upon, <a href='#Page_328'>328</a>;</li> -<li class="isub1">circulation of, <a href='#Page_329'>329</a>;</li> -<li class="isub1">experimental investigation of the influence of mastication and cooking of, <a href='#Page_389'>389</a>-396</li> - -<li class="indx">Foster, Sir Michael, xxiv, xxv, <a href='#Page_26'>26</a>;</li> -<li class="isub1">his note upon Dr. Van Someren’s paper, <a href='#Page_48'>48</a>-52;</li> -<li class="isub1">emphasises the want of exact knowledge of nutrition, <a href='#Page_52'>52</a>, <a href='#Page_53'>53</a>, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a>, <a href='#Page_91'>91</a></li> - -<li class="indx">Fowls, experiments upon, <a href='#Page_299'>299</a></li> - -<li class="indx">Fruitarians, the, <a href='#Page_90'>90</a>, <a href='#Page_397'>397</a></li> - -<li class="indx">Fruit sugar, <a href='#Page_169'>169</a></li> - -<li class="indx">Fruits, <a href='#Page_43'>43</a>;</li> -<li class="isub1">under-ripe and over-ripe, <a href='#Page_141'>141</a>, <a href='#Page_395'>395</a>, <a href='#Page_396'>396</a>;</li> -<li class="isub1">usefulness of, <a href='#Page_397'>397</a></li> - -<li class="indx">Fubini, experiments of, <a href='#Page_383'>383</a></li> - -<li class="indx">Fundus, the, <a href='#Page_317'>317</a>, <a href='#Page_322'>322</a>, <a href='#Page_323'>323</a>, <a href='#Page_324'>324</a>, <a href='#Page_325'>325</a>, <a href='#Page_330'>330</a>, <a href='#Page_333'>333</a>, <a href='#Page_334'>334</a>, <a href='#Page_335'>335</a>, <a href='#Page_336'>336</a>, <a href='#Page_337'>337</a>, <a href='#Page_340'>340</a></li> - - -<li class="ifrst">G</li> - -<li class="indx">Galen, on the functions of the stomach, <a href='#Page_302'>302</a></li> - -<li class="indx">Gastric catarrh, <a href='#Page_249'>249</a></li> - -<li class="indx">—— digestion, <a href='#Page_309'>309</a>, <a href='#Page_316'>316</a></li> - -<li class="indx">—— glands, the, <a href='#Page_182'>182</a>;</li> -<li class="isub1">the vagus and the sympathetic nerves exciters of, <a href='#Page_183'>183</a>, <a href='#Page_198'>198</a>;</li> -<li class="isub1">mechanical and chemical stimulation of the cavity of the mouth has no effect on, <a href='#Page_201'>201</a>;</li> -<li class="indx">psychic excitation of, <a href='#Page_205'>205</a>;</li> -<li class="isub1">sleep exercises no restraining influence upon, <a href='#Page_206'>206</a>;</li> -<li class="isub1">the simultaneous excitation of the different sense organs the first and strongest impulse toward activity of, <a href='#Page_210'>210</a>;</li> -<li class="isub1">psychic secretion the normal commencement of secretory activity on the part of, <a href='#Page_214'>214</a>;</li> -<li class="isub1">conditions upon which depends the secretory work of, <a href='#Page_227'>227</a>;</li> -<li class="isub1">mechanical stimulation of, <a href='#Page_237'>237</a>, <a href='#Page_245'>245</a>, <a href='#Page_249'>249</a>, <a href='#Page_271'>271</a>, <a href='#Page_272'>272</a>, <a href='#Page_274'>274</a>, <a href='#Page_280'>280</a></li> - -<li class="indx">Gastric juice, the, appreciation necessary to stimulate flow of, <a href='#Page_7'>7</a>;</li> -<li class="isub1">destroys micro-organisms, <a href='#Page_41'>41</a>;</li> -<li class="isub1">its flow increased by mastication, <a href='#Page_102'>102</a>, <a href='#Page_146'>146</a>;</li> -<li class="isub1">secretion of, <a href='#Page_181'>181</a>, <a href='#Page_206'>206</a>, <a href='#Page_208'>208</a>, <a href='#Page_211'>211</a>, <a href='#Page_213'>213</a>, <a href='#Page_262'>262</a>;</li> -<li class="isub1">connection between the appetite and, <a href='#Page_265'>265</a>, <a href='#Page_266'>266</a>;</li> -<li class="isub1">experiments for, <a href='#Page_267'>267</a>;</li> -<li class="isub1">too little, <a href='#Page_270'>270</a>, <a href='#Page_272'>272</a>, <a href='#Page_273'>273</a>;</li> -<li class="isub1">salts of sodium promote a flow of, <a href='#Page_277'>277</a>, <a href='#Page_279'>279</a>, <a href='#Page_280'>280</a>, <a href='#Page_329'>329</a>, <a href='#Page_334'>334</a>, <a href='#Page_335'>335</a>, <a href='#Page_337'>337</a>, <a href='#Page_340'>340</a>, <a href='#Page_341'>341</a></li> - -<li class="indx">—— mechanism, the, <a href='#Page_385'>385</a></li> - -<li class="indx">—— movements, the, <a href='#Page_301'>301</a>;</li> -<li class="isub1">early writings on subject of, <a href='#Page_302'>302</a>;</li> -<li class="isub1">later experiments upon, <a href='#Page_303'>303</a>, <a href='#Page_327'>327</a>, <a href='#Page_329'>329</a>, <a href='#Page_338'>338</a></li> - -<li class="indx">—— mucous membrane, the, excitability of, <a href='#Page_181'>181</a>, <a href='#Page_231'>231</a>, <a href='#Page_241'>241</a>, <a href='#Page_249'>249</a>, <a href='#Page_258'>258</a>, <a href='#Page_259'>259</a>, <a href='#Page_264'>264</a></li> - -<li class="indx">—— muscular fibres, the, <a href='#Page_307'>307</a></li> - -<li class="indx">“Gastric tonics,” <a href='#Page_255'>255</a></li> - -<li class="indx">Gastritis, inefficient mastication may produce, <a href='#Page_138'>138</a></li> - -<li class="indx">Gastro-intestinal catarrh, <a href='#Page_144'>144</a></li> - -<li class="indx">Gastronomic enjoyment, increased by proper mastication and insalivation, <a href='#Page_22'>22</a></li> - -<li class="indx">Germany, food in, <a href='#Page_267'>267</a></li> - -<li class="indx">Ginger, preserved, <a href='#Page_141'>141</a></li> - -<li class="indx">Gladstone, William E., his theory of mastication, <a href='#Page_92'>92</a></li> - -<li class="indx">Gland metabolism, <a href='#Page_277'>277</a> -<span class="pagenum" id="Page_416">[Pg 416]</span></li> - -<li class="indx"> -Glinski, Dr., <a href='#Page_190'>190</a>, <a href='#Page_194'>194</a>, <a href='#Page_196'>196</a>, <a href='#Page_197'>197</a></li> - -<li class="indx">Gluten, raw, <a href='#Page_395'>395</a></li> - -<li class="indx">“Glutton or Epicure,” <a href='#Page_26'>26</a>, <a href='#Page_31'>31</a>, <a href='#Page_92'>92</a>, <a href='#Page_389'>389</a>, <a href='#Page_396'>396</a>.</li> -<li class="isub1"><i>See also</i> “New Glutton or Epicure, The”</li> - -<li class="indx">Goose, the, experiments upon, <a href='#Page_288'>288</a></li> - -<li class="indx">Goose-fat, <a href='#Page_100'>100</a></li> - -<li class="indx">Gorilla, the, <a href='#Page_115'>115</a></li> - -<li class="indx">Gran Chaco Indians, the, <a href='#Page_123'>123</a></li> - -<li class="indx">Grape-sugar, chemically made from cane-sugar, <a href='#Page_21'>21</a>, <a href='#Page_169'>169</a></li> - -<li class="indx">Greens, <a href='#Page_132'>132</a></li> - -<li class="indx">Grey, Sir George, <a href='#Page_128'>128</a></li> - -<li class="indx">Griddle-cakes, need not be hurtful, <a href='#Page_21'>21</a></li> - -<li class="indx">Griffin, Charles & Company, <a href='#Page_180'>180</a>, <a href='#Page_181'>181</a></li> - -<li class="indx">Grützner, experiments of, <a href='#Page_278'>278</a>, <a href='#Page_346'>346</a>, <a href='#Page_363'>363</a>, <a href='#Page_377'>377</a>, <a href='#Page_378'>378</a>, <a href='#Page_381'>381</a></li> - -<li class="indx">Gscheidlen, <a href='#Page_235'>235</a></li> - -<li class="indx">Guinea-pigs, experiments upon, <a href='#Page_39'>39</a></li> - -<li class="indx">Gum arabic, chewing, <a href='#Page_103'>103</a></li> - -<li class="indx">Gustatory indifference, <a href='#Page_263'>263</a></li> - -<li class="indx">—— nerves, the, <a href='#Page_263'>263</a>, <a href='#Page_269'>269</a></li> - -<li class="indx">Gut, the, <a href='#Page_344'>344</a>, <a href='#Page_345'>345</a>, <a href='#Page_355'>355</a>, <a href='#Page_360'>360</a>, <a href='#Page_364'>364</a>, <a href='#Page_365'>365</a>, <a href='#Page_374'>374</a></li> - - -<li class="ifrst">H</li> - -<li class="indx">Hæmorrhoids, cannot exist, <a href='#Page_43'>43</a></li> - -<li class="indx">Haller, experiments of, <a href='#Page_304'>304</a>;</li> -<li class="isub1">his summary of the motor functions of the stomach, <a href='#Page_304'>304</a>-305, <a href='#Page_309'>309</a></li> - -<li class="indx">Harvard Medical School, <a href='#Page_68'>68</a></li> - -<li class="indx">—— Physiological Laboratory, the, <a href='#Page_284'>284</a></li> - -<li class="indx">Haste, danger of, <a href='#Page_134'>134</a>-135</li> - -<li class="indx">Headache, produced by inefficient mastication, <a href='#Page_138'>138</a></li> - -<li class="indx">Health, the optimum, xxxi</li> - -<li class="indx">Hearing, the sense of, <a href='#Page_210'>210</a></li> - -<li class="indx">Heart, the, stimulated by mastication, <a href='#Page_96'>96</a>, <a href='#Page_103'>103</a>, <a href='#Page_281'>281</a></li> - -<li class="indx">Heartburn, <a href='#Page_144'>144</a></li> - -<li class="indx">Heat values, <a href='#Page_397'>397</a></li> - -<li class="indx">Heger, Dr. Prof. Paul, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a></li> - -<li class="indx">Heidenhain, <a href='#Page_181'>181</a>, <a href='#Page_182'>182</a>, <a href='#Page_183'>183</a>, <a href='#Page_235'>235</a></li> - -<li class="indx">Herbivora, the, practice thorough mastication, <a href='#Page_97'>97</a></li> - -<li class="indx">Higgins, Dr. Hubert, letter from, xxvii-xxxiii, <a href='#Page_47'>47</a></li> - -<li class="indx">Hirsch, experiments of, <a href='#Page_305'>305</a>, <a href='#Page_315'>315</a></li> - -<li class="indx">Hofmeister, experiments of, <a href='#Page_305'>305</a>, <a href='#Page_308'>308</a>, <a href='#Page_309'>309</a>, <a href='#Page_310'>310</a>, <a href='#Page_311'>311</a>, <a href='#Page_313'>313</a>, <a href='#Page_314'>314</a>, <a href='#Page_326'>326</a>, <a href='#Page_327'>327</a>, <a href='#Page_332'>332</a></li> - -<li class="indx">Hopkins, Dr. F. Gowland, <a href='#Page_26'>26</a>;</li> -<li class="isub1">his paper upon the isolation of the tryptophane element of the proteid molecule, <a href='#Page_47'>47</a></li> - -<li class="indx"><i>Hors d’œuvre</i>, <a href='#Page_266'>266</a></li> - -<li class="indx">Horse, the, experiments upon, <a href='#Page_293'>293</a>, <a href='#Page_294'>294</a>, <a href='#Page_300'>300</a></li> - -<li class="indx">Hospital Corps, the, at New Haven, xiii, <a href='#Page_70'>70</a></li> - -<li class="indx">Hunger, <a href='#Page_241'>241</a>;</li> -<li class="isub1">“the best sauce,” <a href='#Page_254'>254</a></li> - -<li class="indx">Hyperacidity, <a href='#Page_145'>145</a></li> - -<li class="indx">Hyperæmia, <a href='#Page_345'>345</a></li> - -<li class="indx">Hyperchlorhydria, <a href='#Page_144'>144</a>, <a href='#Page_147'>147</a></li> - - -<li class="ifrst">I</li> - -<li class="indx">“Igniting juice,” <a href='#Page_260'>260</a></li> - -<li class="indx">Ignorance, dietic, sin of, xvii</li> - -<li class="indx">Ileocæcal valve, the, <a href='#Page_355'>355</a>, <a href='#Page_362'>362</a>;</li> -<li class="isub1">the competence of, <a href='#Page_362'>362</a>-364, <a href='#Page_367'>367</a>, <a href='#Page_370'>370</a>, <a href='#Page_376'>376</a>, <a href='#Page_381'>381</a>, <a href='#Page_387'>387</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">Ileum, the, <a href='#Page_363'>363</a>, <a href='#Page_364'>364</a>, <a href='#Page_367'>367</a>, <a href='#Page_370'>370</a>, <a href='#Page_382'>382</a>, <a href='#Page_387'>387</a></li> - -<li class="indx">India, <a href='#Page_82'>82</a>, <a href='#Page_128'>128</a></li> - -<li class="indx">Indians of Honduras, the, <a href='#Page_124'>124</a></li> - -<li class="indx">—— of Nicaragua, the, <a href='#Page_124'>124</a></li> - -<li class="indx">—— of North California, the, <a href='#Page_122'>122</a>, <a href='#Page_126'>126</a></li> - -<li class="indx">Indigestion, x;</li> -<li class="isub1">dangers of, xv;</li> -<li class="isub1">caused by anger and worry, <a href='#Page_7'>7</a>;</li> -<li class="isub1">“bunching hits” to oppose, <a href='#Page_13'>13</a>-16</li> - -<li class="indx">Indol, the odourous, <a href='#Page_47'>47</a></li> - -<li class="indx">Industries, the, mastication in, <a href='#Page_124'>124</a></li> - -<li class="indx">Infant life, action of saliva in, <a href='#Page_36'>36</a></li> - -<li class="indx">Innervation mechanism, an, constituent parts of, <a href='#Page_184'>184</a> -<span class="pagenum" id="Page_417">[Pg 417]</span></li> - -<li class="indx">Insalivation, defined, <a href='#Page_8'>8</a>, <a href='#Page_22'>22</a>;</li> -<li class="isub1">increases gastronomic enjoyment, <a href='#Page_22'>22</a>, <a href='#Page_46'>46</a>, <a href='#Page_48'>48</a>;</li> -<li class="isub1">its striking effect upon appetite, <a href='#Page_50'>50</a>, <a href='#Page_60'>60</a>;</li> -<li class="isub1">effects of, <a href='#Page_74'>74</a>, <a href='#Page_89'>89</a>, <a href='#Page_92'>92</a>, <a href='#Page_93'>93</a>, <a href='#Page_96'>96</a>;</li> -<li class="isub1">mastication promotes, <a href='#Page_101'>101</a></li> - -<li class="indx">Insane, the, forced feeding of, <a href='#Page_268'>268</a></li> - -<li class="indx">Instinct, human, the outcome of every-day experience, <a href='#Page_251'>251</a>;</li> -<li class="isub1">physiology merely confirms the precepts of, <a href='#Page_251'>251</a>;</li> -<li class="isub1">provisions for digestion made by, <a href='#Page_267'>267</a>;</li> -<li class="isub1">demands of, <a href='#Page_272'>272</a></li> - -<li class="indx">Intemperance, <a href='#Page_95'>95</a></li> - -<li class="indx">International Congress of Physiologists, the, <a href='#Page_26'>26</a>, <a href='#Page_48'>48</a>, <a href='#Page_56'>56</a>, <a href='#Page_68'>68</a>, <a href='#Page_91'>91</a></li> - -<li class="indx">—— Laboratory of Research, the, proposal to found, <a href='#Page_55'>55</a>-69;</li> -<li class="isub1">suggestions as to staff and personnel, <a href='#Page_62'>62</a>;</li> -<li class="isub1">estimate of initial outlay, <a href='#Page_63'>63</a>;</li> -<li class="isub1">suggestions as to location, <a href='#Page_63'>63</a>;</li> -<li class="isub1">suggestions as to management, <a href='#Page_66'>66</a></li> - -<li class="indx">Intestinal anæmia, <a href='#Page_345'>345</a></li> - -<li class="indx">—— canal, the, <a href='#Page_39'>39</a>, <a href='#Page_346'>346</a></li> - -<li class="indx">—— contents, the, rhythmic segmentation of, <a href='#Page_347'>347</a>-355, <a href='#Page_386'>386</a></li> - -<li class="indx">—— digestive juices, the, <a href='#Page_361'>361</a></li> - -<li class="indx">—— mechanism, the, <a href='#Page_385'>385</a></li> - -<li class="indx">—— movements, difficulties of investigating, <a href='#Page_342'>342</a>;</li> -<li class="isub1">the best known of, <a href='#Page_343'>343</a></li> - -<li class="indx">—— secretion, <a href='#Page_61'>61</a></li> - -<li class="indx">—— wall, the, <a href='#Page_344'>344</a>, <a href='#Page_381'>381</a>, <a href='#Page_386'>386</a></li> - -<li class="indx">Intestine, the large, activity of, <a href='#Page_343'>343</a>;</li> -<li class="isub1">movements of, <a href='#Page_364'>364</a>-377, <a href='#Page_379'>379</a>, <a href='#Page_386'>386</a>, <a href='#Page_387'>387</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">——, the small, <a href='#Page_343'>343</a>, <a href='#Page_346'>346</a>;</li> -<li class="isub1">the movements of, <a href='#Page_347'>347</a>-362, <a href='#Page_366'>366</a>;</li> -<li class="isub1">course of food in, <a href='#Page_360'>360</a>-362, <a href='#Page_365'>365</a>, <a href='#Page_367'>367</a>, <a href='#Page_369'>369</a>, <a href='#Page_378'>378</a>, <a href='#Page_381'>381</a>, <a href='#Page_383'>383</a>, <a href='#Page_385'>385</a>, <a href='#Page_386'>386</a>, <a href='#Page_387'>387</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">——, the, action of the bacteria in, <a href='#Page_39'>39</a>;</li> -<li class="isub1">micro-organic action in, <a href='#Page_40'>40</a>, <a href='#Page_80'>80</a>, <a href='#Page_92'>92</a>;</li> -<li class="isub1">much more sensitive than the stomach, <a href='#Page_139'>139</a>, <a href='#Page_301'>301</a>, <a href='#Page_317'>317</a>, <a href='#Page_328'>328</a>, <a href='#Page_337'>337</a>, <a href='#Page_341'>341</a>;</li> -<li class="isub1">studied by means of the Röntgen rays, <a href='#Page_342'>342</a>-388, <a href='#Page_395'>395</a></li> - - -<li class="indx">J</li> - -<li class="indx">Jaffa, Professor, <a href='#Page_90'>90</a>;</li> -<li class="isub1">and the fruitarians, <a href='#Page_397'>397</a></li> -<li class="indx">Japan, <a href='#Page_82'>82</a></li> - -<li class="indx">Jaws, the, mastication stimulates the nutrition of, <a href='#Page_96'>96</a>, <a href='#Page_103'>103</a>, <a href='#Page_155'>155</a>;</li> -<li class="isub1">influence of mastication upon, <a href='#Page_109'>109</a>, <a href='#Page_148'>148</a>;</li> -<li class="isub1">changes during man’s evolution in, <a href='#Page_115'>115</a>-121;</li> -<li class="isub1">instances of vigorous use, <a href='#Page_122'>122</a></li> - -<li class="indx">Johns Hopkins University, <a href='#Page_68'>68</a></li> - -<li class="indx">“Journal of Physiology, The” (American), <a href='#Page_284'>284</a>, <a href='#Page_301'>301</a>, <a href='#Page_342'>342</a></li> - -<li class="indx">—— (English), <a href='#Page_47'>47</a></li> - - -<li class="ifrst">K</li> - -<li class="indx">Kais Root, <a href='#Page_123'>123</a></li> - -<li class="indx">Kane, Dr., <a href='#Page_125'>125</a></li> - -<li class="indx">Kara, <a href='#Page_124'>124</a></li> - -<li class="indx">Katabolic action, <a href='#Page_41'>41</a></li> - -<li class="indx">Katabolism, <a href='#Page_95'>95</a></li> - -<li class="indx">Kellogg, Dr. J. H., xxvii;</li> -<li class="isub1">letter from, xxxiii-xxxv;</li> -<li class="isub1">his estimate of amount of food habitually used, xxxiv;</li> -<li class="isub1">tribute to, <a href='#Page_391'>391</a>;</li> -<li class="isub1">his experimental investigation of the influence of mastication and cooking of food, <a href='#Page_391'>391</a>-396</li> - -<li class="indx">—— Mrs. J. H., <a href='#Page_389'>389</a>;</li> -<li class="isub1">tribute to, <a href='#Page_391'>391</a></li> - -<li class="indx">Kelp, <a href='#Page_122'>122</a></li> - -<li class="indx">Kotljar, experiment by, <a href='#Page_217'>217</a></li> - -<li class="indx">Kreuznach, <a href='#Page_46'>46</a></li> - -<li class="indx">Kronecker, Dr. Prof. Hugo, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a>, <a href='#Page_284'>284</a>, <a href='#Page_285'>285</a>;</li> -<li class="isub1">theory of deglutition of, <a href='#Page_286'>286</a></li> - -<li class="indx">Kumagawa, experiments of, <a href='#Page_81'>81</a></li> - -<li class="indx"><i>Kwas</i>, <a href='#Page_267'>267</a>, <a href='#Page_269'>269</a>, <a href='#Page_270'>270</a></li> - - -<li class="ifrst">L</li> - -<li class="indx">Lactic acid, prepared in the stomach, <a href='#Page_269'>269</a>, <a href='#Page_393'>393</a>, <a href='#Page_394'>394</a> -<span class="pagenum" id="Page_418">[Pg 418]</span></li> - -<li class="indx">“Lancet, The,” <a href='#Page_8'>8</a>, <a href='#Page_26'>26</a>, <a href='#Page_31'>31</a>;</li> -<li class="isub1">Dr. Campbell’s articles from, <a href='#Page_92'>92</a>-179, <a href='#Page_145'>145</a></li> - -<li class="indx">Lard, <a href='#Page_272'>272</a></li> - -<li class="indx">Laws of Nature, health, strength, and moral tone dependent upon proper fulfilment of, <a href='#Page_73'>73</a></li> - -<li class="indx">Leonardi, Dr. Professor, <a href='#Page_26'>26</a></li> - -<li class="indx">Life, right conduct of, xiii;</li> -<li class="isub1">the essentials and sequence in, <a href='#Page_399'>399</a></li> - -<li class="indx">Lippincott, J. B. & Company, <a href='#Page_180'>180</a>, <a href='#Page_181'>181</a></li> - -<li class="indx">Liqueurs, <a href='#Page_266'>266</a></li> - -<li class="indx">Liquids, how to treat, <a href='#Page_9'>9</a>, <a href='#Page_34'>34</a>, <a href='#Page_93'>93</a>, <a href='#Page_94'>94</a>, <a href='#Page_95'>95</a></li> - -<li class="indx">Lobassoff, Dr., experiments by, <a href='#Page_217'>217</a>, <a href='#Page_218'>218</a>, <a href='#Page_220'>220</a>, <a href='#Page_222'>222</a>, <a href='#Page_226'>226</a></li> - -<li class="indx">Lobster, <a href='#Page_137'>137</a>, <a href='#Page_141'>141</a></li> - -<li class="indx">London, <a href='#Page_65'>65</a></li> - -<li class="indx">Lower Californians, the, <a href='#Page_123'>123</a></li> - -<li class="indx">Ludwig, experiments of, <a href='#Page_342'>342</a></li> - -<li class="indx">Lumen, the, <a href='#Page_374'>374</a></li> - -<li class="indx">Lymph, influence of the contraction of the masticatory muscles on local circulation of, <a href='#Page_107'>107</a>, <a href='#Page_148'>148</a>, <a href='#Page_149'>149</a>, <a href='#Page_355'>355</a></li> - - -<li class="ifrst">M</li> - -<li class="indx">Macaroni, <a href='#Page_132'>132</a></li> - -<li class="indx">—— cheese, <a href='#Page_100'>100</a></li> - -<li class="indx">Mackerel, <a href='#Page_141'>141</a></li> - -<li class="indx">Madrid, <a href='#Page_69'>69</a></li> - -<li class="indx">Magendie, theory of deglutition of, <a href='#Page_284'>284</a></li> - -<li class="indx">Maize, chewed, <a href='#Page_124'>124</a></li> - -<li class="indx">Mal-assimilation, of nutriment, x, xxi;</li> -<li class="isub1">“bunching bits” to oppose, <a href='#Page_13'>13</a>-16;</li> -<li class="isub1">dangers of, <a href='#Page_24'>24</a>, <a href='#Page_35'>35</a></li> - -<li class="indx">Malay, <a href='#Page_128'>128</a></li> - -<li class="indx">Mall, experiments of, <a href='#Page_343'>343</a>, <a href='#Page_345'>345</a>, <a href='#Page_354'>354</a>, <a href='#Page_378'>378</a></li> - -<li class="indx">Mal-nutrition, causes of, xxi, <a href='#Page_35'>35</a></li> - -<li class="indx">“Malt extracts,” <a href='#Page_102'>102</a></li> - -<li class="indx">Maltose, starch turned into, <a href='#Page_101'>101</a>, <a href='#Page_170'>170</a>, <a href='#Page_392'>392</a>, <a href='#Page_393'>393</a></li> -<li class="indx">Man, the First Assistant of Nature, xi;</li> -<li class="isub1">his disparity due to ignorance, xii;</li> -<li class="isub1">absurdity of his ignorance, <a href='#Page_4'>4</a>, <a href='#Page_23'>23</a>;</li> -<li class="isub1">experiments upon, <a href='#Page_300'>300</a>;</li> -<li class="isub1">by nature a frugivorous animal, <a href='#Page_395'>395</a></li> - -<li class="indx">Maple sugar, <a href='#Page_84'>84</a></li> - -<li class="indx">Marckwald, Max, paper “On Digestion of Milk in the Stomach of Full-grown Dogs,” <a href='#Page_46'>46</a></li> - -<li class="indx">Masticate, how to, <a href='#Page_19'>19</a></li> - -<li class="indx">Mastication, inefficient, causation of, <a href='#Page_129'>129</a>;</li> -<li class="isub1">must lead to many evils, <a href='#Page_129'>129</a>;</li> -<li class="isub1">evils resulting from, <a href='#Page_135'>135</a>;</li> -<li class="isub1">conduces to excessive eating, <a href='#Page_135'>135</a>;</li> -<li class="isub1">may cause suffocation, <a href='#Page_137'>137</a>;</li> -<li class="isub1">may produce gastritis, <a href='#Page_138'>138</a>;</li> -<li class="isub1">excess of starch may pass into stomach because of, <a href='#Page_141'>141</a>;</li> -<li class="isub1">prevents a sufficient amount of alkali to pass into the stomach, <a href='#Page_146'>146</a>;</li> -<li class="isub1">causes evils with the jaws and their appendages and the adjacent structures, <a href='#Page_148'>148</a>;</li> -<li class="isub1">responsible for adenoids, <a href='#Page_148'>148</a>-152;</li> -<li class="isub1">a potent cause of Rigg’s disease, <a href='#Page_159'>159</a>;</li> -<li class="isub1">secondary evils of, <a href='#Page_164'>164</a>, <a href='#Page_394'>394</a></li> - -<li class="indx">——, proper, increases gastronomic enjoyment, <a href='#Page_22'>22</a>, <a href='#Page_46'>46</a>, <a href='#Page_48'>48</a>, <a href='#Page_60'>60</a>;</li> -<li class="isub1">effects of, <a href='#Page_74'>74</a>, <a href='#Page_89'>89</a>;</li> -<li class="isub1">Dr. Campbell’s observations upon, <a href='#Page_96'>96</a>-173;</li> -<li class="isub1">the effects of, <a href='#Page_96'>96</a>;</li> -<li class="isub1">primary object of, <a href='#Page_96'>96</a>;</li> -<li class="isub1">promotes flow of saliva, <a href='#Page_96'>96</a>, <a href='#Page_101'>101</a>;</li> -<li class="isub1">stimulates the heart and circulation, <a href='#Page_96'>96</a>, <a href='#Page_103'>103</a>;</li> -<li class="isub1">influences the nutrition of the jaws, <a href='#Page_96'>96</a>, <a href='#Page_103'>103</a>;</li> -<li class="isub1">facilitates swallowing, <a href='#Page_97'>97</a>;</li> -<li class="isub1">brings the food into intimate contact with the digestive juices, <a href='#Page_98'>98</a>;</li> -<li class="isub1">increases amount of alkaline saliva passing into the stomach, <a href='#Page_96'>96</a>, <a href='#Page_102'>102</a>;</li> -<li class="isub1">acts reflexly upon the stomach, <a href='#Page_102'>102</a>;</li> -<li class="isub1">the muscles of, <a href='#Page_104'>104</a>;</li> -<li class="isub1">its influence upon the jaw-bones, <a href='#Page_109'>109</a>;</li> -<li class="isub1">its influence upon the teeth, <a href='#Page_110'>110</a>; -<span class="pagenum" id="Page_419">[Pg 419]</span></li> -<li class="isub1">in the preparation of beverages, <a href='#Page_123'>123</a>;</li> -<li class="isub1">in the industries, <a href='#Page_124'>124</a>;</li> -<li class="isub1">the instinct of, <a href='#Page_126'>126</a>;</li> -<li class="isub1">the causation of inefficient, <a href='#Page_129'>129</a>;</li> -<li class="isub1">less opportunity than formerly for, <a href='#Page_130'>130</a>-133;</li> -<li class="isub1">defective apparatus for, <a href='#Page_133'>133</a>;</li> -<li class="isub1">affected by individual differences, <a href='#Page_134'>134</a>;</li> -<li class="isub1">tends to diminish amount of food consumed, <a href='#Page_136'>136</a>;</li> -<li class="isub1">most effective way to secure starch digestion, <a href='#Page_145'>145</a>;</li> -<li class="isub1">effect upon the nasal passages, naso-pharynx, and faucial tonsils, <a href='#Page_148'>148</a>;</li> -<li class="isub1">fast becoming a lost art, <a href='#Page_157'>157</a>;</li> -<li class="isub1">means of insuring adequate, <a href='#Page_164'>164</a>, <a href='#Page_389'>389</a>;</li> -<li class="isub1">experimental investigation of the influence of, <a href='#Page_391'>391</a></li> - -<li class="indx">Masticatory instinct, the, <a href='#Page_126'>126</a>-129</li> - -<li class="indx">—— muscles, the, <a href='#Page_104'>104</a>;</li> -<li class="isub1">influence of their contraction on local circulation of blood and lymph, <a href='#Page_107'>107</a>, <a href='#Page_148'>148</a></li> - -<li class="indx">Matri, <a href='#Page_128'>128</a></li> - -<li class="indx">Meadville, Penn., <a href='#Page_396'>396</a></li> - -<li class="indx">Measles, <a href='#Page_149'>149</a></li> - -<li class="indx">Meat, <a href='#Page_78'>78</a></li> - -<li class="indx">—— broth, <a href='#Page_266'>266</a>;</li> -<li class="isub1">an important chemical excitant of gastric secretion, <a href='#Page_266'>266</a>, <a href='#Page_267'>267</a></li> - -<li class="indx">—— extract, <a href='#Page_268'>268</a></li> - -<li class="indx">—— juice, <a href='#Page_268'>268</a></li> - -<li class="indx">Mechanical stimulus, great importance assigned to, <a href='#Page_257'>257</a></li> - -<li class="indx">Medical practice, largely based upon empiricism, <a href='#Page_52'>52</a></li> - -<li class="indx">—— science, not possessed of final information concerning questions of nutrition, <a href='#Page_52'>52</a></li> - -<li class="indx">Medicine, ideal only when it can take its proper position, <a href='#Page_249'>249</a>;</li> -<li class="isub1">physiology can make no pretence to guide the field of, <a href='#Page_251'>251</a>;</li> -<li class="isub1">to what it will at length grow, <a href='#Page_251'>251</a>;</li> -<li class="isub1">treats too lightly the loss of appetite, <a href='#Page_256'>256</a></li> - -<li class="indx">Melanesia, <a href='#Page_128'>128</a></li> - -<li class="indx">Melanesians, the, <a href='#Page_120'>120</a></li> - -<li class="indx">Meltzer, Dr., <a href='#Page_284'>284</a>;</li> -<li class="isub1">experiments of, <a href='#Page_294'>294</a>, <a href='#Page_296'>296</a>, <a href='#Page_297'>297</a>, <a href='#Page_298'>298</a></li> - -<li class="indx">Mendel, Dr. Lafayette B., <a href='#Page_69'>69</a></li> - -<li class="indx">Mendel Pass, <i>bei</i> Bozen, Süd Tirol, Austria, experiments at, <a href='#Page_26'>26</a></li> - -<li class="indx">Mental energy, <a href='#Page_41'>41</a></li> - -<li class="indx">—— state, <a href='#Page_12'>12</a>;</li> -<li class="isub1">its effect upon digestion and nutrition, <a href='#Page_74'>74</a></li> - -<li class="indx">Menticulture, physical and mental equipments necessary to promote, <a href='#Page_7'>7</a></li> - -<li class="indx">“Menticulture,” xxi, xxiv</li> - -<li class="indx">Metabolism, <a href='#Page_37'>37</a>;</li> -<li class="isub1">determination of, <a href='#Page_40'>40</a>;</li> -<li class="isub1">calorimetric trial-balance measurement of, <a href='#Page_54'>54</a></li> - -<li class="indx">Micro-organisms, <a href='#Page_40'>40</a>;</li> -<li class="isub1">destroyed by acid gastric juices, <a href='#Page_41'>41</a></li> - -<li class="indx">Middletown, Conn., experiments at, <a href='#Page_54'>54</a></li> - -<li class="indx">Milk, how to drink, <a href='#Page_9'>9</a>;</li> -<li class="isub1">experiments in drinking, <a href='#Page_36'>36</a>, <a href='#Page_38'>38</a>-39, <a href='#Page_78'>78</a>, <a href='#Page_84'>84</a>, <a href='#Page_93'>93</a>, <a href='#Page_94'>94</a>, <a href='#Page_268'>268</a>;</li> -<li class="isub1">takes a special position among foods, <a href='#Page_272'>272</a>;</li> -<li class="isub1">the three properties of, <a href='#Page_273'>273</a>;</li> -<li class="isub1">its relation to the secretion of the digestive juices, <a href='#Page_274'>274</a>, <a href='#Page_275'>275</a>, <a href='#Page_276'>276</a>, <a href='#Page_277'>277</a></li> - -<li class="indx">—— pudding, <a href='#Page_97'>97</a>, <a href='#Page_143'>143</a>, <a href='#Page_172'>172</a></li> - -<li class="indx">“Modern Medicine,” <a href='#Page_389'>389</a>, <a href='#Page_391'>391</a></li> - -<li class="indx">Modoc Indians, the, <a href='#Page_123'>123</a></li> - -<li class="indx">Moist foods, <a href='#Page_97'>97</a></li> - -<li class="indx">Moritz, experiments of, <a href='#Page_324'>324</a>, <a href='#Page_328'>328</a>, <a href='#Page_332'>332</a></li> - -<li class="indx">Mosso, Dr. Prof. Angelo, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a>, <a href='#Page_284'>284</a>, <a href='#Page_285'>285</a></li> - -<li class="indx">Mouth, the, should do all it can, <a href='#Page_93'>93</a>, <a href='#Page_180'>180</a>;</li> -<li class="isub1">examination of, <a href='#Page_174'>174</a>-179;</li> -<li class="isub1">rinsing, <a href='#Page_179'>179</a>;</li> -<li class="isub1">mechanical and chemical stimulation of the cavity of, <a href='#Page_201'>201</a>, <a href='#Page_285'>285</a>, <a href='#Page_286'>286</a></li> - -<li class="indx">—— breathing, evils of, <a href='#Page_151'>151</a>-153</li> - -<li class="indx">—— discrimination, <a href='#Page_94'>94</a></li> - -<li class="indx">—— thoroughness, <a href='#Page_8'>8</a></li> - -<li class="indx">—— treatment, of food, <a href='#Page_5'>5</a>, <a href='#Page_12'>12</a>, <a href='#Page_92'>92</a>;</li> -<li class="isub1">a preliminary necessity of easy digestion, <a href='#Page_180'>180</a>, <a href='#Page_389'>389</a> -<span class="pagenum" id="Page_420">[Pg 420]</span></li> - -<li class="indx">Mucosa, the, <a href='#Page_343'>343</a>, <a href='#Page_355'>355</a></li> - -<li class="indx">Mucous membrane, the, <a href='#Page_346'>346</a></li> - -<li class="indx">Munich, <a href='#Page_56'>56</a>, <a href='#Page_76'>76</a>, <a href='#Page_81'>81</a></li> - -<li class="indx">Muster, <a href='#Page_128'>128</a></li> - -<li class="indx">Mutton, <a href='#Page_100'>100</a></li> - - -<li class="ifrst">N</li> - -<li class="indx">Nansen, J. F., <a href='#Page_123'>123</a></li> -<li class="indx"><a id="FNanchor_36" href="#Footnote_36" class="fnanchor">[36]</a></li> -<li class="indx">Napoleon, died from fast eating, <a href='#Page_138'>138</a></li> - -<li class="indx">Nasal passages, the, effect of mastication upon, <a href='#Page_148'>148</a></li> - -<li class="indx">Naso-pharyngitis, <a href='#Page_144'>144</a>, <a href='#Page_148'>148</a>, <a href='#Page_149'>149</a></li> - -<li class="indx">Naso-pharynx, the, influence of mastication upon, <a href='#Page_148'>148</a></li> - -<li class="indx">National Academy of Sciences, the, contribute to fund for research, <a href='#Page_69'>69</a></li> - -<li class="indx">Natural Automatic Processes, <a href='#Page_3'>3</a>, <a href='#Page_180'>180</a></li> - -<li class="indx">Nature, plan of evolution of, xi;</li> -<li class="isub1">Man the First Assistant of, xi;</li> -<li class="isub1">her reward for conformity with her requirements, xii;</li> -<li class="isub1">her generous assumption of forty-seven forty-eighths of labour, <a href='#Page_5'>5</a>, <a href='#Page_12'>12</a>;</li> -<li class="isub1">given an opportunity by economic nutrition, <a href='#Page_22'>22</a>;</li> -<li class="isub1">her plans perfect if her laws are obeyed, <a href='#Page_29'>29</a>;</li> -<li class="isub1">never intended a special diet or bottle of medicine, <a href='#Page_30'>30</a>;</li> -<li class="isub1">endeavours to prepare lactic acid in the stomach, <a href='#Page_269'>269</a></li> - -<li class="indx">Negritos, the, <a href='#Page_118'>118</a></li> - -<li class="indx">Negroes, the African, <a href='#Page_120'>120</a></li> - -<li class="indx">Nerve cells, the, specific qualities of, <a href='#Page_187'>187</a></li> - -<li class="indx">—— fibres, <a href='#Page_184'>184</a></li> - -<li class="indx">Nervous system, the, influence upon the glands of, <a href='#Page_183'>183</a></li> - -<li class="indx">Neutralisation, <a href='#Page_92'>92</a></li> - -<li class="indx">“New Glutton or Epicure,” the, xxviii, <a href='#Page_47'>47</a>.</li> -<li class="isub1"><i>See</i> also “Glutton or Epicure”</li> - -<li class="indx">New Guinea, <a href='#Page_124'>124</a></li> - -<li class="indx">New Haven (Conn.), scientific experiments at, xiii, <a href='#Page_54'>54</a>, <a href='#Page_71'>71</a>.</li> -<li class="isub1"><i>See</i> Yale investigation, the, and Yale test, the</li> - -<li class="indx">Nitrogen, <a href='#Page_85'>85</a>, <a href='#Page_86'>86</a></li> - -<li class="indx">Nitrogenous equilibrium, <a href='#Page_86'>86</a></li> - -<li class="indx">—— measurements, tests of, <a href='#Page_26'>26</a></li> - -<li class="indx">“No Breakfast Plan,” the, <a href='#Page_396'>396</a></li> - -<li class="indx">Nothnagel, experiments of, <a href='#Page_343'>343</a>, <a href='#Page_345'>345</a></li> - -<li class="indx">Northwest London Hospital, the, <a href='#Page_8'>8</a>, <a href='#Page_92'>92</a></li> - -<li class="indx">Nutarians, <a href='#Page_90'>90</a></li> - -<li class="indx">Nutrient enemata, <a href='#Page_367'>367</a>, <a href='#Page_379'>379</a>, <a href='#Page_380'>380</a>, <a href='#Page_382'>382</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">—— fluid, <a href='#Page_381'>381</a></li> - -<li class="indx">Nutriment, selection of, <a href='#Page_7'>7</a></li> - -<li class="indx">Nutrition, economic, experiments upon problem of, ix, x, <a href='#Page_48'>48</a>-52;</li> -<li class="isub1">active interest now taken in, x;</li> -<li class="isub1">the financial saving the least of the profits in, xi;</li> -<li class="isub1">the key to England’s welfare, xxv;</li> -<li class="isub1">attitude of the scientific mind towards, xxvii;</li> -<li class="isub1">little accurate knowledge concerning, xxx;</li> -<li class="isub1">psychology of, <a href='#Page_6'>6</a>-7;</li> -<li class="isub1">appetite the most important factor in, <a href='#Page_6'>6</a>;</li> -<li class="isub1">mechanical and chemical physiology of, <a href='#Page_8'>8</a>;</li> -<li class="isub1">its entire principle simple and practical, <a href='#Page_19'>19</a>;</li> -<li class="isub1">does not advise avoiding starchy foods for stout people, <a href='#Page_21'>21</a>;</li> -<li class="isub1">assures that the same food will add or decrease weight, <a href='#Page_21'>21</a>;</li> -<li class="isub1">keeps one in perfect condition, <a href='#Page_22'>22</a>;</li> -<li class="isub1">its requirements not hardships but pleasures, <a href='#Page_22'>22</a>;</li> -<li class="isub1">not a joke or fad, <a href='#Page_24'>24</a>; -<span class="pagenum" id="Page_421">[Pg 421]</span></li> -<li class="isub1">an appeal to self-examination and self-instruction, <a href='#Page_25'>25</a>;</li> -<li class="isub1">first scientific recognition of principles of, <a href='#Page_26'>26</a>;</li> -<li class="isub1">medical science not possessed of final information concerning questions of, <a href='#Page_52'>52</a>;</li> -<li class="isub1">plan for institution of an international inquiry into the subject of, <a href='#Page_53'>53</a>-55;</li> -<li class="isub1">proposed to found an international laboratory of research for the study of, <a href='#Page_55'>55</a>-68;</li> -<li class="isub1">no question of greater importance, <a href='#Page_72'>72</a>;</li> -<li class="isub1">poverty and vice traced to perversion of, <a href='#Page_73'>73</a>;</li> -<li class="isub1">great need of thorough physiological study of, <a href='#Page_74'>74</a>;</li> -<li class="isub1">effect of the mental state upon, <a href='#Page_74'>74</a></li> - -<li class="indx">Nutrition, animal, <a href='#Page_56'>56</a>, <a href='#Page_57'>57</a>, <a href='#Page_58'>58</a></li> - -<li class="indx">Nutritive equilibrium, <a href='#Page_37'>37</a>;</li> -<li class="isub1">experiments in, <a href='#Page_37'>37</a>-39</li> - -<li class="indx">Nuts, <a href='#Page_141'>141</a>, <a href='#Page_173'>173</a>;</li> -<li class="isub1">usefulness of, <a href='#Page_397'>397</a></li> - -<li class="indx">Nuttall, Dr. George H. F., <a href='#Page_26'>26</a>, <a href='#Page_39'>39</a>, <a href='#Page_47'>47</a></li> - - -<li class="ifrst">O</li> - -<li class="indx">Œsophagus, the, may protect the stomach, <a href='#Page_139'>139</a>, <a href='#Page_192'>192</a>, <a href='#Page_285'>285</a>, <a href='#Page_286'>286</a>, <a href='#Page_289'>289</a>, <a href='#Page_291'>291</a>, <a href='#Page_292'>292</a>, <a href='#Page_297'>297</a>, <a href='#Page_299'>299</a>, <a href='#Page_300'>300</a>, <a href='#Page_303'>303</a>, <a href='#Page_304'>304</a>, <a href='#Page_307'>307</a>, <a href='#Page_316'>316</a>, <a href='#Page_325'>325</a>, <a href='#Page_326'>326</a>, <a href='#Page_336'>336</a>, <a href='#Page_341'>341</a></li> - -<li class="indx">Openchowski, experiments of, <a href='#Page_305'>305</a>, <a href='#Page_325'>325</a></li> - -<li class="indx">Orang, the, <a href='#Page_115'>115</a></li> - -<li class="indx">Oranges, <a href='#Page_169'>169</a></li> - -<li class="indx">O’Reilly, Surgeon-General, xvii, <a href='#Page_69'>69</a>, <a href='#Page_70'>70</a></li> - -<li class="indx">Ozawa, Professor, <a href='#Page_55'>55</a></li> - - -<li class="indx">P</li> - -<li class="indx">Pabulum, the, derivation of, <a href='#Page_40'>40</a>, <a href='#Page_41'>41</a></li> - -<li class="indx">Pacific Islands, the, <a href='#Page_124'>124</a></li> - -<li class="indx">Padua, Italy, <a href='#Page_28'>28</a></li> - -<li class="indx">Palate, the, “the dietetic conscience,” <a href='#Page_75'>75</a></li> - -<li class="indx">Pancreas, the, excited by the vagus and the sympathetic nerves, <a href='#Page_183'>183</a>,</li> -<li class="indx">270;</li> -<li class="isub1">special relations of acids to, <a href='#Page_270'>270</a>, <a href='#Page_271'>271</a>, <a href='#Page_273'>273</a>, <a href='#Page_274'>274</a>, <a href='#Page_279'>279</a></li> - -<li class="indx">Pancreatic digestion, <a href='#Page_395'>395</a></li> - -<li class="indx">—— gland, the, <a href='#Page_269'>269</a>, <a href='#Page_270'>270</a>, <a href='#Page_271'>271</a>, <a href='#Page_280'>280</a></li> - -<li class="indx">—— juice, the, experiments for, <a href='#Page_267'>267</a>, <a href='#Page_270'>270</a>, <a href='#Page_273'>273</a>, <a href='#Page_279'>279</a>, <a href='#Page_360'>360</a>, <a href='#Page_395'>395</a></li> - -<li class="indx">Paris, <a href='#Page_56'>56</a>, <a href='#Page_65'>65</a></li> - -<li class="indx">Pastry, <a href='#Page_132'>132</a>, <a href='#Page_172'>172</a></li> - -<li class="indx">Patagonians, the, <a href='#Page_128'>128</a></li> - -<li class="indx">Pathology, <a href='#Page_249'>249</a></li> - -<li class="indx">Pavia, University of, <a href='#Page_26'>26</a></li> - -<li class="indx">Pawlow, Dr. Prof. J. P., <a href='#Page_6'>6</a>, <a href='#Page_7'>7</a>, <a href='#Page_12'>12</a>;</li> -<li class="isub1">researches of, <a href='#Page_61'>61</a>, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a>;</li> -<li class="isub1">his demonstrations of psychic influence in digestion, <a href='#Page_180'>180</a>-283</li> - -<li class="indx">Peas, <a href='#Page_132'>132</a></li> - -<li class="indx"><i>Pendelbewegung</i>, the, <a href='#Page_342'>342</a></li> - -<li class="indx">Pendulum movement, the, <a href='#Page_358'>358</a>-360</li> - -<li class="indx">Penegal, xxxiii</li> - -<li class="indx">Peptic digestion, <a href='#Page_318'>318</a>, <a href='#Page_335'>335</a></li> - -<li class="indx">Peristalsis, <a href='#Page_327'>327</a>, <a href='#Page_330'>330</a>, <a href='#Page_333'>333</a>, <a href='#Page_337'>337</a>, <a href='#Page_340'>340</a>, <a href='#Page_343'>343</a>, <a href='#Page_344'>344</a>, <a href='#Page_346'>346</a>, <a href='#Page_348'>348</a>, <a href='#Page_355'>355</a>-357, <a href='#Page_361'>361</a>, <a href='#Page_365'>365</a>, <a href='#Page_377'>377</a>, <a href='#Page_378'>378</a>, <a href='#Page_383'>383</a>, <a href='#Page_384'>384</a>, <a href='#Page_386'>386</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">Peristaltic wave, the, <a href='#Page_343'>343</a>, <a href='#Page_353'>353</a>, <a href='#Page_365'>365</a></li> - -<li class="indx">Pflüger’s Archives, <a href='#Page_182'>182</a></li> - -<li class="indx">Pharynx, the, <a href='#Page_285'>285</a>, <a href='#Page_286'>286</a>, <a href='#Page_290'>290</a>, <a href='#Page_298'>298</a></li> - -<li class="indx">Philippines, the, <a href='#Page_69'>69</a></li> - -<li class="indx">Physicians, most of them called on to restore appetite, <a href='#Page_254'>254</a>;</li> -<li class="isub1">their indifference to appetite, <a href='#Page_257'>257</a>;</li> -<li class="isub1">in Russia, <a href='#Page_260'>260</a>;</li> -<li class="isub1">should bear in mind the question of psychic secretion, <a href='#Page_261'>261</a></li> - -<li class="indx">Physiology, applied, <a href='#Page_251'>251</a></li> - -<li class="indx">Pine-apple, <a href='#Page_141'>141</a></li> - -<li class="indx">Pitcherie, chewing, <a href='#Page_129'>129</a></li> - -<li class="indx">Polynesia, <a href='#Page_128'>128</a></li> - -<li class="indx">Poorer classes, the, appetite stronger among, <a href='#Page_253'>253</a>;</li> -<li class="isub1">food of, <a href='#Page_266'>266</a>, <a href='#Page_267'>267</a></li> - -<li class="indx">“Popular Science Monthly, The,” xxxiii, <a href='#Page_53'>53</a>;</li> -<li class="isub1">Professor Chittenden’s article in, <a href='#Page_69'>69</a>-91</li> - -<li class="indx">Pork, <a href='#Page_100'>100</a>, <a href='#Page_141'>141</a></li> - -<li class="indx">Porridge, <a href='#Page_97'>97</a>, <a href='#Page_143'>143</a>, <a href='#Page_172'>172</a>, <a href='#Page_270'>270</a> -<span class="pagenum" id="Page_422">[Pg 422]</span></li> - -<li class="indx">Potato, made digestible by saliva, <a href='#Page_20'>20</a>;</li> -<li class="isub1">if masticated, need not produce fat, <a href='#Page_21'>21</a>;</li> -<li class="isub1">experiments with, <a href='#Page_38'>38</a>, <a href='#Page_102'>102</a>;</li> -<li class="isub1">yields abundant sugar by long-continued mastication, <a href='#Page_142'>142</a>, <a href='#Page_146'>146</a></li> - -<li class="indx">Potatoes, boiled, <a href='#Page_143'>143</a>, <a href='#Page_172'>172</a></li> - -<li class="indx">Poverty, traced to perversion of nutrition, <a href='#Page_73'>73</a></li> - -<li class="indx">Proteid, demanded by the appetite, xxxii;</li> -<li class="isub1">the putrid decomposition of, <a href='#Page_47'>47</a>;</li> -<li class="isub1">minimum amount of, <a href='#Page_74'>74</a>, <a href='#Page_78'>78</a>, <a href='#Page_79'>79</a>;</li> -<li class="isub1">Asiatics consume smaller proportion of, <a href='#Page_82'>82</a>, <a href='#Page_83'>83</a>, <a href='#Page_85'>85</a>, <a href='#Page_98'>98</a>, <a href='#Page_100'>100</a>, <a href='#Page_272'>272</a>, <a href='#Page_394'>394</a></li> - -<li class="indx">——, the high, xxxii, xxxiii</li> - -<li class="indx">——, the low, xxxi, xxxii, xxxiii</li> - -<li class="indx">—— digestion, perfect, <a href='#Page_394'>394</a>, <a href='#Page_395'>395</a></li> - -<li class="indx">—— molecule, the, isolation of the tryptophane element of, <a href='#Page_47'>47</a></li> - -<li class="indx">Physiology, experimental, <a href='#Page_249'>249</a>;</li> -<li class="isub1">can make no pretence to guide the field of medicine, <a href='#Page_251'>251</a>;</li> -<li class="isub1">merely confirms the precepts of instinct, <a href='#Page_251'>251</a></li> - -<li class="indx">Psychic environment, <a href='#Page_12'>12</a></li> - -<li class="indx">—— excitation, <a href='#Page_259'>259</a></li> - -<li class="indx">—— influence, in digestion, <a href='#Page_180'>180</a>-283</li> - -<li class="indx">—— juice, the, <a href='#Page_213'>213</a>, <a href='#Page_257'>257</a>, <a href='#Page_267'>267</a></li> - -<li class="indx">—— secretion, <a href='#Page_261'>261</a></li> - -<li class="indx">—— stimulation, <a href='#Page_249'>249</a></li> - -<li class="indx">Pultaceous foods, <a href='#Page_95'>95</a>, <a href='#Page_97'>97</a></li> - -<li class="indx">Pyloric sphincter, the, movements of, <a href='#Page_314'>314</a></li> - -<li class="indx">Pylorus, the, stands guard over the intestines, <a href='#Page_139'>139</a>, <a href='#Page_141'>141</a>;</li> -<li class="isub1">observations of Fallopius upon, <a href='#Page_302'>302</a>;</li> -<li class="isub1">ideas of early writers concerning, <a href='#Page_303'>303</a>;</li> -<li class="isub1">later experiments, <a href='#Page_304'>304</a>, <a href='#Page_307'>307</a>, <a href='#Page_308'>308</a>, <a href='#Page_315'>315</a>, <a href='#Page_316'>316</a>, <a href='#Page_317'>317</a>, <a href='#Page_325'>325</a>, <a href='#Page_326'>326</a>, <a href='#Page_328'>328</a>, <a href='#Page_330'>330</a>, <a href='#Page_331'>331</a>, <a href='#Page_332'>332</a>, <a href='#Page_333'>333</a>, <a href='#Page_340'>340</a>, <a href='#Page_341'>341</a>, <a href='#Page_360'>360</a></li> - - -<li class="ifrst">R</li> - -<li class="indx">Rabbit, the, experiments upon, <a href='#Page_344'>344</a>, <a href='#Page_359'>359</a>, <a href='#Page_371'>371</a></li> - -<li class="indx">Rage, effect of, <a href='#Page_388'>388</a></li> - -<li class="indx">Raiser, experiments of, <a href='#Page_359'>359</a>, <a href='#Page_371'>371</a></li> - -<li class="indx">Rectal injections, stimulating effect on movements of small intestine of, <a href='#Page_367'>367</a></li> - -<li class="indx">Rectum, the, <a href='#Page_374'>374</a>, <a href='#Page_379'>379</a>, <a href='#Page_382'>382</a></li> - -<li class="indx">Reed, Dr. Major Walter (martyr to science), <a href='#Page_70'>70</a></li> - -<li class="indx">Regina Margherita Laboratory, the, summit Monte Rosa, <a href='#Page_64'>64</a>, <a href='#Page_68'>68</a></li> - -<li class="indx">Regurgitation, <a href='#Page_35'>35</a></li> - -<li class="indx">Rhinitis, <a href='#Page_144'>144</a>, <a href='#Page_148'>148</a>, <a href='#Page_149'>149</a></li> - -<li class="indx">Rhythmic segmentation, of the intestinal contents, <a href='#Page_347'>347</a>-355, <a href='#Page_358'>358</a>, <a href='#Page_360'>360</a>, <a href='#Page_362'>362</a>, <a href='#Page_383'>383</a>, <a href='#Page_386'>386</a></li> - -<li class="indx">Rice, <a href='#Page_82'>82</a>, <a href='#Page_132'>132</a></li> - -<li class="indx">Rickets, <a href='#Page_144'>144</a></li> - -<li class="indx">Rigg’s disease, <a href='#Page_159'>159</a>, <a href='#Page_163'>163</a></li> - -<li class="indx">Rjasanzew, Professor, experiments of, <a href='#Page_275'>275</a></li> - -<li class="indx">Roberts, Sir William, <a href='#Page_75'>75</a>, <a href='#Page_147'>147</a></li> - -<li class="indx">Rockefeller, John D., xxxv</li> - -<li class="indx">—— Institute of Preventive Medicine, the, <a href='#Page_68'>68</a></li> - -<li class="indx"><i>Rollbewegung</i>, <a href='#Page_345'>345</a></li> - -<li class="indx">Röntgen rays, the, Dr. Cannon’s studies with, <a href='#Page_180'>180</a>, <a href='#Page_284'>284</a>, <a href='#Page_287'>287</a>-300, <a href='#Page_301'>301</a>-341, <a href='#Page_342'>342</a>-388</li> - -<li class="indx">Roosevelt, President Theodore, <a href='#Page_70'>70</a></li> - -<li class="indx">Root, Secretary of War, Elihu, <a href='#Page_70'>70</a></li> - -<li class="indx">Rosa, Monte, <a href='#Page_64'>64</a>, <a href='#Page_68'>68</a></li> - -<li class="indx">Rossbach, experiments of, <a href='#Page_305'>305</a>, <a href='#Page_309'>309</a>, <a href='#Page_311'>311</a>, <a href='#Page_313'>313</a>, <a href='#Page_314'>314</a></li> - -<li class="indx">Roux, experiments of, <a href='#Page_314'>314</a>, <a href='#Page_315'>315</a>, <a href='#Page_327'>327</a>, <a href='#Page_328'>328</a></li> - -<li class="indx">Royal Society, the, <a href='#Page_68'>68</a></li> - -<li class="indx">Rumination, <a href='#Page_35'>35</a>, <a href='#Page_98'>98</a></li> - -<li class="indx">Russell, Dr. William, <a href='#Page_145'>145</a></li> - -<li class="indx">Russia, physicians in, <a href='#Page_260'>260</a>;</li> -<li class="isub1">food in, <a href='#Page_267'>267</a>, <a href='#Page_272'>272</a></li> - -<li class="indx">Russian Imperial Military School of Medicine, the, <a href='#Page_68'>68</a></li> - -<li class="indx">—— peasant, the, <a href='#Page_270'>270</a> -<span class="pagenum" id="Page_423">[Pg 423]</span></li> - - -<li class="ifrst">S</li> - -<li class="indx">Sabbatani, experiments of, <a href='#Page_378'>378</a></li> -<li class="indx">St. Martin, Alexis, investigations on, <a href='#Page_305'>305</a>, <a href='#Page_309'>309</a></li> - -<li class="indx">Saliva, its chemical effect upon potato, <a href='#Page_20'>20</a>;</li> -<li class="isub1">upon syrup, <a href='#Page_21'>21</a>, <a href='#Page_33'>33</a>, <a href='#Page_34'>34</a>, <a href='#Page_35'>35</a>;</li> -<li class="isub1">its action in infant life, <a href='#Page_36'>36</a>;</li> -<li class="isub1">an important therapeutic agent, <a href='#Page_45'>45</a>, <a href='#Page_93'>93</a>, <a href='#Page_94'>94</a>, <a href='#Page_95'>95</a>;</li> -<li class="isub1">mastication promotes flow of, <a href='#Page_96'>96</a>, <a href='#Page_101'>101</a>;</li> -<li class="isub1">dry food produces greater flow than moist, <a href='#Page_97'>97</a>, <a href='#Page_147'>147</a>;</li> -<li class="isub1">complicated physiological functions of, <a href='#Page_191'>191</a>-192, <a href='#Page_337'>337</a>, <a href='#Page_392'>392</a>, <a href='#Page_393'>393</a>, <a href='#Page_395'>395</a>, <a href='#Page_396'>396</a></li> - -<li class="indx">Salivary digestion, in the stomach, <a href='#Page_335'>335</a>, <a href='#Page_341'>341</a>;</li> -<li class="isub1">effect of mastication and cooking of food upon, <a href='#Page_391'>391</a>;</li> -<li class="isub1">imperfect, <a href='#Page_394'>394</a></li> - -<li class="indx">—— glands, the, <a href='#Page_155'>155</a>;</li> -<li class="isub1">analogy between the innervation mechanism and the glands of digestion, <a href='#Page_188'>188</a>-190;</li> -<li class="isub1">the exciting agencies of the nervous mechanism of, <a href='#Page_191'>191</a>;</li> -<li class="isub1">their particular properties, <a href='#Page_191'>191</a>-194;</li> -<li class="isub1">differences between the exciting agencies of the different, <a href='#Page_194'>194</a>-198;</li> -<li class="isub1">Professor Pawlow’s sham-feeding experiment, <a href='#Page_198'>198</a>-211, <a href='#Page_280'>280</a></li> - -<li class="indx">—— secretion, excitants of, <a href='#Page_191'>191</a></li> - -<li class="indx">Sapidity, <a href='#Page_44'>44</a></li> - -<li class="indx">Sauces, <a href='#Page_269'>269</a></li> - -<li class="indx">Schäfer, <a href='#Page_40'>40</a>, <a href='#Page_82'>82</a></li> - -<li class="indx">Schmidt, experiments of, <a href='#Page_202'>202</a>, <a href='#Page_204'>204</a>, <a href='#Page_231'>231</a>;</li> -<li class="isub1">conditions for success, <a href='#Page_204'>204</a>-206</li> - -<li class="indx">Schütz, experiments of, <a href='#Page_305'>305</a>, <a href='#Page_308'>308</a>, <a href='#Page_309'>309</a>, <a href='#Page_310'>310</a>, <a href='#Page_311'>311</a>, <a href='#Page_313'>313</a>, <a href='#Page_314'>314</a>, <a href='#Page_327'>327</a>, <a href='#Page_332'>332</a></li> - -<li class="indx">Schwartz, experiments of, <a href='#Page_303'>303</a>, <a href='#Page_304'>304</a></li> - -<li class="indx">Scientific Assessors, Board of, <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a>, <a href='#Page_181'>181</a></li> - -<li class="indx">Secretions, digestive, <a href='#Page_180'>180</a></li> - -<li class="indx">Secretory fibres, <a href='#Page_183'>183</a></li> - -<li class="indx">—— nerves, <a href='#Page_266'>266</a></li> - -<li class="indx">Segmentation, <a href='#Page_386'>386</a>, <a href='#Page_388'>388</a></li> - -<li class="indx">Selection, of nutriment, <a href='#Page_7'>7</a></li> - -<li class="indx">Self-nutrition, secret of, xii</li> - -<li class="indx">Sensory nerves, <a href='#Page_187'>187</a></li> - -<li class="indx">Sham feeding, experiments in, <a href='#Page_198'>198</a>-211, <a href='#Page_214'>214</a>-246;</li> -<li class="isub1">psychic effect may become an absolute and independent factor in, <a href='#Page_209'>209</a>, <a href='#Page_279'>279</a></li> - -<li class="indx">Sheffield Scientific School, the, experiments at, <a href='#Page_53'>53</a>, <a href='#Page_68'>68</a></li> - -<li class="indx">Sight, the sense of, <a href='#Page_210'>210</a></li> - -<li class="indx">Sivén, experiments of, <a href='#Page_81'>81</a></li> - -<li class="indx">Skatol, the odourous, <a href='#Page_47'>47</a></li> - -<li class="indx">Sleep, exercises no restraining influence upon the gastric glands, <a href='#Page_206'>206</a>;</li> -<li class="isub1">effect of, <a href='#Page_383'>383</a>-386</li> - -<li class="indx">Smell, the sense of, <a href='#Page_210'>210</a></li> - -<li class="indx">Snyder, Dr., experiment in nutritive equilibrium, <a href='#Page_37'>37</a>-38</li> - -<li class="indx">Société de Biologie, the, <a href='#Page_46'>46</a></li> - -<li class="indx">Sodium, salts of, <a href='#Page_277'>277</a>;</li> -<li class="isub1">promote a flow of gastric juice, <a href='#Page_277'>277</a>, <a href='#Page_278'>278</a>, <a href='#Page_279'>279</a>, <a href='#Page_281'>281</a>, <a href='#Page_282'>282</a></li> - -<li class="indx">Soft foods, <a href='#Page_97'>97</a>, <a href='#Page_129'>129</a>, <a href='#Page_136'>136</a>, <a href='#Page_142'>142</a>, <a href='#Page_160'>160</a>, <a href='#Page_162'>162</a></li> - -<li class="indx">Solid foods, <a href='#Page_94'>94</a>, <a href='#Page_268'>268</a></li> - -<li class="indx">Solray Sociological Institute, the, <a href='#Page_68'>68</a></li> - -<li class="indx">Sorbonne, Universitie de la, <a href='#Page_68'>68</a></li> - -<li class="indx">Soups, <a href='#Page_266'>266</a>, <a href='#Page_267'>267</a></li> - -<li class="indx">South Africa, <a href='#Page_11'>11</a></li> - -<li class="indx">—— America, <a href='#Page_124'>124</a></li> - -<li class="indx">“Spectator,” the, <a href='#Page_28'>28</a></li> - -<li class="indx">Sphincter, the, <a href='#Page_315'>315</a>, <a href='#Page_316'>316</a>, <a href='#Page_317'>317</a>, <a href='#Page_331'>331</a>, <a href='#Page_333'>333</a>, <a href='#Page_341'>341</a></li> - -<li class="indx">Spinach, <a href='#Page_99'>99</a></li> - -<li class="indx">Spirits, <a href='#Page_93'>93</a>, <a href='#Page_94'>94</a></li> - -<li class="indx">Ssanozki, Professor, experiments of, <a href='#Page_203'>203</a>, <a href='#Page_228'>228</a></li> - -<li class="indx">Starch, needed by body, <a href='#Page_20'>20</a>, <a href='#Page_21'>21</a>, <a href='#Page_78'>78</a>, <a href='#Page_98'>98</a>;</li> -<li class="isub1">changed into maltose, <a href='#Page_101'>101</a>, <a href='#Page_102'>102</a>;</li> -<li class="isub1">danger to the stomach in receiving an excess of, <a href='#Page_141'>141</a>-146;</li> -<li class="isub1">the last constituent to leave the stomach, <a href='#Page_145'>145</a>, <a href='#Page_170'>170</a>, <a href='#Page_171'>171</a>, <a href='#Page_172'>172</a>, <a href='#Page_270'>270</a>, <a href='#Page_337'>337</a>, <a href='#Page_393'>393</a>, <a href='#Page_395'>395</a>, <a href='#Page_396'>396</a>; -<span class="pagenum" id="Page_424">[Pg 424]</span></li> - -<li class="indx">Starling, experiments of, <a href='#Page_343'>343</a>, <a href='#Page_344'>344</a>, <a href='#Page_345'>345</a>, <a href='#Page_346'>346</a>, <a href='#Page_359'>359</a></li> - -<li class="indx">Stews, <a href='#Page_266'>266</a></li> - -<li class="indx">Stomach, the, struggles bravely to overcome abuse, <a href='#Page_19'>19</a>;</li> -<li class="isub1">man’s ignorance concerning requirements of, <a href='#Page_23'>23</a>;</li> -<li class="isub1">mastication acts reflexly upon, <a href='#Page_102'>102</a>;</li> -<li class="isub1">a long-suffering organ, <a href='#Page_138'>138</a>;</li> -<li class="isub1">its danger of receiving an excess of starch, <a href='#Page_141'>141</a>;</li> -<li class="isub1">starch the last constituent to leave, <a href='#Page_145'>145</a>;</li> -<li class="isub1">necessity of alkali in, <a href='#Page_146'>146</a>;</li> -<li class="isub1">secretory work of, <a href='#Page_182'>182</a>, <a href='#Page_183'>183</a>, <a href='#Page_229'>229</a>;</li> -<li class="isub1">secretory nerves of, <a href='#Page_210'>210</a>, <a href='#Page_227'>227</a>;</li> -<li class="isub1">the seat of certain definite sensations, <a href='#Page_241'>241</a>;</li> -<li class="isub1">the initial impulse towards awakening an appetite may originate in, <a href='#Page_244'>244</a>, <a href='#Page_246'>246</a>;</li> -<li class="isub1">no material progress in the physiology of, <a href='#Page_250'>250</a>;</li> -<li class="isub1">Nature endeavours to prepare lactic acid in, <a href='#Page_269'>269</a>;</li> -<li class="isub1">acids supplement weak action in, <a href='#Page_270'>270</a>, <a href='#Page_279'>279</a>;</li> -<li class="isub1">catarrhal affections of, <a href='#Page_280'>280</a>;</li> -<li class="isub1">gives no obvious external sign of its workings, <a href='#Page_301'>301</a>;</li> -<li class="isub1">studied by means of the Röntgen rays, <a href='#Page_301'>301</a>-341;</li> -<li class="isub1">Galen’s observations on the functions of, <a href='#Page_302'>302</a>;</li> -<li class="isub1">Fallopius’s views upon, <a href='#Page_302'>302</a>;</li> -<li class="isub1">the motor functions of, <a href='#Page_304'>304</a>;</li> -<li class="isub1">the anatomy of, <a href='#Page_306'>306</a>;</li> -<li class="isub1">its relations to the shadow, <a href='#Page_306'>306</a>;</li> -<li class="isub1">the musculature of, <a href='#Page_308'>308</a>;</li> -<li class="isub1">normal movements of, <a href='#Page_309'>309</a>;</li> -<li class="isub1">the peptonising function of, <a href='#Page_314'>314</a>;</li> -<li class="isub1">its appearance at various stages of digestion, <a href='#Page_319'>319</a>;</li> -<li class="isub1">composed of two physiologically distinct portions, <a href='#Page_324'>324</a>, <a href='#Page_340'>340</a>;</li> -<li class="isub1">its movements in vomiting, <a href='#Page_325'>325</a>;</li> -<li class="isub1">effect of its movements upon the food, <a href='#Page_328'>328</a>;</li> -<li class="isub1">attempts to perform function of teeth, <a href='#Page_333'>333</a>;</li> -<li class="isub1">salivary digestion in, <a href='#Page_335'>335</a>;</li> -<li class="isub1">inhibition of its movements during emotion, <a href='#Page_337'>337</a></li> - -<li class="indx">—— fluids, <a href='#Page_393'>393</a>, <a href='#Page_394'>394</a></li> - -<li class="indx">Suffocation, caused by inefficient mastication, <a href='#Page_137'>137</a></li> - -<li class="indx">Sugar, <a href='#Page_21'>21</a>, <a href='#Page_78'>78</a>, <a href='#Page_89'>89</a>, <a href='#Page_95'>95</a>, <a href='#Page_169'>169</a>, <a href='#Page_337'>337</a>, <a href='#Page_393'>393</a>, <a href='#Page_395'>395</a></li> - -<li class="indx">Sugar-cane, <a href='#Page_123'>123</a>, <a href='#Page_124'>124</a>, <a href='#Page_169'>169</a></li> - -<li class="indx">“Sure and Certain Method of Attaining a Long and Healthful Life,” Luigi Cornaro’s treatise upon, <a href='#Page_28'>28</a></li> - -<li class="indx">Swallowing, facilitated by mastication, <a href='#Page_97'>97</a>;</li> -<li class="isub1">mechanism of, <a href='#Page_284'>284</a>.</li> -<li class="isub1"><i>See also</i> Swallowing Impulse, the</li> - -<li class="indx">—— Impulse, the, xxxii, <a href='#Page_8'>8</a>, <a href='#Page_9'>9</a>, <a href='#Page_93'>93</a>, <a href='#Page_94'>94</a></li> - -<li class="indx">—— reflex, Dr. Van Someren’s, <a href='#Page_26'>26</a>, <a href='#Page_44'>44</a></li> - -<li class="indx">Sweet potato, <a href='#Page_124'>124</a></li> - -<li class="indx">Sweets, why pleasant, <a href='#Page_268'>268</a>, <a href='#Page_269'>269</a></li> - -<li class="indx">Sympathetic nerve, the, an undoubted exciter of the gastric glands and of the pancreas, <a href='#Page_183'>183</a></li> - -<li class="indx">Syrup, chemical effect of saliva upon, <a href='#Page_21'>21</a></li> - - -<li class="ifrst">T</li> - -<li class="indx">Tapioca, <a href='#Page_132'>132</a></li> - -<li class="indx">Taplin, <a href='#Page_125'>125</a></li> - -<li class="indx">Tasmanians, the, <a href='#Page_122'>122</a></li> - -<li class="indx">Taste, delicacy of the sense of, <a href='#Page_22'>22</a>, <a href='#Page_23'>23</a>;</li> -<li class="isub1">should be dissipated in the mouth, <a href='#Page_93'>93</a>, <a href='#Page_210'>210</a>;</li> -<li class="isub1">necessary to give an impulse to the organs of, <a href='#Page_253'>253</a>;</li> -<li class="isub1">the nutritive value of food should be considered rather than, <a href='#Page_261'>261</a></li> - -<li class="indx">—— gratification, <a href='#Page_93'>93</a></li> - -<li class="indx">Tea, <a href='#Page_132'>132</a></li> - -<li class="indx">Tea-taster, the professional, methods of, <a href='#Page_23'>23</a>, <a href='#Page_93'>93</a></li> - -<li class="indx">Teeth, the, influence of mastication upon, <a href='#Page_110'>110</a>;</li> -<li class="isub1">changes during man’s evolution, <a href='#Page_115'>115</a>-121;</li> -<li class="isub1">instances of vigorous use, <a href='#Page_122'>122</a>-126;</li> -<li class="isub1">irregularity in, <a href='#Page_156'>156</a>;</li> -<li class="isub1">evils of imperfect use of, <a href='#Page_157'>157</a>;</li> -<li class="isub1">examination of, <a href='#Page_174'>174</a>-179;</li> -<li class="isub1">the stomach attempts to perform function of, <a href='#Page_333'>333</a> -<span class="pagenum" id="Page_425">[Pg 425]</span></li> - -<li class="indx">“Text-Book of Physiology,” Schäfer’s, <a href='#Page_40'>40</a></li> - -<li class="indx">“That Last Waif: or Social Quarantine,” xxv</li> - -<li class="indx">Therapeutic experiments, pathological, <a href='#Page_249'>249</a></li> - -<li class="indx">Therapeutics, precepts of, <a href='#Page_272'>272</a></li> - -<li class="indx">Thierfelder, <a href='#Page_39'>39</a></li> - -<li class="indx">Thirst, <a href='#Page_95'>95</a></li> - -<li class="indx">Thompson, Dr., <a href='#Page_142'>142</a></li> - -<li class="indx">—— Prof. W. H., <a href='#Page_180'>180</a>, <a href='#Page_181'>181</a></li> - -<li class="indx">Thorax, the, <a href='#Page_290'>290</a></li> - -<li class="indx">Tobacco-chewing, <a href='#Page_103'>103</a>, <a href='#Page_129'>129</a></li> - -<li class="indx">Tokio, University of, <a href='#Page_55'>55</a></li> - -<li class="indx">Tongue, the, needs exercise, <a href='#Page_154'>154</a></li> - -<li class="indx">Tonic constrictions, the, <a href='#Page_344'>344</a>;</li> -<li class="isub1">the appearance of, <a href='#Page_370'>370</a>-373, <a href='#Page_385'>385</a>, <a href='#Page_387'>387</a></li> - -<li class="indx">—— rings, the, <a href='#Page_373'>373</a></li> - -<li class="indx">Tonsillitis, <a href='#Page_144'>144</a>, <a href='#Page_148'>148</a></li> - -<li class="indx">Tooth-brush, the, <a href='#Page_177'>177</a></li> - -<li class="indx">Tooth-powder, <a href='#Page_178'>178</a></li> - -<li class="indx">Toxins, absorbed into the blood, <a href='#Page_40'>40</a>, <a href='#Page_41'>41</a>, <a href='#Page_44'>44</a>, <a href='#Page_143'>143</a></li> - -<li class="indx">Training, for athletes, why necessary, <a href='#Page_22'>22</a></li> - -<li class="indx">“Traité Analytique de la Digestion,” Blondlot’s, <a href='#Page_181'>181</a></li> - -<li class="indx">Treves, Sir Frederick, on bolting of food, <a href='#Page_140'>140</a>, <a href='#Page_141'>141</a></li> - -<li class="indx">Trinity College, Dublin, <a href='#Page_180'>180</a></li> - -<li class="indx">Trophic fibres, <a href='#Page_183'>183</a></li> - -<li class="indx">Tryptophane, <a href='#Page_47'>47</a></li> - -<li class="indx">Tuberculosis, <a href='#Page_144'>144</a></li> - -<li class="indx">Turin, Italy, Congress of Physiologists at, <a href='#Page_26'>26</a>, <a href='#Page_48'>48</a>, <a href='#Page_56'>56</a>, <a href='#Page_91'>91</a></li> - -<li class="indx">——, University of, <a href='#Page_68'>68</a>, <a href='#Page_284'>284</a></li> - - -<li class="ifrst">U</li> - -<li class="indx">Urine, should be inoffensive, <a href='#Page_42'>42</a>, <a href='#Page_93'>93</a>, <a href='#Page_274'>274</a></li> - - -<li class="ifrst">V</li> - -<li class="indx">Vagus nerve, the, an undoubted exciter of the gastric glands and of the pancreas, <a href='#Page_183'>183</a>;</li> -<li class="isub1">its functions almost interminable, <a href='#Page_183'>183</a>, <a href='#Page_249'>249</a></li> - -<li class="indx">Van Someren, Dr. Ernest, xxv, <a href='#Page_7'>7</a>, <a href='#Page_12'>12</a>;</li> -<li class="isub1">his paper “Was Luigi Cornaro Right?” <a href='#Page_26'>26</a>-46;</li> -<li class="isub1">his swallowing reflex, <a href='#Page_26'>26</a>, <a href='#Page_44'>44</a>;</li> -<li class="isub1">his experiments confirmed by Marckwald, <a href='#Page_46'>46</a>;</li> -<li class="isub1">Sir Michael Foster’s Note upon his paper, <a href='#Page_48'>48</a>-52;</li> -<li class="isub1">the Cambridge tests, <a href='#Page_49'>49</a>-52, <a href='#Page_53'>53</a>, <a href='#Page_60'>60</a>, <a href='#Page_91'>91</a>, <a href='#Page_92'>92</a>, <a href='#Page_98'>98</a></li> - -<li class="indx">Van Valzah, <a href='#Page_146'>146</a></li> - -<li class="indx">Veal, <a href='#Page_100'>100</a></li> - -<li class="indx">Veddahs, the, <a href='#Page_128'>128</a></li> - -<li class="indx">Vegetable food, experiments with, <a href='#Page_40'>40</a>;</li> -<li class="isub1">necessitates more thorough mastication than animal, <a href='#Page_97'>97</a>, <a href='#Page_98'>98</a>, <a href='#Page_173'>173</a>;</li> -<li class="isub1">influenced more by cooking than animal, <a href='#Page_118'>118</a>, <a href='#Page_132'>132</a>, <a href='#Page_170'>170</a></li> - -<li class="indx">Vegetables, <a href='#Page_43'>43</a>, <a href='#Page_78'>78</a></li> - -<li class="indx">Venice, Italy, <a href='#Page_30'>30</a>, <a href='#Page_63'>63</a>, <a href='#Page_64'>64</a>, <a href='#Page_91'>91</a></li> - -<li class="indx">Vermicelli, <a href='#Page_132'>132</a></li> - -<li class="indx">Vermicular contraction, <a href='#Page_343'>343</a></li> - -<li class="indx">—— wave, the, <a href='#Page_345'>345</a></li> - -<li class="indx">Vermiform appendix, the, <a href='#Page_140'>140</a></li> - -<li class="indx">Vice, traced to perversion of nutrition, <a href='#Page_73'>73</a></li> - -<li class="indx">Vienna, <a href='#Page_65'>65</a></li> - -<li class="indx">—— bread, <a href='#Page_131'>131</a></li> - -<li class="indx">Vinegar, <a href='#Page_269'>269</a></li> - -<li class="indx">Vivisection, <a href='#Page_303'>303</a>, <a href='#Page_305'>305</a></li> - -<li class="indx">Voice, the, requires lusty exercise in youth, <a href='#Page_149'>149</a></li> - -<li class="indx">Voit diet, the, <a href='#Page_76'>76</a>, <a href='#Page_81'>81</a>, <a href='#Page_84'>84</a>, <a href='#Page_86'>86</a></li> - -<li class="indx">Vomiting, the act of, <a href='#Page_193'>193</a>, <a href='#Page_303'>303</a>;</li> -<li class="isub1">movements of the stomach in, <a href='#Page_325'>325</a>, <a href='#Page_341'>341</a></li> - - -<li class="ifrst">W</li> - -<li class="indx">Wallace, Dr. G. Sim, <a href='#Page_110'>110</a>, <a href='#Page_113'>113</a>, <a href='#Page_130'>130</a>, <a href='#Page_154'>154</a>, -<a href='#Page_158'>158</a>, <a href='#Page_161'>161</a>, <a href='#Page_169'>169</a>, <a href='#Page_174'>174</a>, <a href='#Page_177'>177</a> -<span class="pagenum" id="Page_426">[Pg 426]</span></li> - -<li class="indx">Walther, Dr., experiments of, <a href='#Page_267'>267</a>, <a href='#Page_276'>276</a></li> - -<li class="indx">Washington, D. C., <a href='#Page_70'>70</a></li> - -<li class="indx">Water, how to drink, <a href='#Page_9'>9</a>, <a href='#Page_34'>34</a>, <a href='#Page_95'>95</a>, <a href='#Page_268'>268</a>, <a href='#Page_391'>391</a>, <a href='#Page_392'>392</a></li> - -<li class="indx">—— biscuit, <a href='#Page_391'>391</a></li> - -<li class="indx">Weight, must become normal, <a href='#Page_43'>43</a></li> - -<li class="indx">Welch, Dr. Prof. William H., <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a></li> - -<li class="indx">Wepfer, experiments of, <a href='#Page_303'>303</a>, <a href='#Page_304'>304</a></li> - -<li class="indx">Wheat, unground pearl, <a href='#Page_392'>392</a>, <a href='#Page_393'>393</a>, <a href='#Page_394'>394</a></li> - -<li class="indx">—— flour, <a href='#Page_392'>392</a></li> - -<li class="indx">Wine, how to take, <a href='#Page_9'>9</a>, <a href='#Page_22'>22</a>, <a href='#Page_23'>23</a></li> - -<li class="indx">Wine-tasters, the professional, methods of, <a href='#Page_23'>23</a>, <a href='#Page_93'>93</a></li> - -<li class="indx">Wolves, experiments upon, <a href='#Page_303'>303</a></li> - -<li class="indx">Wood, Maj. Gen. Leonard, <a href='#Page_69'>69</a>, <a href='#Page_70'>70</a></li> - -<li class="indx">Worry, causes indigestion, <a href='#Page_7'>7</a></li> - -<li class="indx">Wulfson, Dr., <a href='#Page_197'>197</a></li> - - - -<li class="ifrst">X</li> - -<li class="indx">X-ray. <i>See</i> Röntgen ray</li> - - -<li class="ifrst">Y</li> - -<li class="indx">Yale investigation, the, x, xi, xiii-xv, xvii, xviii, xix, xxxiii</li> - -<li class="indx">—— Gymnasium, the, <a href='#Page_87'>87</a></li> - -<li class="indx">—— test, the, <a href='#Page_5'>5</a>, <a href='#Page_69'>69</a>, <a href='#Page_75'>75</a>-91</li> - -<li class="indx">—— University, <a href='#Page_68'>68</a></li> - - -<li class="ifrst">Z</li> - -<li class="indx">Z, in the nutrition alphabet, <a href='#Page_10'>10</a>, <a href='#Page_12'>12</a>;</li> - -<li class="indx">Zuntz, Dr. Prof. N., <a href='#Page_67'>67</a>, <a href='#Page_68'>68</a></li> -</ul> - - -<div class="footnotes"><h3>FOOTNOTES:</h3> - -<div class="footnote"> - -<p><a id="Footnote_1" href="#FNanchor_1" class="label">[1]</a> Appetite alone can judge accurately of the former, and -the true Swallowing Impulse is the limitation of the latter. If -we study the natural instincts, the rest will take care of itself.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_2" href="#FNanchor_2" class="label">[2]</a> This is very strong evidence that appetite knows what -to do and when to do it, if you study and consult it and give -it a chance to prescribe.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_3" href="#FNanchor_3" class="label">[3]</a> The Yale test reported herein by Professor Chittenden -showed the possibility of full alimentation according to the -requirements of Economic Nutrition in from 24 to 26 minutes -daily, which is less than 1/48 of a day. Beginners of the practice -of careful mouth-treatment of their food <i>may</i> require -more time, but, whatever it may be, it is worth it. A little -care for a short period will establish a right habit, and then -no further tedious attention nor unusual time will be necessary -to accomplish a perfectly healthy nutrition.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_4" href="#FNanchor_4" class="label">[4]</a> Physiological Economy in Nutrition: The Frederick A. -Stokes Company, New York.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_5" href="#FNanchor_5" class="label">[5]</a> William Heinemann: London.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_6" href="#FNanchor_6" class="label">[6]</a> The author is not yet permitted to publish the particulars -of these reforms in process, but he has official information -regarding them and is in full sympathy with them.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_7" href="#FNanchor_7" class="label">[7]</a> Dental surgeons now speak of the upper jaw as the maxilla, -and of the lower jaw as the mandible.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_8" href="#FNanchor_8" class="label">[8]</a> This subject I am obliged to deal with very briefly, and -am compelled to omit the reasons for my conclusions.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_9" href="#FNanchor_9" class="label">[9]</a> Recent observations go to show that man possesses no -power of digesting cellulose, though this substance is to a -limited extent capable of solution by the agency of bacteria -in the lower portions of his alimentary canal.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_10" href="#FNanchor_10" class="label">[10]</a> I am under great obligation to Miss Eva Dunn, who has -collected valuable information for me on this and kindred -subjects.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_11" href="#FNanchor_11" class="label">[11]</a> Social History of the Races of Mankind, 1881.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_12" href="#FNanchor_12" class="label">[12]</a> S. Powers: Tribes of California, 1877.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_13" href="#FNanchor_13" class="label">[13]</a> E. M. Curr: The Australian Races, 1886-7. Taplin: The -Narrinyeri; an account of Tribes of South Australian Aborigines, -1879.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_14" href="#FNanchor_14" class="label">[14]</a> J. F. Nansen: Eskimo Life, 1893.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_15" href="#FNanchor_15" class="label">[15]</a> Dr. Kane: Arctic Exploration, 1854.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_16" href="#FNanchor_16" class="label">[16]</a> E. Astrup: With Peary near the Pole, 1898.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_17" href="#FNanchor_17" class="label">[17]</a> Sir George Grey: Journal of Two Expeditions in North-West -and Western Australia, 1841.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_18" href="#FNanchor_18" class="label">[18]</a> Muster: With the Patagonians, 1869.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_19" href="#FNanchor_19" class="label">[19]</a> Bailey: Transactions of the Ethnological Society, 1862.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_20" href="#FNanchor_20" class="label">[20]</a> E. M. Curr: The Australian Race, 1886-87.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_21" href="#FNanchor_21" class="label">[21]</a> The Causes and Prevention of Decay in Teeth, pp. 88, -89. London, 1902.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_22" href="#FNanchor_22" class="label">[22]</a> Gilbert Barling also traces the relationship between appendicitis -and diet. “In a considerable number of cases,” he -writes, “the attack of appendicitis can be directly attributed -to unsuitable food—pork, mackerel, over-ripe or under-ripe -fruit, uncooked vegetables” (Brit. Med. Jour., vol. i., 1903, -p. 61).</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_23" href="#FNanchor_23" class="label">[23]</a> My friend, Dr. Thompson, undertook, at my suggestion, -some experiments to test the digestibility of raw starch within -the mouth; he found that raw potato yields abundant sugar -when subjected to long-continued mastication.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_24" href="#FNanchor_24" class="label">[24]</a> <i>The Lancet</i>, March 21st, 1903, p. 806.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_25" href="#FNanchor_25" class="label">[25]</a> Brit. Med. Jour., Epitome, vol. i., 1903, p. 45.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_26" href="#FNanchor_26" class="label">[26]</a> A further aid to the circulation in the naso-pharynx is -afforded by the lusty use of the voice. It a natural for the -young human to cry and to shout, and unless this instinct is -allowed full play the child is apt to suffer in health. I cannot -but think that the modern child is too much repressed in this -respect, and that he is not afforded, especially in towns, proper -opportunity of venting his vocal energy in out-door play. May -we not have here a contributory factor in the causation of -adenoids?</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_27" href="#FNanchor_27" class="label">[27]</a> Among the Australian skulls I have examined in museums -caries of the wisdom teeth—<i>i.e.</i>, in those very teeth -which, as shown by their atrophy, are least used—is by no -means uncommon (though it is possible that some of the skulls -belong to natives who have embraced the dietetic customs of -the white man). I submit that this fact may fairly be used as -an argument in favour of the view that inefficient use of the -teeth predisposes them to caries by interfering with their -resisting power, though it must be acknowledged that the position -of the wisdom teeth places them at a disadvantage, owing -to the tendency of food to accumulate about them, especially -in undeveloped jaws in which they have not adequate room.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_28" href="#FNanchor_28" class="label">[28]</a> This film can be felt by the tongue as a somewhat rough -covering, which gives place to a smooth surface after the use -of the tooth-brush.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_29" href="#FNanchor_29" class="label">[29]</a> By the term “external stimulus” I mean here without -distinction every outward agency of nature, as well as every -agency which has its seat within the organism. The word -“external” applies here to everything with the single exception -of the nervous system itself.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_30" href="#FNanchor_30" class="label">[30]</a> One may be permitted to use this expression for the -sake of brevity.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_31" href="#FNanchor_31" class="label">[31]</a> <i>Kwas</i> is a favourite Russian drink, prepared from water, -bread or meal, with malt and yeast. It contains a considerable -quantity of lactic acid, some acetic acid, and other products -of fermentation.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_32" href="#FNanchor_32" class="label">[32]</a> An investigation by Cannon and Day (<i>American Journal -of Physiology</i>, 1903) has confirmed this conclusion. An hour -after starchy food mixed with saliva was ingested a unit volume -of the food in the cardiac end of the stomach contained -almost twice the amount of sugar found in a unit volume of -the food in the pyloric end.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_33" href="#FNanchor_33" class="label">[33]</a> The results of this investigation were reported to the -Boston Society of Medical Sciences, November 19, 1901.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_34" href="#FNanchor_34" class="label">[34]</a> Without the possibility of seeing the relations of a movement -to the ends of the intestine, it cannot be stated absolutely -whether the movement is peristaltic or antiperistaltic. Such -relations can be seen on the fluorescent screen only near the -stomach and near the ileocæcal valve. The evidence that -advancing peristalsis is the normal movement is so overwhelming -that I have assumed that when food is moving -in loops not visibly related to fixed points it is moving -forward.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_35" href="#FNanchor_35" class="label">[35]</a> In this case the fæces were soft.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_36" href="#FNanchor_36" class="label">[36]</a> While Napoleon was building his -power and fame he was very careful -and abstemious, but in later life succumbed -to luxury and gluttony; Bismarck’s -rise and decline were similarly -related to dietary influences.—H. -F.</p> - -</div> -</div> - - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK THE A.B.-Z. 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