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 THE LIBRARY 
 
 OF 
 
 HENRY JAMES 
 COLLECTION 
 
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 LIBRARY 
 
 UNIVERSITY OF 
 CALIFORNIA 
 SAN DIEGO
 
 V 
 
 \p 
 
 THE ROLE OF MODERN DIETETICS 
 
 IN 
 
 THE CAUSATION OF DISEASE 
 
 THE UNIVERSITY LIBRARY 
 n OF CALIFORNIA, SAN OKB1 
 LA JOLLA. CALIFORNIA
 
 THE ROLE OF 
 
 MODEKN DIETETICS 
 
 IN 
 
 J. SIM WALLACE, M.D., D.Sc., L.D.S. 
 
 HON. DENTAL SURGEON WEST END HOSPITAL FOR NERVOUS DISEASES AND ASSISTANT 
 DENTAL SUKOEON NATIONAL DENTAL HOSPITAL, W. 
 
 LONDON 
 
 BAILLIEKE, TINDALL AND COX 
 
 8, HENRIETTA STREET, COVENT GARDEN 
 1905 
 
 [All rights reserved]
 
 PREFACE. 
 
 THIS book is a collection of essays which appeared 
 originally in the British Medical Journal., the Lancet, the 
 Medical Press, the British Dental Journal, and the British 
 Journal of Dental Science. Some now appear for the first 
 time, and it is to be hoped they may constitute a fairly- 
 coherent whole. I am indebted to my wife, not only for 
 many corrections from a literary point of view, but also 
 for putting the principles which I advocate into practice 
 with the most excellent results. I am also indebted to my 
 friend, Dr. W. G. Creswell, for several corrections and 
 suggestions. His important work on avian pathology and 
 on the feeding of birds, which from a biological stand- 
 point runs somewhat parallel to my own, and his large 
 experience as a medical practitioner, have led me to 
 consult him on points upon which I had imperfect infor- 
 mation. 
 
 J. SIM WALLACE. 
 
 30A, WIMPOLE STREET, 
 
 CAVENDISH SQUARE. 
 April, 1905.
 
 CONTENTS. 
 
 CHAP. p AOE 
 
 INTRODUCTION - .... 1 
 
 I. THE CAUSATION OF DISEASE - - 3 
 
 II. THE INCREASE AND DECREASE OF DISEASE - - 10 
 
 III. THE PHYSIOLOGY OF MASTICATION - - 17 
 
 IV. SOME EFFECTS OF THE EEFINEMENT OF FOOD - 21 
 V. NASAL OBSTRUCTION AND MOUTH-BREATHING - - 39 
 
 VI. PHYSICAL DETERIORATION IN RELATION TO THE TEETH 53 
 VII. COMMENT ON PHYSICAL DETERIORATION IN RELATION 
 
 TO THE TEETH - - 69 
 
 VIII. SPECULATIONS AND SUGGESTIONS - - - 73 
 
 vii
 
 " IF physicians could be got to realize the importance of 
 providing the jaws, teeth, and the muscular coats of the 
 digestive tract with adequate work, an untold amount of 
 disease and suffering would be averted." 
 
 HARRY CAMPBELL, M.D., F.R.C.P. 
 (Lancet, December 24, 1904).
 
 INTRODUCTION. 
 
 SEVERAL years ago my attention was directed to the 
 subject of dietetics while investigating the causes of 
 dental caries. At that time hereditary, constitutional 
 and developmental considerations were generally held to 
 be responsible for the prevalence of the disease. I became 
 convinced, however, that these factors were practically 
 negligible, while certain dietetic errors were to all intents 
 and purposes responsible. 
 
 The dietetic factor: from the point of view which I 
 considered important had scarcely been considered, and 
 therefore it specially engaged my attention. It became 
 evident, however, that if any substantial amelioration of 
 the dietetic conditions was to be made, it would be 
 necessary to appeal to physicians and parents, and to be 
 able to show that the advantage which I claimed would 
 accrue to the teeth from the proposed change would not be 
 antagonistic to the welfare of the body in general. On 
 further investigation it became evident that the havoc 
 played among the teeth was only a local manifestation 
 of other more general and equally serious troubles result- 
 ing from the same dietetic errors. 
 
 Unfortunately general useful knowledge is so carefully 
 
 1 1
 
 2 INTRODUCTION 
 
 excluded from the education of those who become parents, 
 that the homely and important subjects of diet and disease 
 seem to them abstruse topics written by specialists in an 
 unknown language. These essays are therefore only 
 addressed to the members of the medical profession and 
 those who are conversant with the principles of biology. 
 At the same time it is to be hoped that the subject matter 
 may soon reach intelligent parents, for the ultimate object 
 of this work is the prevention of disease, and this should 
 be as much the concern of parents as of medical practi- 
 tioners.
 
 CHAPTER I. 
 THE CAUSATION OF DISEASE. 
 
 IT is unusual except in philosophical writings to attempt 
 to form any distinct idea of what we mean when we use 
 the word cause. Generally, however, the word is used 
 with accuracy, and it is only on account of the occasional 
 abuse of the word that it is necessary to mention the 
 meaning which it properly has, and to recognise more 
 especially the significance of the word as it will be used in 
 what is to follow. Philosophically speaking, the cause 
 " is the sum total of the conditions, positive and negative 
 taken together, the whole of the contingencies of every 
 description, which, being realized, the consequent invari- 
 ably follows.''''* Fortunately, however, common usage 
 spares us contemplating such an array of conditions ; and, 
 thanks to common-sense, we purposely select only one or 
 two as the cause or causes, while we regard the rest merely 
 as conditions which need not be mentioned. 
 
 A source of much confusion is done away with by 
 recognising that the antecedent to which we assign the 
 name " cause " depends upon what we are concerned with. 
 Thus, for example, in ordinary parlance the cause of a 
 disease is that antecedent which, if it had been prevented, 
 * J. S. Mill, "A System of Logic." 
 
 3 12
 
 4 THE CAUSATION OF DISEASE 
 
 the disease would not have occurred A surgeon contem- 
 plating the cure of septic poisoning by the removal of an 
 abscess may quite correctly say that the cause of the trouble 
 was the abscess. Then again, the pathologist might equally 
 correctly say that the cause was certain septic micro- 
 organisms ; while the patient might say that the cause 
 was a severe blow and a weak state of health at the 
 time. 
 
 Sometimes the cause, from two or more points of view, 
 may be the same ; thus, for example, whether we have in 
 mind the prevention or treatment of consumption, we 
 may speak of lack of fresh air as the cause, for this is the 
 antecedent which it is a prime necessity to recognise in 
 either case. 
 
 The cause of a disease may or may not be the immediate 
 antecedent, and whether the immediate antecedent shall be 
 designated the cause, depends on whether it is the ante- 
 cedent which may be remediable or advisedly altered. 
 When remediable it is unnecessary to pursue its antecedents 
 further ; where, however, it is not, we must find a prior 
 antecedent which is remediable, even though this is com- 
 plex and requires to have its connection with the immediate 
 cause explained. As an example of this we may refer to 
 the cause of dental caries. When the pathology of this 
 disease was elucidated it was found that the invariable and 
 necessary antecedent was acid fermentation, or acids and 
 micro-organisms. It was quite natural to consider that 
 this was the cause, and having done so, to advocate the 
 use of antiseptics and alkaline mouth-washes, for by this 
 means it was expected to prevent the disease. As, how-
 
 THE CAUSATION OF DISEASE 5 
 
 ever, it has been found that the effect of these antiseptics 
 and antacids has been quite unsatisfactory as means of 
 preventing the disease, the cause has been sought in a prior 
 antecedent, that is to say, in some dietetic error, which if 
 rectified, the disease does not take place. Now we recog- 
 nise the cause of dental caries to be that the natural food- 
 stuffs are to a large extent deprived of their accompanying 
 fibrous parts, and prepared and consumed in a manner 
 which renders them especially the carbohydrates liable 
 to lodge and undergo acid fermentation in the mouth. 
 
 A somewhat perplexing circumstance is brought to light 
 in investigating the causation of disease, for it so happens 
 that the antecedent which we wish to avert may be an 
 absence of some particular condition. Thus, for example, 
 we are justified in saying that lack of the proper nutri- 
 tive constituents in the food causes certain deviations 
 from a normal state of health, and certainly a case of 
 starvation will justify us in saying that lack of food is the 
 cause of the condition. This is confusing, since the cause 
 is generally supposed to be a positive agent. I emphasize 
 this, as it so very frequently happens that diseases do 
 arise from lack of the normal conditions which should 
 obtain. 
 
 Another source of complexity is to be observed in the 
 peculiar and variable reaction of the patient. We speak 
 of susceptibility and immunity to disease, but this resolves 
 itself into a recognition of a counteracting condition, 
 which, when sufficiently powerful, the disease does not take 
 place. Susceptibility and immunity are properly recog- 
 nised as causes when considering the etiology of disease,
 
 () THE CAUSATION OF DISEASE 
 
 though they are rather to be looked upon as links in the 
 chain of causation than as actual causes themselves. Thus, 
 for example, exhaustion brings on a state of transient suscep- 
 tibility, and disease may supervene. We rightly and usefully 
 refer to the exhaustion as having been a cause of the disease 
 by rendering the patient susceptible, or more generally it 
 may be said that antecedents which give rise to a condition 
 of susceptibility, whether transitory, permanent, or 
 hereditary, are rightly and usefully called causes of 
 disease. It is, however, a futile pretence at elucidating 
 causation to say that heredity itself is a cause, for it is 
 merely a condition as constant as obvious, and as well 
 recognised as the necessary existence of the patient. It is 
 possible that the exact environmental conditions which 
 give rise to the hereditary peculiarities may be discovered, 
 and then we shall be able to regard such as causes of 
 disease, or at least of susceptibility and immunity, for 
 such antecedents may conceivably be preventable. In the 
 meantime, however, it is desirable to refer to those condi- 
 tions which to a certain extent are known to have given 
 rise to varying degrees of immunity in different people 
 and individuals, for the provisional knowledge which is 
 derived from a reference to these is at least suggestive. 
 Some races have become immune to certain diseases on 
 account of a more rigid extermination of those who were 
 susceptible ; thus, for example, we know that Negroes 
 living in malarious regions are much less susceptible to 
 malaria than Europeans, while, on the other hand, 
 Europeans are much less susceptible to tuberculosis than 
 Negroes. Other somewhat similar considerations may be
 
 THE CAUSATION OF DISEASE 7 
 
 mentioned. Certain individuals or families are more 
 susceptible to troubles caused by cold and damp. As 
 man in primitive times was an animal living almost 
 entirely in tropical regions, a cold and damp environment 
 is one to which he has only recently become adapted. 
 Bearing this in mind, and recognising that the most 
 recently established characters are the most unstable, it 
 can hardly surprise us that considerable fluctuations in the 
 degree of immunity to such troubles should commonly 
 present themselves. 
 
 Correlated to this we may mention variations in 
 susceptibility to certain diseases on account of recently 
 acquired habits corresponding to which the hereditary 
 organization has as yet hardly become thoroughly adapted. 
 Many instances of this may be found in a consideration of 
 those diseases which are influenced by the upright posture. 
 A simple example may be observed in varicose veins. 
 This is obviously and directly related to the upright 
 posture and the habits of the patient. Some diseases 
 may, however, have the upright posture as an indirect and 
 secondary antecedent. This will be found to be so in the 
 most unsuspected cases. To me this idea has proved a 
 most useful guide in forming provisional hypotheses, and I 
 have recorded some cases in my own special department 
 where it is obviously beneficial to recognise it as a cause 
 both in prevention and treatment. Here, however, I 
 would record my conviction that " neurasthenia " is in part 
 a result of the upright posture, and I believe a recognition 
 of this in the future will be of considerable service. 
 
 A correlated idea which occasionally proves to be of
 
 8 THE CAUSATION OF DISEASE 
 
 value in discovering the cause of disease is the fact that 
 the development of the individual recapitulates the evolu- 
 tion of the species, and that the environment suitable for 
 an individual at any one period may be surmised by a con- 
 sideration of the environment which his ancestry has been 
 subjected to for prolonged ages in its remote history, even 
 although the immediate predecessors for many generations 
 may not have been influenced by such environment. I do 
 not know that I can give an unequivocal example of this, 
 but possibly the benefit which is so often derived from 
 giving young children fresh fruit and vegetable juices may 
 be taken as showing a still inherited relic of our arboreal 
 and frugivorous existence before the advent of man. A 
 recognition of this principle, together with other considera- 
 tions, led me to believe that acid fruits would not be 
 harmful to the teeth, especially of young children, and 
 practical experience and clinical evidence proves this 
 hypothesis to be correct. * 
 
 Now, notwithstanding our general recognition of the 
 significance of differences in susceptibility and immunity, 
 we recognise that these variations are not important in 
 dealing with the prevention of disease. This is admitted, 
 and there is a general recognition of the fact that as 
 marriage is continually producing a regression towards 
 mediocrity, we must presume the essential homogeneity 
 of the hereditary constitution, unless we have very special 
 evidence of the contrary. Moreover, whether predisposed 
 
 * I am, of course, aware that students are still taught that all 
 foods which are acid in themselves should be avoided. Smale and 
 Colyer, " Diseases and Injuries of the Teeth/' p. 279.
 
 THE CAUSATION OF DISEASE 9 
 
 to disease or not, identical methods and precautions are 
 necessary to prevent it. 
 
 A survey of the above leads us to conclude that, in 
 general, disease is caused by imposing environmental 
 conditions upon the individual differing from those which 
 obtained during the evolution of the species ; while 
 disease is prevented by maintaining the essential similarity 
 of the environment to that which obtained during the 
 evolution of the species. This simple, obvious, important, 
 and useful generalization is very frequently overlooked, 
 and by modern writers on dietetics is completely ignored.
 
 CHAPTER II. 
 
 INCREASE AND DECREASE OF DISEASE. 
 
 IN a general survey of the progress of medicine one of the 
 most pleasant features is the decreased prevalence of most 
 diseases. This and the kindred consideration of the 
 decreasing mortality is often referred to with a certain 
 amount of pride by the medical profession. On the 
 other hand the increased prevalence of certain diseases is 
 generally overlooked, or mentioned together with some 
 more or less plausible argument or statement, which 
 mitigates the painful impression which otherwise might 
 be conveyed by a consideration of the lamentable fact. 
 Probably it would be productive of more good to make 
 an open and unqualified admission that there has been an 
 increase in those diseases which statistics appear to prove 
 pretty conclusively have increased. The general decrease 
 of disease is by no means sufficiently marked to warrant 
 us in supposing that all diseases must have decreased in 
 frequency. The marked and undeniable increase of some 
 diseases precludes any such conclusions. 
 
 We may mention a few diseases which have increased 
 in frequency. The diseases and irregularities of the teeth, 
 adenoids, appendicitis, neurasthenia associated with gastric 
 
 10
 
 INCREASE AND DECREASE OF DISEASE 1] 
 
 insufficiency, infantile diarrhoea, "indigestion," anaemia, 
 rickets, internal cancer in men, and insanity. 
 
 It may be noted in passing that all these diseases are 
 more or less directly associated with digestion or the 
 digestive tract, and how they result from the modern 
 practices and theories of dietetics will be suggested in the 
 following chapters. 
 
 References to the diseases of the teeth, however, will be 
 almost wholly omitted, as I have already dealt with these 
 in separate works. It will of course be readily understood 
 that though reference is not made to the diseases of the 
 teeth their importance is not to be overlooked. 
 
 The effects of erroneous restrictions in diet are most 
 readily shown in the mouth, for it is easily inspected, and 
 indeed it was a study of the pathology of the teeth and 
 the conditions which brought about their diseases, which 
 gave me the key to the dietetic errors which are responsible 
 for the increase of the diseases we have just referred to. 
 
 Nor will any full reference be made to those diseases 
 which are already more or less fully recognised to be the 
 result of dietetic errors. Thus it is not necessary to refer 
 to the relationship between insanity and malnutrition. It 
 is admitted that the development of the brain no less than 
 the development of the body is dependent on healthy 
 nutrition. 
 
 If we can show that there is increased malnutrition of 
 children and mothers we shall show a cause of the increase 
 of insanity. 
 
 We may now refer to some typical examples of the most 
 important and at one time common diseases which have
 
 12 INCREASE AND DECREASE OF DISEASE 
 
 decreased in frequency. Typhus fever, relapsing fever, 
 rabies and small-pox have almost vanished from the 
 country, while the ravages of tuberculous diseases have 
 been largely curtailed. It may be noted that these are 
 diseases depending largely for their propagation on foul 
 air, infection, and insanitary surroundings. That a certain 
 group of diseases connected with the digestive tract 
 should have increased, while those depending on sanitary 
 surroundings should have decreased, is noteworthy, for 
 insanitary surroundings certainly cannot be beneficial to 
 the digestive tract, nor can an impaired alimentary tract 
 be anything but conducive to the inception of diseases 
 primarily dependent upon insanitary surroundings. Indeed 
 it is admitted that neurasthenic patients, for example, are 
 predisposed to tubercle and typhoid fever. I believe these 
 are not only striking but also suggestive facts, and a 
 consideration of the principles of the causation of disease 
 will show why we can expect a rapid decrease of these 
 diseases as soon as the cause of the increase is discovered 
 and generally appreciated. 
 
 It is well known that disease is the result of surround- 
 ings which are inimical to the inherent nature of the 
 individual, while health is the result of the continuous 
 harmony of the individual with his environment. In the 
 course of countless ages man became hereditarily adapted 
 to the environment to which he was continuously subjected, 
 and any change in the surroundings is almost certain to 
 bring a train of diseases which continue till the organism 
 becomes adapted to the new environment or until the 
 environment returns to what it originally was. The
 
 INCREASE AND DECREASE OF DISEASE 13 
 
 diseases which have hitherto been decreasing were so 
 obviously the result of the surroundings which man 
 brought upon himself, that it is hardly necessary to refer 
 to the fact. The close, ill- ventilated houses, the over- 
 crowding and the accumulation of insanitary matter 
 seldom occurred or spread before the building of houses, 
 and more especially before the close congregation of people 
 in towns. However, as soon as it was made known that 
 diseases arose from ill-lit, ill-ventilated, and insanitary 
 dwellings the diseases gradually decreased in frequency and 
 in some cases have become almost completely exorcised. 
 
 When we consider the diseases which have recently 
 increased and which are at present increasing, we observe 
 this similarity ; they are the result of surroundings or 
 conditions which have been thoughtlessly brought about 
 by the agency of civilized man. The diseases which have 
 increased are so obviously associated with the food that 
 the wonder is that the explanation has not been already 
 worked out in detail. That the food we consume, and 
 more especially the food which children are compelled to 
 consume, is in some respects radically different from that 
 which was consumed in bygone ages may readily be 
 observed when we recognise that cow^s milk and the 
 prepared cereal foods were quite unknown to precibicultural 
 man and all his progenitors. The processes of refinement, 
 and the elaborate methods of preparation of food should 
 at once suggest that the alimentary canal may not be 
 wholly or perfectly adapted for the foods which are now 
 presented to it. Of course it will be claimed that the 
 methods of preparation are brought into existence in
 
 14 INCREASE AND DECREASE OF DISEASE 
 
 order to suit the requirements of the alimentary canal, 
 and in some ways it may be admitted that the end desired 
 is partially attained. The question however is, has the 
 process of refinement not frequently brought unexpected 
 derangements ? An inquiry into the nature of the foods 
 which have been subjected to refinement shows us that the 
 refined products are much more nutritious, and that the 
 innutritions matter which naturally accompanies natural 
 unprepared foods is partially or even totally eliminated, as 
 for example in sugar. As a very general rule the matter 
 which is excluded is cellulose, an inert, indigestible or rather 
 an inassimilable material of a more or less fibrous nature. 
 Thus a result of the refinement of food is the elimination 
 of this part which on account of its physical nature 
 demands a large amount of mastication. Now havijtig 
 admitted that the alimentary canal has through countless 
 generations become adapted for food which contained 
 quite a large amount of this innutritious matter, can we 
 go on satisfactorily without a fairly liberal supply of 
 cellulose ? I venture to say we cannot. " It is impossible 
 for the intestine to perform its functions properly unless 
 there is a very considerable amount of inert matter for it 
 to transmit." This has of course been long recognised by 
 physiologists, but it would really appear that it had been 
 quite overlooked by medical practitioners. The current 
 practices among medical men have come about from 
 several causes, among which we may mention the fact that 
 physiologists, when dealing with the inert matter have 
 little to say about it because it is inert. It passes along 
 the alimentary canal to be evacuated, it never really enters
 
 INCREASE AND DECREASE OF DISEASE 15 
 
 the body and hence the detailed consideration of it is 
 supposed to be superfluous. The very fact that this 
 matter is called inert is a mistake and misfortune. It is 
 only inert from a chemical point of view. Its presence in 
 the intestine is a continual stimulus, and this in itself is of 
 considerable importance in an age of constipation ; but all 
 forms of " inert " matter are not similarly stimulating, and 
 which forms are most suitable for certain kinds of dyspepsia 
 have apparently been considered of no importance nor have 
 they ever been investigated. Thus it is that the medical 
 practitioner in his student days has the importance of this 
 subject but little impressed on him. Then again in active 
 practice the physician is continuously having presented 
 before him emaciated children who obviously appear to 
 require more nourishment, and as is quite natural the 
 doctor prescribes food which he knows from the reports 
 of chemical analysis contains a large supply of assimilable 
 nourishment. Very frequently during the last few years I 
 have read the reports of the analysis of different foods, and 
 I cannot remember ever having seen any mention of the 
 nature of the inassimilable matter, and foods are actually 
 belauded because they do not contain more than one or two 
 per cent, of non-assimilable matter. This would be all 
 right if the patient had been trying to live on turnips and 
 cabbages, but the diseases which have increased, have 
 done so principally among those classes which have had a 
 liberal supply of highly nutritious foods. 
 
 Again throughout the whole course of evolution the 
 instinct to select the nutritious, and reject the innutritious 
 was beneficent, for until recently although the food was
 
 16 INCREASE AND DECREASE OF DISEASE 
 
 selected with care there was always plenty of the innutritious 
 part. So that independent of current teaching there is no 
 doubt a tendency for people to take too much nutriment, 
 and too little innutritious matter when they get the 
 chance. 
 
 Several other factors which have led to the craze for 
 highly nutritious foods will be noticed in succeeding 
 chapters, and the above remarks must only be considered 
 as introductory.
 
 CHAPTER III. 
 THE PHYSIOLOGY OF MASTICATION.* 
 
 IN the following description of the act of mastication 
 taken from Huxley's " Elementary Physiology," there 
 seems to be an incompleteness if not an error. It runs : 
 " When solid food is taken into the mouth it is cut and 
 ground by the teeth, the fragments which ooze out upon 
 the outer side of their crowns being pushed beneath 
 them again by the muscular contractions of the cheeks 
 and lips ; while those that escape on the inner side are 
 thrust back by the tongue, until the whole is thoroughly 
 rubbed down. . . . When the food is sufficiently ground, 
 it is collected, enveloped in saliva, into a mass or bolus 
 which rests upon the back of the tongue, and is carried 
 backwards to the aperture which leads into the pharynx." 
 
 It will be observed that this description would lead 
 one to think that the food is comminuted, mixed with 
 saliva, and made into bolus form and then swallowed. 
 
 What actually takes place is very different. Firstly, 
 however, it must be noted that certain food-stuffs which 
 are consumed at the present day are hardly subjected to 
 the process of mastication at all. The food is simply 
 
 * Published originally November, 1 900, British Journal of Dental 
 Science. 
 
 17 2
 
 18 THE PHYSIOLOGY OF MASTICATION 
 
 taken into the mouth, receives a general squash between 
 the teeth or between the dorsum of the tongue and the 
 hard palate, and is then swallowed. This method of 
 mastication if mastication it can be called is, as a rule, 
 adopted for custards, fine meal porridge, soft puddings, 
 and soft non-fibrous foods generally. 
 
 When there is a certain amount of coarse or fibrous 
 matter in the food-stuff, then the process is essentially 
 different, and mastication is performed in a more thorough 
 manner. In this latter case, the food is crushed and toni 
 between and heaped on to the masticating surfaces of the 
 teeth by the muscular contractions of the tongue, cheeks, 
 lips, and motions of the lower jaw. During comminution 
 between the teeth, the juices of the food-stuffs, the saliva 
 which becomes incorporated, and the suspended non- 
 fibrous part, are pressed out from the fibres and gradu- 
 ally collect during the process on the middle of the dorsum 
 of the tongue, which is gradually hollowed out for the recep- 
 tion of alch food, and this part is then swallowed. The 
 fibrous part of the food, however, is subjected again and 
 again to the crushing and disintegration between the 
 teeth. If any of the fibrous part passes towards the back 
 of the dorsum of the tongue, it is arrested by the pressure 
 of the anterior part of the tongue against the rugae of the 
 palate, and while the fluid and finely comminuted part 
 gets sucked or pressed back into the hollow formed at the 
 back of the dorsum of the tongue, the coarse and fibrous 
 parts are thrown between the teeth and subjected again to 
 the crushing, squeezing, and comminution. The rough 
 surface of the tip and dorsum of the tongue and the
 
 THE PHYSIOLOGY OF MASTICATION 19 
 
 smooth-ridged palate are especially well adapted for this 
 separation of the food prepared for swallowing, and that 
 which requires further mastication. 
 
 If careful note be taken of this process, therefore, it 
 will be found that the food is not, as a rule, formed into 
 a bolus and then swallowed, but that the bolus is con- 
 tinually slipping away to the dorsum of the tongue to be 
 swallowed till there is almost or quite no bolus left at all. 
 
 The recognition of this, which I consider the essential 
 nature of the process of mastication, is of great import- 
 ance, for, as I have pointed out elsewhere,* the effect of 
 chewing food of a more or less fibrous nature tends to 
 dislodge the fine particles of food-stuffs which otherwise 
 are apt to lodge between and in the crevices of the teeth, 
 and then give rise to dental caries. 
 
 At the present day there is a positive craze for the 
 elimination of coarse and fibrous matter from the food- 
 stuffs, and thus to a certain extent real mastication can be 
 but imperfectly performed, and its beneficent eflbcts are 
 almost wholly lost. 
 
 It is well known that the lodging of food-particles 
 (especially carbo-hydrates) in the mouth is liable to bring 
 about caries of the teeth, and if the chemical nature of 
 the fibrous part of the food, even that taken from the 
 vegetable kingdom, be taken into consideration, it will be 
 observed to be less amylaceous or saccharine than is the 
 non-fibrous part. 
 
 There are other ways in which the masticating of fibrous 
 food is beneficial. Not only are the teeth kept cleaner 
 * " The Cause and Prevention of Decay in Teeth."
 
 20 THE PHYSIOLOGY OF MASTICATION 
 
 than a tooth-brush can keep them, but the salivary and 
 buccal secretions are more thoroughly stimulated, the 
 deposit of tartar and the recession of the gums are pre- 
 vented, and the tongue when required to perform the 
 requisite motions during the process of thorough masti- 
 cation develops more fully, and brings about a more 
 regular set of teeth than can possibly be got if the tongue 
 is not well developed. Finally the stomach and intestines 
 are supplied with that more or less innutritions matter 
 which is necessary for the healthy performance of their 
 functions. 
 
 It is, I believe, partly on account of a want of a correct 
 knowledge of the Physiology of Mastication and its bene- 
 ficent effects, together with an almost exclusive con- 
 sideration of the food-stuffs from the point of view of 
 assimilability, which leads to prescribing foods for invalids 
 and children which are almost invariably so refined and 
 prepared as to encourage little or no mastication. 
 
 A thorough appreciation of the process, the essential 
 nature of which I have simply alluded to, its beneficence 
 when well performed, and its seriously harmful results 
 when it is not efficiently performed, would, I feel sure, 
 work a total change in our conceptions of what are 
 supposed to be good wholesome foods at the present day. 
 
 The beneficent results of mastication cannot be got by 
 trying to go through the process if the food is not fit for 
 mastication. It is therefore useless to tell patients that 
 they must masticate their food without at the same time 
 prescribing food which can be, and in fact requires to be, 
 thoroughly masticated.
 
 CHAPTER IV. 
 SOME EFFECTS OF THE REFINEMENT OF* FOOD.* 
 
 THERE are at present several different dietetic theories of 
 the cause of the prevalence of dental caries ; one element, 
 however, is common to them all, namely, that the change 
 brought about by modern processes for preparing and 
 refining food is answerable for the prevalence of the disease. 
 It is maintained by some that the removal of the husk 
 from the grain, for example, impoverishes the amount of 
 bone-forming salts, phosphates, etc. ; by others, again, 
 that the removal of the husk diminishes the amount the 
 jaws require to be used and deleteriously affects the blood- 
 supply and consequent nutrition of the teeth. By still 
 others, the refinement of the foods is supposed to cause 
 the food-stuffs and bacteria to be specially lodgable in the 
 crevices of and between the teeth, etc. It is not my 
 intention to enter into a discussion on the relative merits 
 of the different views ; suffice it here to say that if we 
 maintain that the elimination of the coarse and fibrous 
 elements, e.g., the husks of the grain, the skins of fruit, 
 the tough parts of meat, etc., is harmful to the teeth, we 
 are bound to consider whether the supposed advantages 
 
 * Paper delivered before the Odontological Society of Great 
 Britain, June, 1902. 
 
 21
 
 22 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 gained for the stomach and economy in general by such 
 refinement are of more importance than the deleterious 
 effect upon the teeth. 
 
 It does seem very surprising to maintain that the refined 
 foods which are prepared with all care should be conducive 
 to such havoc in the teeth, while that very refinement 
 appears to be a necessity for the stomach. It is as if we 
 would maintain that Nature had adapted us so that we 
 must always exist between Scylla and Charybdis. I very 
 frequently tell my patients that they must give up feeding 
 their children on refined foods, and am generally met with 
 the rejoinder that the stomach is of much more import- 
 ance than the teeth, and that coarse and tough foods 
 could not be digested by the patient, much less by children. 
 With children's specialists, too, a like idea prevails. They 
 appear to think that in general the feeding of children, as 
 advocated in current text-books, is as sufficiently nearly 
 correct as is necessary for all general purposes. This, 
 however, I believe to be an erroneous idea. 
 
 Let us approach the subject philosophically. Firstly, 
 let us consider the subject deductively from biological 
 principles, and having found the general principle let us 
 subject it to the test of facts so far as they are known 
 and admitted. 
 
 It is a general law brought about by the agency of 
 natural selection that animals, when subjected to any 
 particular environment, either become in the course 
 of generations adapted to that environment or else die 
 out as a race, and that in the event of them having become 
 adapted to the environment, they thereby acquire a
 
 SOME EFFECTS OF THE REFINEMENT OF FOOD 23 
 
 hereditary structure which tends to continue indefinitely 
 till impressed forces or change of environment changes 
 that hereditary structure. It follows that animals are 
 adapted to that environment under which they have lived 
 for countless generations, and are not adapted to a changed 
 environment when such is forced upon them. 
 
 To descend now from the general principle to the case 
 in hand. The ancestors of present-day man, savages, 
 Anthropoid progenitors, etc., lived a life which necessitated 
 their living largely on natural foods. The environment 
 remained practically the same from one generation to 
 another, and the hereditary structure became eminently 
 adapted to this environment. As regards these foods, 
 they were simply much the same as the natural foods are 
 to-day before they are subjected to processes of elaborate 
 refinement and cookery. The hereditary structure accord- 
 ing to biological principles still survives, if not in its 
 entirety yet in great part. That we are structurally 
 unfitted to the new foods is amply manifested by the fact 
 that about 95 per cent, of us are now well supplied with 
 carious teeth and a similar percentage troubled with 
 chronic or occasional indigestion. I will say, at least, that 
 carious teeth and dyspepsia are among the very commonest 
 afflictions to which man is subject. We know that pre- 
 historic man had relatively excellent teeth, and we know 
 also that Nature would have made short work of him 
 had he been crippled with dyspepsia. We know, more- 
 over, that in their natural environment savages and an- 
 thropoids are not very subject to dyspepsia. In fact, 
 they must maintain themselves in fairly vigorous health
 
 24 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 throughout their whole life, or succumb to their natural 
 
 J 
 enemies. 
 
 Since it has been ascertained that acquired characters 
 are not transmitted, we must conclude that civilized man 
 should have just about as excellent a digestive apparatus 
 as uncivilized man or his progenitors, and that decayed 
 teeth and indigestion are practically in all cases brought 
 about by avoidable indiscretions, especially indiscretions in 
 diet. This, at least, is my belief, and a perusal of what 
 follows may show the likelihood of the general truth of 
 the assertion. 
 
 Let us consider the matter from an analysis of known 
 facts. Food must, according to the physiologist, supply 
 the following requirements ; it must contain a certain 
 amount of proteids, carbo-hydrates, hydrocarbons, salts 
 and water, and, what is most important from the point of 
 view of the present paper, it absolutely must contain a 
 certain and considerable amount of indigestible., innu- 
 tritions, and unabsorbable matter. This fact is very 
 generally overlooked, and it is the origin of most of our 
 digestive and dental troubles. Do not many of children's 
 troubles arise from constipation and the varied decom- 
 posing products generated in the intestine from the lodg- 
 ment of food ? Is not the very first step in the treatment 
 the administering of some drug which will clear out the 
 foul mass of faecal matter ? A very general state of affairs 
 is first a gradual onset of constipation, then a purge, and 
 the patient goes on well again with a tendency to con- 
 stipation, which must inevitably increase if a reasonable 
 amount of unabsorbable matter is not given. Special care
 
 SOME EFFECTS OF THE REFINEMENT OF FOOD 25 
 
 is taken not to give anything irritating, for it is supposed 
 that if such food is given it will, of course, augment the 
 evil effects of the fermenting mass in the intestines. But 
 surely, this is a stupid way to go on. Would it not be 
 much better to allow a moderate amount of inert, in- 
 nutritious matter, such as cellulose, to remain in the foods ? 
 A sufficiency to stimulate the peristaltic actions of the 
 stomach and intestines, and so induce a continuous, regular, 
 and rhythmic performance of this natural function. It is 
 extremely difficult for the intestine to transmit tiny quan- 
 tities a " very considerable quantity " is necessary. 
 
 " This extraordinary care " which is taken " to employ 
 nothing in our diet but matter which has nutritive value, 
 that is, can be absorbed into the system is founded upon 
 want of knowledge of the first principles of digestion, and 
 yet, strange to say, the mistaken, indeed mischievous, 
 practice is supported, probably for want of thought, by 
 many who ought to know better."* 
 
 A fact of some significance is that very many cases 
 of chronic dyspepsia are due to want of sufficient move- 
 ment of the stomach or intestines, or both. Here, again, 
 the stimulus of a coarse and fibrous diet would in the 
 early stages presumably avert the disease. I may here 
 refer to the fact that frequently a loose use of certain 
 words gives rise to much error. Thus the word " indi- 
 gestible " is frequently used as meaning taking a long 
 time to digest or as giving rise to dyspeptic symptoms 
 accompanied by pain. A patient may pass inert matter 
 almost in the state in which it was swallowed, and it may 
 
 * " Food and Feeding/' by Sir Henry Thompson.
 
 26 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 then be said to be obviously indigestible, meaning " unab- 
 xorbable.' 1 '' The patient is promptly told to avoid eating 
 this substance again, because it is indigestible in the sense 
 that it requires a long time to digest. Such foods are, 
 however, ex Jiypoihesi inert, they pass through the body 
 unchanged and exert no action, or at least only that 
 muscular activity of the intestine which is necessary to 
 transmit them, and which is so necessary to be kept in 
 a high state of efficiency. 
 
 So far, therefore, as regards the necessary innutritious 
 matters in the food-stuffs are concerned, the refinement 
 does not appear to be any more beneficial from the point 
 of view of gastric digestion than it is premised to be from 
 the point of view of the teeth. 
 
 Now let us turn our attention more especially to the 
 carbohydrates. Let it be remembered that the starchy 
 matters of the food are to a considerable extent digested 
 by the action of the ptyaline of the saliva in the mouth. 
 Let it be remembered, too, that when the starch passes 
 into the stomach its digestion is after a very short time 
 completely arrested. Now, if the starchy matter is much 
 refined and taken in a form in which it does not require 
 to be retained in the mouth and masticated, then, of 
 course, it is passed rapidly into the stomach and the 
 salivary digestion is almost nil. The stomach is liable 
 to be overloaded with undigested starch and the various 
 disorders of amylaceous dyspepsia may result. If, how- 
 ever, the innutritious fibre, which is to a large extent 
 cellulose, had not been removed or pulverised in the 
 process of refinement, then the teeth would have had to
 
 SOME EFFECTS OF THE REFINEMENT OF FOOD 27 
 
 perform their natural function ; the food by its coarseness 
 would have necessitated thorough trituration and insaliva- 
 tion ; the starch would have been much more thoroughly 
 converted ; the stomach would not have been overloaded 
 with an unnecessary amount of unconverted starch, and 
 the innutritions cellulose would stimulate the rhythmical 
 action of the stomach and intestine, which is frequently 
 so sluggish. 
 
 It is somewhat curious to notice the devices which are 
 being adopted to overcome the harmful effects of refining 
 the carbohydrates. One error is introduced to rectify a 
 previous error ; whereas a study of natural foods and 
 Nature's methods indicates that the first error should be 
 corrected and the supplementary secondary errors would 
 be superfluous. Malted foods and predigested starch are 
 administered in the hope of rectifying matters, but 
 whether this is really properly accomplished is, according 
 to Aitchison Robertson,* doubly doubtful. 
 
 With regard to sugar, the effect of refinement is par- 
 ticularly harmful. The refinement of the food-stuffs from 
 which sugar is obtained is carried to such an extent that 
 instead of the succulent tuber of the beet or the fibrous 
 sugar-cane we get the highly concentrated and crystalline 
 product we know as sugar. Now it is known that sugar 
 can be easily swallowed in quantity, and the result on the 
 gastric digestion is to cause irritation and an excessive 
 secretion of mucus in the stomach. I think, too, that 
 this excessive secretion of mucus takes place in the mouth 
 from like irritation. The harmful effect on both teeth 
 * Journal of Anatomy and Physiology, 1808.
 
 28 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 and stomach is generally acknowledged. If, however, the 
 sugar could only be got in the relatively unconcentrated 
 form by chewing the beet or the sugar-cane, the secretion 
 of mucus might only be beneficial in coating the innu- 
 tritious cellulose and putting it in a fit state for passage 
 along the alimentary canal. Within limits, too, the 
 mucus probably acts as a protective coating to the teeth. 
 Moreover, retention of sugar in the mouth in a dilute 
 form, together with the fresh vegetable juices which 
 accompany it in the sugar-cane, stimulates the flow of 
 saliva and facilitates its conversion into a less irritating 
 and more assimilable form. The fact that the eating of 
 sugar stimulates thirst suggests the natural need for its 
 dilution, and the fact of the secretion of mucus suggests 
 the adaptation of the organism to cope best with this 
 article of diet when taken in the form in which Nature 
 presents it to us. 
 
 With regard to hydrocarbons, fortunately, when de- 
 prived of the fibrous envelope in which the fat globules 
 are usually enclosed, that is, when refined to the extent 
 that sugar is refined, they are too disgusting and sicken- 
 ing, and are consequently less apt to be harmful. Still, 
 ways and means have been found, and muffins soaked in 
 melted butter, or pastry of a similar constitution, are 
 easily swallowed. Fats as foods in Nature are presented 
 with an enveloping membrane. They do not hinder 
 digestion as they are thus at least partly emulsified. It 
 is otherwise when the fat or oil is made to surround the 
 starch and other food-stuffs, for then the fat acts as an 
 envelope excluding the digestive juices, and so hinders
 
 SOME EFFECTS OF THE REFINEMENT OF FOOD 29 
 
 digestion. Possibly, if the oils or fats which are incor- 
 porated in nuts, or fruits, or flesh were taken in a more 
 or less natural form, more benefit would accrue to the 
 teeth and less harm to the stomach. 
 
 With regard to proteids, they are usually eaten in a 
 more or less natural state and the beneficial effect to the 
 teeth is recognised, while, should the cooking not be bad, 
 and the amount reasonably limited, the stomach is well 
 able to derive benefit from them. The really refined 
 proteid diet is, however, the beef essence, meat juice, 
 extract of ox in a tea-cup class of foods. They are more 
 harmful to the digestion, for though, indeed, they are 
 easily digested, inasmuch as they are quickly passed out 
 of the stomach, and completely absorbed, they set up 
 a secretion of acid and an unnatural craving for food at 
 short intervals, which is equally harmful both to teeth 
 and stomach. 
 
 With regard to the salts, especially the earthy phos- 
 phates which are eliminated with the refinements of foods, 
 as, for example, those contained in the husks of grain, 
 the want of a sufficient supply of these in the diet may 
 possibly cause some derangement in the natural functions 
 of the digestive organs. Possibly the beneficial results 
 got by drinking mineral waters natural and artificial 
 may indicate an incidental benefit by their general reten- 
 tion in the food-stuff's. The fact that a mixed diet is 
 more beneficial than one containing almost solely pro- 
 teids, carbohydrates, or hydrocarbons is recognised in our 
 ordinary daily dietary, but I should also insist on foods 
 being mixed still further, inasmuch as the food ought to
 
 :>>0 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 be partly fibrous as well as non-fibrous, as the fibrous 
 part necessitates mastication and consequently insalivation. 
 The mastication necessitated by the fibrous part sets free 
 the starch so that it may be converted by the saliva, 
 disintegrates the proteid matter, and allows of the 
 covering of the mechanically irritant part with a coating 
 of mucus, while the mastication stimulates the flow of 
 lymph and prevents the harmful results to which 
 Dr. Harrv Campbell has called attention of the stagna- 
 tion of the lymph in the neighbourhood of the muscles 
 of mastication. 
 
 It should also be remembered that water taken after 
 meals not only tends to cleanse the mouth, but when it 
 passes into the stomach it stimulates peristalsis and helps 
 digestion. 
 
 There are also some general effects on the stomach 
 produced by the refinement of foods to which attention 
 should be drawn, for example, the ease with which refined 
 foods can be swallowed and the want of bulk composed of 
 inert matter leads to a very general habit of over eating. 
 The requirements of the body can be satisfied by a small 
 amount of highly concentrated food, but if the inert and 
 tasteless matter is absent the palate is keenly whetted, and 
 until the stomach is moderately full more is easily eaten. 
 If, however, a moderate amount of innutritions fibre has 
 to be consumed, not only is the stomach gradually filled, 
 but the amount of saliva swallowed is considerable and the 
 digestive juices add their littie to fill the stomach, and 
 bring about a feeling of satisfaction. 
 
 No doubt coarse food, or food which contains a fair
 
 SOME EFFECTS OF THE REFINEMENT OF FOOD 31 
 
 proportion of cellulose, takes longer to digest is delayed 
 longer in the stomach but this is no disadvantage what- 
 ever, all that is required is to leave longer intervals 
 between meals. Five or six hours between each meal is 
 much better than the habit, engendered by eating too 
 quickly digestible meals, of nibbling between meals, or the 
 taking of four, five, or even six meals a day. 
 
 There is a class of foods which are sometimes confused 
 with those inert substances and classed roughly as in- 
 digestible. I refer to irritant or even poisonous substances, 
 they are soluble, and may give rise to more or less violent 
 irritation of the stomach. Many foods contain such 
 irritants and, of course, should be avoided, especially 
 concentrated or in excess. So, too, those foods which give 
 rise to irritant products during the process of digestion 
 should not be eaten. As a precaution against the forma- 
 tion and lodging of such substances care should be 
 taken that sufficient inert matter is consumed to stimulate 
 regular evacuation of the bowels. 
 
 There is another general consideration seldom thought 
 of, that is, the strengthening of the digestive apparatus. 
 People who have not much to do are often what may be 
 called healthy, but those who lead an active life are 
 stronger and healthier. So, too, people may be able to 
 eat ordinary refined meals and do fairly well upon them, 
 but throw a little extra strain on their digestive organs, 
 and they break down. This, I believe, is the " normal " 
 state with many people. Men, however, should have a 
 much more powerful digestive apparatus than this if 
 only it is kept regularly in vigorous activity. This may
 
 32 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 gradually be brought about by eating a less refined diet 
 at longer intervals. The muscular powers of the stomach 
 and intestine are as easily developed or allowed to grow 
 flabby as are the muscles of the rest of the body. There 
 are limits, of course, to the eating of coarse and fibrous 
 food. There are natural guides for this also. For 
 example, take the tail end of a chop and masticate it 
 more or less, then take a corresponding amount of potato, 
 masticate still further, and it will be observed that the 
 potato is swallowed while the too fibrous part of the chop 
 remains ; take more potato and masticate and still it will 
 be found that the more fibrous part of the chop remains. 
 Such fibrous parts may be avoided. 
 
 Here it should be remarked that I thoroughly appreciate 
 the beneficial effect of the refinement of food and its 
 preparation in a very easily digested or even predigested 
 form in cases of debility, whether general or localised in 
 the digestive organs. Minced meat, pounded fish, fine 
 bread, partially converted starch, etc., are equally beneficial, 
 both when the teeth are absent or inoperative and when 
 the stomach is weakened by disease. So, too, milk in 
 small quantities at frequent intervals is undoubtedly of 
 great use in many cases of acute dyspepsia. Little good 
 can be derived by stimulating an already over irritable 
 stomach. Rest in bed is frequently the best possible 
 treatment for certain debilitated conditions of the system, 
 but vigorous exercise is much more conducive to good 
 health with those who are not debilitated by disease. 
 This leads me to state one reason why the craze for the 
 refinement of foods has come about. I am firmly con-
 
 J 
 
 r > V # 
 
 ^*y\ 
 
 SOME EFFECTS OF THE REFINEMENT Ol 
 
 vinced that many specialists are largely to blame. Doctors 
 are continually associated with the weak and diseased. 
 Recognising the need of nutrition at the least possible TJi \K 
 expense to the economy, they naturally advise foods which 
 will be easily and readily assimilated. They observe over 
 and over again that when such invalids throw excessive 
 work on their digestive organs they break down, just as j> 
 many people find that when eating coarse food their teeth 
 break, and a carious cavity shows itself. They natural 1] 
 recognise the immediate cause, while forgetting that the 
 original cause has been working, either in weakening the 
 teeth from caries, or the stomach from want of vigorous 
 exercise, perhaps for years. The coarse food brings about<_ 
 the crisis, but the refined food has insidiously performed ^K 
 its mischievous effects, which are bound sooner or later to 
 result in a breakdown. 
 
 Rest is undoubtedly advisable when an organ has 
 broken down, but by exercise alone can we expect to 
 regain vigorous health. We must not continuously 
 advocate the diet of the sick for children and healthy 
 adults, even if they are not particularly strong. The 
 subject, too, is not clearly presented in medical books. \"vj(>)/ 
 Although medically qualified myself, I had, since grad- .A. 
 uating, considerable difficulty in arriving at anything like . fa^jvT^ 
 a clear understanding of the subject. We have tables of v^^lfviT*^ 
 digestibility presented to us which say, for example, that 
 boiled rice takes one and a half hours to digest, others that 
 it takes three to three and a half hours. We read, however, 
 that rice is largely composed of starch, and that the diges-tyf^ 
 tion of starch in the stomach does not take place at all, V\
 
 
 ~ \ \ v ' 
 
 ^A v 
 
 ' 34 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 \^ N ,at least only to a very slight extent, and then only during 
 ' Jtf 4 the first twenty minutes or half-hour that it lodges in the 
 
 ' '/ the first twenty minutes or half-hour that it lodges 
 
 stomach. This is, of course, rather confusing when one 
 
 j\ ^ 'fs/V 
 
 "wants to arrive at a definite understanding of the subject. 
 _J^ It might possibly be useful if, when the word "digestible'" 
 ^ \ v rW^ 8 usec U it were made quite clear whether chemical digestion, 
 V*") ^T^ or P n y s i ca l digestion, or absorbability was meant : so, too, 
 when the word " indigestible " is used, it would be well to 
 know whether the food-stuff was meant to take a consider - 
 u C*V \V a ^^ e time to undergo chemical or physical digestion, or 
 whether it was unabsorbable, or whether it was of such a 
 
 nature that it gave rise to gastric or intestinal trouble, 
 either from its irritant nature or from an irritant nature 
 * acquired during the process of digestion. 
 
 Then, again, if carefully read, it will be noticed that 
 " bulk," " ballast," or " innutritious matter " is a neces- 
 sary constituent of a healthy diet. But this subject is 
 dealt with so cursorily that one is left almost wholly in 
 ignorance as to what these substances are and as to the 
 quantity required. A definite recognition of the amount 
 of proteid, carbo-hydrate, fat, and water, is clearly set 
 forth as necessary for a man of such and such a weight 
 ^j** performing no work, or moderate work, or hard work, but 
 'v/M j^-^no recognition is taken of the quantity of innutritious 
 matter. Again, although this innutritious matter is 
 spoken of as inert, strictly speaking it is not so. It 
 stimulates peristalsis, and some forms of it may stimulate 
 peristalsis more vigorously than others, but an investiga- 
 tion into the nature of the different kinds of innutritious 
 matters requires to be made. Although a return to eating
 
 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 the natural food-stuffs would, I have no doubt, be suffi- 
 cient to bring about a healthy and vigorous digestion, yet 
 accurate knowledge is wanted. 
 
 It is especially with regaru co children's feeding that a 
 correct knowledge of what is best is most necessary : and 
 here I should like to make a few observations in regard 
 a theory which seems to me to be worthy of consideration. 
 It is known that a knowledge of the dentition of extinct 
 animals gives a clue to the methods of feeding of these *,* 
 animals, and I believe a recognition of the dentition of 
 children forms a guide to the correct feeding of a child. 
 I do not refer only to the fact that up to the time of cutting i 
 the incisor teeth the diet ought to be solely the milk 
 which Nature supplies, nor to the fact that the existence 
 of temporary molars indicates that food ought to be given 
 which requires to be masticated. These facts are already 
 recognised, at least theoretically, by many, but the perplex- 
 ing period is the time between the cutting of the lower ^ 
 incisors and the appearance of the temporary molars. It (r <$*> 
 
 is during this period that much difficulty is found in 
 regulating the diet of infants, for the appearance of the 
 incisors indicates that suckling ought to be stopped, and in 
 fact it occasionally forcibly does stop this natural process, (f , 
 The child must be weaned. A sudden change to the foods < ' 
 which are procurable in a natural state would, as ad- 
 
 i 
 
 (UVV 
 
 V*' 
 
 A T 
 
 v ' *k 
 ministered at the present day, give rise to gastric troubles. 4 p* JT 
 
 Natural foods are always accompanied by a considerable ,, tf-'^iy 
 proportion of inert matter which would be apt, if not i " 
 certain, to induce indigestion. Consider the instincts of . 
 the child. Its indomitable habit of gnawing all edible r 
 
 4~*r4*. 
 
 o _ 
 3 
 
 .. 
 
 
 7.
 
 36 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 substances presented to it together with its inveterate 
 habit of sucking. Add to this that it first cuts two lower 
 incisors, then the two upper central incisors, and shortly 
 after the two upper lateral incisors. This being completed, 
 there is a long interval of about five or six months before 
 the cutting of the next group of teeth, which includes the 
 lower lateral incisors and the four first temporary molars. 
 Now during all this long time the child possesses two 
 lower incisors. And they are sharp. Surely all this 
 indicates that the best way to wean a child is to give it 
 succulent foods which it can pierce with its incisors, espe- 
 cially the lower ones, and suck the juices from such foods. 
 Why should starch be so difficult for the infant to digest ? 
 Surely it indicates that during the process of evolution the 
 child sucked soluble matter ? To supply the carbohydrate 
 food, the sugars, the soluble starches and the vegetable 
 juices would be consumed, and doubtless the craving for 
 sugar and vegetable acid indicates a beneficial provision of 
 Nature to put the child in fit correspondence with its 
 natural environment. This undoubtedly would supplement 
 the delicate morsels from the animal and vegetable king- 
 doms which the primitive mother could procure for her 
 child. No doubt, too, the fresh vegetable juices exert 
 beneficial effects, at least it is generally recognised that a 
 good supply of these juices is necessary to prevent the 
 occurrence of scurvy, rickets, and other diseases which 
 are sometimes inflicted on infants through the agency of 
 modern civilization. This indicates that children should 
 not get much inert and innutritious matter from about 
 the seventh to the fourteenth month. I have knowledge
 
 SOME EFFECTS OF THE REFINEMENT OF FOOD 37 
 
 of a little infant who, during this period, was given 
 orange liths, which he relished : he chewed them so far 
 as he could, but was always willing for the fibre to be 
 taken from his mouth after he had extracted the juices. 
 He opened his mouth for the purpose, and did not show 
 much disposition to swallow the innutritious fibre, at least 
 in quantity. And with regard to sugar-cane, which he 
 relished even more, he chewed it with his incisors, sucked 
 out the juices, but did not try to swallow the fibrous part. 
 
 With the advent of the temporary molars more solid 
 food should be given, and at this period starch can be 
 much more easily borne. By this time the salivary glands 
 have largely developed, and the stimulus given by con- 
 tinual gnawing and sucking, and sugars and vegetable 
 juices, largely promotes the growth and functional develop- 
 ment of these glands. Next consider the shape of the 
 molars. Is there not a large grinding surface on each? 
 If man were a carnivore this would be hardly necessary, 
 but being partly a vegetable feeder it is necessary for 
 the vegetable food to be masticated, for the cellulose 
 enveloping the starch to be crushed, and for the starch 
 to be at least partly digested in the mouth. By the time 
 all the permanent molars are in position the child is able, 
 within limits, to eat anything, and only a vicious civiliza- 
 tion is able to undermine the natural and powerful 
 digestion which by this time ought to have been gained. 
 
 As guides in the feeding of children, the following 
 points might be attended to : 
 
 (1) A knowledge of the natural food-stuffs which have 
 in past ages been habitually given to children.
 
 38 SOME EFFECTS OF THE REFINEMENT OF FOOD 
 
 (2) Knowledge of the artificial foods which are generally 
 used, together with a knowledge of their defects, physical 
 and chemical. 
 
 (3) A recognition of the likes and dislikes of the child 
 with regard to natural foods. 
 
 (4) To introduce only one new food-stuff' into the dietary 
 of a child at once, and to make sure that this agrees with 
 the child before making further alteration. 
 
 (5) To increase the intervals between meals according 
 to the length of time required for digestion in the 
 stomach ; this attention is to be regulated by previous 
 knowledge, the appetite of the child, and the needs of 
 civilization, i.e., regularity of meals and ultimately three 
 meals daily. 
 
 I need not pursue the subject further. Enough has 
 been said to show that the teeth and the stomach require 
 similar food, and it is only our habit of disregarding the 
 dictates of Nature and common-sense which leads to any 
 such supposition as that the foods which are suitable for 
 the teeth are harmful to the stomach. 
 
 NOTE. A large supply of true cellulose is strongly advocated 
 both from the point of view of the teeth and the alimentary canal, 
 but derivatives of cellulose such as ligriin and suberin should only be 
 sparingly consumed. Thus the skin of fruit should, as a rule, be 
 removed and wholemeal bread indulged in sparingly. It must not 
 be supposed, however, that the role of cellulose cannot largely, if 
 not entirely, be filled by any other article of diet. Thus with the 
 Esquimaux oil or fat takes the place of cellulose, and even in 
 European countries children are frequently restored to health, at 
 least for a time, by the aid of continual doses of castor and cod-liver 
 oil.
 
 CHAPTER V. 
 NASAL OBSTRUCTION AND MOUTH-BREATHING.* 
 
 WE who are concerned with the health of the community 
 must look with satisfaction on the progress which has been 
 made in hygiene and sanitation, for these sciences guard 
 the avenues leading to physical well-being. So, too, we 
 must look with satisfaction on the progress of medicine, 
 and the decrease and eradication of many diseases. So, 
 again, we cannot but be gratified by the general advance 
 of science, which in its application has led to an enormous 
 increase in the production of the necessaries of life, and 
 has even allowed what once were considered luxuries to 
 come within the easy reach of all thrifty members of the 
 community. Lastly, we must feel much satisfaction in 
 the diffusion of knowledge relating to the laws of health 
 to an extent which could hardly have been dreamt of by 
 the medical practitioner of half a century ago. On the 
 other hand, it must cause us disappointment and chagrin 
 when we think of the alarming increase of certain diseases 
 which we are as yet unable to control or prevent. It is 
 one of these troubles which is rapidly becoming more 
 prevalent that we have met to-day to discuss. Nasal 
 
 * Paper delivered before the British Laryngological, Rliinologieal, 
 and Otological Society, January, 1!)05. 
 
 3!)
 
 40 NASAL OBSTRUCTION AND MOUTH-BREATHING 
 
 obstruction is now quite a common disease, although but 
 a few generations ago it was practically unknown. This 
 can be easily proved, because nasal obstruction and mouth- 
 breathing give rise to a characteristic deformity of the 
 jaws, and to an easily recognisable irregularity of the 
 teeth. The mouth-breather's jaw is absent in all but 
 recent collections of skulls. Even in the Hythe collec- 
 tion, which is probably only a few hundred years old, 
 there is, I understand, not a single example to betray the 
 existence of mouth- breathing at that time. 
 
 When we recognise these facts, we naturally ask, What 
 change has taken place which will account for the increased 
 prevalence of nasal obstruction and mouth-breathing ? 
 One would naturally suppose that in all probability the 
 artificial warming and imperfect ventilation of houses 
 might be the chief change and initial cause. The sudden 
 changes in temperature to which the nasal mucous mem- 
 brane is subjected on passing from a heated room to the 
 cold outer air, can hardly be otherwise than prejudicial, 
 nor can a stuffy and germ-laden atmosphere be considered 
 conducive to the health of the nasal passages. 
 
 Dr. Scanes Spicer holds this view, and says : " In this 
 way the nasal mucous membrane gets into a state of 
 inferior vitality and irritable weakness, and erects, in- 
 flames and hypertrophies. . . . The secretions of the 
 disordered mucous membrane become abnormal and irri- 
 tate the lymphoid channels and follicles in the naso- 
 pharynx, and adenoid vegetations are the result." That 
 these conditions tend to give rise to morbid conditions 
 of the nose and naso-pharynx is, I believe, generally
 
 NASAL OBSTRUCTION AND MOUTH-BREATHING 41 
 
 acknowledged, but that they do not supply a complete 
 explanation of the prevalence of nasal obstruction and 
 mouth-breathing is equally generally recognised. 
 
 Another condition, possibly of greater importance, is 
 an interference with the perspiratory function of the nose. 
 The nose is not only a respiratory organ, for it has a 
 perspiratory function also. If we consider what happens 
 when we breathe, we observe that a large amount of air 
 which is drawn into the air passages never reaches the 
 air cells of the lungs at all, but is broken up, forming 
 eddies over the various moist projections and recesses of 
 the nasal cavities. The air which ultimately does reach 
 the lungs gets moistened, of course, but so does that 
 greater amount which is exhaled without ever reaching 
 the lungs at all. When we are at rest in bed and well 
 covered, perhaps too well covered, it is obvious that the 
 general surface of the body is not so well adapted for the 
 perspiratory function as when we are up and moving about, 
 with the air circulating more or less freely around us. In 
 fact, when we are lying at rest the only parts of the body 
 over which a current of air is freely passing, are the walls 
 of the nasal cavities and the respiratory passages. It is 
 thus perfectly natural that if we get warm in bed the 
 nasal mucous membrane will get congested, just as the 
 surface of the body gets congested when we become over- 
 heated. If the nasal passages are not unduly narrow, 
 only good would result, for the evaporation caused by the 
 current of air through the nose would help to keep the 
 body temperature normal and prevent undue perspiration 
 elsewhere. I need not refer to the harmful effects of an
 
 42 NASAL OBSTRUCTION AND MOUTH-BREATHING 
 
 undue rise of bodily temperature, or to an undue amount 
 of perspiration at night. What it is of special import- 
 ance to note is, that the nose is a perspiratory organ, and 
 if the function of perspiration is interfered with, various 
 deleterious results are certain to be brought about. Many 
 known facts seem to corroborate this hypothesis ; for 
 example, the fact that nasal obstruction is commonest 
 in damp localities i.e., localities in which the perspiratory 
 function is carried on under more disadvantageous condi- 
 tions than when the atmosphere is dry. So, too, the fact 
 that children who are " coddled " i.e., who are kept too 
 warm, often in a close atmosphere, and in general placed 
 in conditions which tax unduly the perspiratory function, 
 are highly susceptible to colds and nasal obstruction. 
 Then, again, we recognise that in the treatment of these 
 troubles a moderate covering of flannel, which will keep 
 the child warm without inducing undue perspiration is 
 beneficial. 
 
 Another concomitant of civilization which plays an 
 important part in inducing nasal obstruction is the 
 unsuitable nature of the food upon which children now 
 subsist. Any great change in the habits or in the 
 environment to which man has, through countless genera- 
 tions, become adapted, is almost certain to bring about 
 some harmful results, and that an extraordinary change 
 has come over the food and feeding of children is undeni- 
 able. Thus, for example, before cows were kept it is 
 obvious that milk was unknown to children after they 
 were weaned, say between the age of one year and two 
 years, nor were the proprietary foods which imitate
 
 NASAL OBSTRUCTION AND MOUTH-BREATHING 43 
 
 milk, available for children. Nor was bread, nor porridge, 
 nor milk pudding available, so that the staple articles 
 of the modern child's diet were utterly unknown to the 
 children of primitive man and all his progenitors. 
 
 Those who know of nothing but the orthodox milk diet 
 for young children find it almost impossible to imagine 
 how the children of primitive man could possibly have 
 been reared on the natural foods at the disposal of the un- 
 tutored or un-Chavassed mother. 
 
 In order to indicate the magnitude of the change in 
 feeding to which children are subjected, I shall first 
 briefly indicate the kind of diet which the children of our 
 ancestors were able to thrive upon. After the mother's 
 milk began to fail in quantity and quality, and the child 
 had erupted two sharp little incisor teeth, the child had, 
 I believe, to supplement the decreasing milk supply by 
 using its teeth to pierce the succulent and more or less 
 nutritious roots, shoots and fruits which had been procured 
 for it to gnaw and mck. This, together with some 
 little animal food, probably gnawed and sucked from a 
 bone, had to serve in increasing quantity for the de- 
 creasing supply of milk until about the thirteenth month, 
 when the first molar teeth appeared and allowed some 
 food also to be actually ground or masticated. After 
 this age was past, the sucking process became gradually 
 abandoned, while mastication became more thorough, 
 until the primitive child became able to eat all and 
 sundry with his parents. Here, be it observed, the 
 carbohydrates, consumed after laborious gnawing and 
 sucking, were unlikely to give rise to indigestion. They
 
 44 NASAL-OBSTRUCTION AND MOUTH-BREATHING 
 
 were diluted and much too thoroughly insalivated to 
 escape without conversion or preparation for the stomach. 
 Nor were the salivary glands denied their natural stimulus 
 for full and healthy development. If we consider the 
 natural period of lactation, the time of eruption of the 
 gnawing incisor teeth and of the masticating teeth, 
 together with the time of appearance of ptyalin and the 
 natural stimulus for its secretion, we see that the pre- 
 historic child was well adapted for its primitive surround- 
 ings, instinctively, anatomically and physiologically. 
 Compare this with the recognised ordinary methods of 
 feeding at the present day, and we find that the foods are 
 in but few ways suited for the anatomical, physiological, 
 or instinctive peculiarities of the child. Instead of being 
 gradually weaned and given food which will demand 
 gnawing, sucking and insalivation, it is cheated into 
 gulping down concentrated carbohydrate food such as 
 bread soaked in milk, porridge and milk, milk puddings, 
 and potatoes and gravy. It seldom gets the chance of 
 learning to separate the liquid part which is fit for 
 swallowing, and leaving or rejecting the innutritions fibre 
 which so often accompanies natural foods. Nor does it 
 get the chance of learning to masticate its food in such a 
 way that the fluid and finely comminuted part is swallowed 
 first, while the less finely ground part which requires 
 further mastication is thrown back on to the teeth again 
 and again until it, too, is finely ground and thoroughly 
 insalivated. In a similar way, the physical homogeneity 
 of the soft milk-soaked diet prevents the stomach from 
 acquiring the habit of allowing the digested part of the
 
 NASAL OBSTRUCTION AND MOUTH-BREATHING 45 
 
 food to pass on through the pylorus, while it forces back 
 the insufficiently digested part into the body of the 
 stomach to be more thoroughly digested. But to cut a 
 long story short, the modern child frequently, perhaps 
 usually, falls into a state of chronic indigestion, and three 
 of the consequences which usually follow must be men- 
 tioned, as they tend to bring on nasal obstruction. The 
 first consequence of chronic indigestion to which I would 
 refer is a correlated disturbance in the neighbourhood of 
 the naso-pharynx. We know of the flabby state of the 
 tongue and the red and swollen papillae and sides towards 
 its root. We are aware that even in adults, who are 
 not so subject to inflammatory swellings as children, 
 " enlargement of the tonsils is not infrequently present in 
 cases of gastric insufficiency," and this is especially so 
 " when occurring in children near puberty " (Sidney 
 Martin, "Diseases of the Stomach"). Finally, that the 
 pharynx is red and congested in many cases of gastric 
 disturbance, is recognised by those who have specially 
 directed their attention to this subject. Is it then a 
 great difficulty to suppose that the pharyngeal tonsil 
 undergoes a similar enlargement to the faucial tonsil? 
 Is it not the case that hypertrophy of the faucial tonsils 
 is presumptive evidence of the enlargement of the 
 pharyngeal tonsil ? I need not mention the effect 
 which this enlargement of the pharyngeal tonsil has in 
 predisposing to mouth-breathing, and possibly also to 
 colds, scarlet fever and measles, which in themselves 
 are by no means without suspicion in causing adenoid 
 vegetations.
 
 -Hi NASAL OBSTRUCTION AND MOUTH-BREATHING 
 
 Chronic dyspepsia with concomitant malnutrition may 
 predispose to nasal obstruction in another way. It would 
 appear to derange the perspiratory function and bring on 
 attacks of perspiration from trivial causes. It is perhaps 
 partly on account of this that the idea of an association 
 between rheumatism and adenoids has arisen, for the 
 disturbance of perspiration, together with cold and damp, 
 is, as we have seen, likely to predispose to adenoids as it 
 does to rheumatism. 
 
 Diagrammatic representation of a section of the mouth 
 and nose to illustrate the palate and position of 
 the teeth when : (1) The tongue has heen normal ; 
 and (2) when the tongue has been small or 
 emaciated during the development of the palate. 
 
 Lastly, indigestion may predispose to nasal obstruction 
 and mouth-breathing by the emaciation and general lack 
 of strength to which it gives rise. How this comes about 
 must here engage our attention. We know that the 
 growth and development of the maxillae are intimately 
 associated with the growth and development of the 
 tongue. The general truth of this contention has now 
 been so fully corroborated by the elaborate investigation 
 and careful measurements of Dr. Grevers, of Amsterdam, 
 that I do not feel called upon to. recapitulate the evidence
 
 NASAL OBSTRUCTION AND MOUTH-BREATHING 47 
 
 which originally led me to recognise this truth. All I 
 need here say is, that a normal or unemaciated tongue 
 stimulates the growth in breadth of the maxillae and 
 brings about a broad palate. 
 
 But just as the palate is made broad by this stimulus, 
 so, too, is the base of the nose similarly broadened, and 
 consequently, the part which is, par excellence, the 
 respiratory part is correspondingly broadened. It is 
 known to dentists, at least, that any mechanical force, 
 when acting in the mouth more or less continuously, 
 will expand the dental arches, arid if the tongue grows 
 as it ought, it must necessarily press the dental arches 
 outwards also. The suture between the maxillae allows 
 of the deposition of bone and consequent separation of 
 the bodies of the maxillary bones, provided that there is 
 something to stimulate such growth. What could be 
 more natural than that the developing tongue should be 
 the normal stimulus? On the other hand, it is only 
 natural that if the tongue is emaciated, so, too, will the 
 palate lack breadth. 
 
 The growth in breadth of the palate is also stimulated 
 by efficient mastication, for with efficient mastication 
 there comes a corresponding wearing of the cusps, espe- 
 cially of the temporary teeth, and a consequent loss in 
 depth of the mouth, which is compensated for by a 
 corresponding increase in breadth. If the tongue is 
 compressed from above downwards, the lateral expan- 
 sion is correspondingly increased. Again, efficient masti- 
 cation stimulates the growth in breadth of the palate, by 
 the fact that it supplies an intermittent strain on the
 
 48 NASAL OBSTRUCTION AND MOUTH-BREATHING 
 
 sutures, especially through the more or less transverse 
 action of the external pterygoid muscles. We thus see 
 that emaciation of the tongue, inefficient mastication, and 
 the lack of wear of the teeth brought about by the soft 
 food given to children, all tend to produce a narrow 
 palate, narrow jaws, and corresponding lack of breadth of 
 the nasal passages. From similar causes the naso-pharynx 
 not only lacks breadth, but also depth from before back, 
 for an inefficiently developed tongue does not cause that 
 normal forward translation of the maxillae which a fully 
 developed tongue does ; and the lack of the intermittent 
 pressure and strain normally produced, especially by the 
 action of the external pterygoids during efficient mastica- 
 tion, gives rise to a corresponding lessening of the natural 
 stimulation to the deposition of bone between the various 
 sutures which run transversely between the basi-occipital 
 and the maxilla?. Now, in narrow nasal passages and a 
 constricted naso-pharynx we have a strong predisposition 
 to nasal obstruction, and when mouth-breathing is once 
 commenced the chances of spontaneous recovery are almost 
 nil, for nasal obstruction itself arrests the further develop- 
 ment of the nasal cavities, as has been experimentally 
 proved by von Ziem. Furthermore, nasal obstruction 
 induces mouth-breathing, and this removes the normal 
 pressure of the tongue from the maxillary alveolus on 
 either side, so that still further is the natural stimulus for 
 the natural broadening of the palate, and consequently the 
 nasal breathway, removed. 
 
 I might here allude to Dr. Harry Campbell's ideas with 
 regard to the beneficent action of efficient mastication in
 
 NASAL OBSTRUCTION AND MOUTH-BREATHING 49 
 
 stimulating the flow of lymph and blood, and thus 
 establishing a healthier state of the neighbouring tissues ; 
 but I presume you are all well acquainted with his views 
 on these and correlated subjects,* and will only say that 
 if his contentions are correct they would help to enforce 
 one of my main arguments viz., that soft foods are 
 responsible for a large amount of indigestion, and indirectly 
 for adenoids among children. 
 
 Another cause of imperfect broadening of the nasal 
 passages, is the upright posture associated with prolonged 
 ill-health and malnutrition. When the health is con- 
 tinuously below par the vigorous tonicity of the muscles 
 is lessened, and instead of the thorax being held up in the 
 manner which is characteristic of robust health, it falls 
 somewhat, and an attitude such as that caused by 
 exhaustion becomes almost chronic. But the fall of the 
 thorax and viscera naturally drags hyoid, tongue and jaw 
 downwards from the palate, thus removing the natural 
 stimulus for broadening it, while at the same time the 
 mouth is actually pulled open. 
 
 It frequently happens that the nose is specially con- 
 gested at night, while but little blocking is observable by 
 day. The congestion by night causes mouth-breathing 
 by obstruction, while the conditions just referred to pre- 
 dispose to mouth-breathing by day. If the child were in 
 vigorous health, the mouth-breathing by day would not 
 take place, and the pathological condition in the naso- 
 
 * " Influence of Mastication on the Jaws." Transactions of the 
 Odontolpgical Society, 1902, pp. 102 and 120; also "Observation on 
 Mastication" (Lancet, July 11, 18, 25, and August 8,, 1903). 
 
 4
 
 50 NASAL OBSTRUCTION AND MOUTH-BREATHING 
 
 pharynx would have a much better chance of recovery. 
 Thus, then, delicate health from indigestion or any other 
 cause not necessitating the hori/ontal position, tends 
 mechanically, and otherwise, to induce mouth- breathing 
 and concomitant abnormal conditions. 
 
 Another condition to which we must just allude is an 
 imperfect development of the lower jaw, where the ramus 
 joins the body. When mastication is vigorously per- 
 formed the mandible develops fully in the neighbourhood 
 of the angle, and thus a square and broad jaw is brought 
 about; whereas, when mastication is insufficiently carried 
 on, the angle remains more obtuse. This obtuseness of the 
 angle of the mandible, however, has an effect on the 
 arrangement of the teeth, for it tends to make the molars 
 meet or occlude before the rest of the teeth. In other 
 words, the mouth is prevented from closing. It is 
 necessarily held open. Other effects follow. The upper 
 molar teeth are forced forward, and may either become 
 very irregular, or the incisors may be forced to protrude, 
 and the typical mouth-breather's jaw be foreshadowed. 
 The teeth towards the front of the mouth rise as it were 
 in their sockets till they meet, but it frequently happens 
 that the alveolus is so much deepened that the lips do not 
 close without a special effort, and at least an approxima- 
 tion to the adenoid type of face is closely simulated. 
 From a consideration of these facts it will be seen that 
 the imperfect broadening of the palate associated with 
 mouth-breathing is, or may be, brought about indepen- 
 dently of nasal obstruction, and may ante-date it. The 
 stenosis may give rise to obstruction with but little hyper-
 
 NASAL OBSTRUCTION AND MOUTH-BREATHING 51 
 
 trophy of the lymphoid or other tissue which is so liable 
 to hypertrophy. * 
 
 In conclusion, it should be noted that if the general 
 truth of my contentions be admitted, then two important 
 corollaries naturally follow. The first is, that " the cure 
 of mouth-breathing should be carried out by the rhinolo- 
 gist part passu with the treatment of the teeth and palate 
 at the hands of the dental surgeon^t I give this corollary 
 in the words of a distinguished rhinologist, for his words 
 cannot be supposed to be biassed in the way in which 
 mine might be. In the treatment of the irregularities of 
 the teeth, we dental surgeons recognise the important 
 help to be derived from the laryngologist in the restora- 
 tion of the functions of the nose, but I doubt if all 
 rhinologists recognise that some benefit might accrue 
 from the expansion of the palate by the dental surgeon, 
 and by the restoration of the means of efficient mastica- 
 tion. 
 
 The second and more important corollary is that we 
 should enter a most vigorous protest against the iniquitous 
 and ubiquitous system of feeding children almost entirely 
 on soft milk-soaked foods. Not because milk is occasion- 
 ally the bearer of tubercle, scarlet fever, diphtheria, etc., 
 nor because it leads to constipation, fermentation and 
 summer diarrhoea, but because this pap system is the 
 insidious cause of lifelong suffering from the numerous 
 derangements of the alimentary canal which it brings on. 
 
 * A fuller account of many of the structural alterations caused 
 by mouth-breathing will be found in the author's work on "The 
 Irregularities of the Teeth." 
 
 t Scanes Spicer, M.D. 
 
 42
 
 52 NASAL OBSTRUCTION AND MOUTH-BREATHING 
 
 It begins by producing the wholesale ruin of the teeth, 
 together with many consequent troubles. It leads to 
 adenoids and all the unfortunate sequelae with which you 
 are familiar. Finally, it almost necessarily begets gastric 
 insufficiency, malassimilation, and malnutrition, together 
 with the general wreck of physical well-being which these 
 derangements ultimately produce.
 
 CHAPTER VI. 
 
 PHYSICAL DETERIORATION IN RELATION TO 
 THE TEETH.* 
 
 THE question of the deterioration of the physique is one 
 of national importance, and we, as members of the medical 
 profession, have a special charge laid upon us to do what 
 we can to maintain the physical well-being at as high a 
 standard as circumstances will allow. I do not intend to 
 go into this general question in all its bearings, but will 
 rather begin by mentioning a limitation. Deterioration 
 may be inherent, and then might properly be called de- 
 generation, or it may be the result of an environment 
 becoming progressively more unfavourable. It is only in 
 this latter aspect that I intend to consider this subject. 
 
 It is unnecessary for us to inquire whether there is any 
 increased deterioration in the national physique. For 
 this inquiry it is sufficient that the subject has been raised, 
 and that, as regards the teeth, there are hardly two 
 opinions. Nor can there be, for the teeth of the present 
 day are not at all equal to those of our ancestors, and the 
 further we go back the more obvious is this truth. 
 
 * Paper delivered before the British Dental Association at 
 Aberdeen, August, 11)04, and in part at the meeting of the British 
 Medical Association, Oxford, July, 1904. 
 
 53
 
 54 PHYSICAL DETERIORATION 
 
 We may direct attention to the relation between physical 
 degeneration and the teeth from three points of view. 
 First, let us ask whether the degenerate state of the teeth . 
 is a result of general physical degeneration. Have we any 
 substantial evidence that the ill-developed classes have 
 teeth more susceptible to decay than those whose physical 
 development is distinctly good ? I venture to believe that 
 there is not any distinct evidence to support this view. 
 It must, however, be admitted that some eminent authori- 
 ties consider that vitiation of the oral secretions from 
 general ill-health is the chief predisposing cause of dental 
 caries. I do not wish to seem to contend that vitiation of 
 the oral secretions may not predispose to caries ; I would, 
 indeed, maintain that certain disturbances may, and do, 
 prejudicially alter the buccal secretions. Moreover, general 
 and prolonged ill-health tends to diminish the amount and 
 vigour of mastication, which in itself predisposes to caries. 
 Nevertheless, I do not contend that these predisposing 
 causes are of any great moment when brought about by 
 a state of imperfect development alone. 
 
 It is not only by inducing caries, however, that the teeth 
 may be injured. Their use and their beauty may be 
 greatly impaired by irregularity. Physical degeneration 
 and irregularities of the teeth are necessarily intimately 
 correlated, because the conditions which give rise to 
 imperfect development are almost invariably associated 
 with prolonged malnutrition and emaciation, and general 
 emaciation is practically always associated with emaciation 
 of the tongue. I cannot here enter into how the develop- 
 ment of the dental arches and jaws is dependent on the
 
 IN RELATION TO THE TEETH 55 
 
 development of the tongue,* but I have no hesitation in 
 saying that it is a fact, and when \ve see an adult with 
 irregular teeth we can tell, with something approaching 
 absolute certainty, that he was emaciated for a consider- 
 able time during youth. 
 
 Secondly, we may consider the question whether physical 
 degeneration may or may not be due, as a general rule, to 
 bad teeth. To this question there seems to be but one 
 answer. We cannot expect physical development to go on 
 satisfactorily so long as the teeth are decaying or are other- 
 wise diseased. How this must necessarily be so is well 
 known to all of us : dental caries is simply an outcome of 
 oral indigestion. The carbohydrates are not digested as 
 they ought to be ; they are neither subjected to the churn - 
 motions of mastication nor the insalivation they require, 
 for they are, as a rule, nowadays presented to children in a 
 state which stimulates neither mastication nor flow of 
 saliva. All parts of the function of digestion are neces- 
 sarily intimately correlated, so that it does not surprise us 
 that this disturbance of the first stage of digestion is very 
 apt to upset the normal working of the stomach. Of 
 course, if digestion does not go on satisfactorily, neither 
 will physical development. 
 
 In addition to this we must consider the carious cavities, 
 their contents and consequences. We can hardly imagine 
 that the products of the numerous bacteria associated with 
 caries can by any possibility be otherwise than detrimental. 
 
 * This subject is fully dealt with in " The Irregularities of the 
 Teeth with Special Reference to a Theory of Causation and the 
 Principles of Prevention and Treatment/' hy J. Sim Wallace, 
 M.D., D.Sc., L.D.S.
 
 56 PHYSICAL DETERIORATION 
 
 The harmful results of decaying teeth may also be brought 
 about by the injury and inflammation inflicted on the 
 gums. This might not be considered serious, were it not 
 that the inflammation is apt to spread backwards to the 
 throat, and thus render it susceptible to be attacked by 
 pathogenic micro-organisms. It has at least been main- 
 tained that several diseases having a local manifestation in 
 the throat are predisposed to by such conditions. Diseases, 
 such as scarlet fever, diphtheria, whooping-cough, tonsillitis, 
 etc., might be less frequently contracted if the mucous 
 membrane of the throat had not its resistive power 
 enfeebled by the chronic irritation and extension of in- 
 flammation engendered by decaying teeth. 
 
 Akin to these considerations is the belief that the 
 normal bacterial flora of the mouth is inimical to patho- 
 genic microbes, as contended by Dr. Miller and others. 
 Whether these views are strictly accurate or not remains 
 to be proved, but they are so much in accord with common- 
 sense and the analogy of other cavities having a communi- 
 cation with the outside, that the burden of proof would 
 appear to rest with those who might venture to question 
 its truth. 
 
 Much has of late been written with regard to the harm- 
 ful effect of swallowing the septic products of dead and 
 suppurating roots. No doubt it is injurious to digestion, 
 no doubt the evidence is sufficiently conclusive to warrant 
 us in maintaining that physical development is not likely 
 to go on satisfactorily so long as dead roots are left in the 
 mouth. But the swallowing of septic matter is probably 
 not the most seriously detrimental effect. It is the direct
 
 IN RELATION TO THE TEETH 57 
 
 absorption of septic matter into the blood. This condition 
 is common and chronic. I am probably within the mark 
 in saying that 50 per cent, of growing boys and girls of 
 the working classes in towns, have one or more septic roots 
 in their mouths prejudicially affecting their health. How- 
 ever, I do not intend to go into this subject of oral sepsis ; 
 its importance is beginning to be a little more adequately 
 recognised, and is the subject of another communication 
 at this meeting. Here, however, the question arises, Does 
 the class which is physically most degenerate really suffer 
 more from septic roots ? To this there can be but one 
 answer. They do. It is generally supposed, and no 
 doubt it is true, that the upper classes are more subject to 
 dental caries than the lower classes, but they are much 
 more careful to have their teeth attended to. On the 
 other hand, it is remarkable how few of the lower classes 
 are without several septic roots. 
 
 Lastly, let us direct attention to the question whether 
 there is anything in our surroundings or general mode of 
 living which is prejudicial both to the teeth and to general 
 physical well-being. I venture emphatically to submit 
 that there is. Medical science has made such progress, we 
 hardly dream that something may have been overlooked. 
 Yet an investigation into the subject will prove that it is 
 so. " What is true of science generally is likewise true of 
 every scientific problem. Everything does not mean 
 advance ; we often meet with a standstill, sometimes take 
 a retrograde movement. A striking example of this is 
 shown in the investigation of the salivary glands. After 
 the appearance of the classical work of Mitscherlich, and
 
 58 PHYSICAL DETERIORATION 
 
 a number of talented investigators, such as Claude Bernard, 
 Schiff, and others,"* there came a retrograde movement, 
 and now what we read in our text-books would lead " one 
 to suppose that the work of the salivary glands is of no 
 import, and that they respond in haphazard fashion to 
 every form of stimulus.' 1 ! 
 
 Then, again, there is the unfortunate, though perhaps 
 convenient, division of the process of digestion into three 
 stages namely, buccal, gastric, and intestinal, for, as has 
 been so ably shown by Professor Pawlow, all stages of the 
 process are most intimately co-ordinated. 
 
 Working from quite another standpoint I came to 
 recognise the importance of a similar conclusion. I had 
 been struck by the marked superiority of the teeth of 
 those who ate the least soft and refined food, and also saw 
 what appeared to me good evidence that those who had 
 been brought up on, and continued to eat, natural, un- 
 refined food, had a much better digestion than those who 
 ate the most refined and apparently physiologically 
 digestible food. In other words, I came to the conclusion 
 that food which demanded efficient mastication was not 
 only best for the teeth, but for the stomach and intestines 
 also. 
 
 It is interesting to see how certain experimental pro- 
 cedures have given rise to most disastrous conclusions. 
 Some experiments were made outside the body showing, it 
 was supposed, how gastric digestion went on. Here was 
 apparently unquestionable evidence set before one's eyes 
 
 * Pawlow and Thompson, ' ' The Work of the Digestive Glands/' 
 p. 150. 
 t Ibid.
 
 IN RELATION TO THE TEETH 59 
 
 showing digestion going on in a glass bottle. It was seen 
 that finely-divided particles were rapidly digested, whereas 
 the process was slower if the pieces were large. Now, 
 nothing could have been more natural than to advocate 
 that the food should be refined, pulverized, or ground, so 
 that the digestive juices would be more able to deal with 
 it. It was not anticipated that this refinement would 
 tend to make children swallow their food with little or no 
 mastication. Nor was it expected that by habituating the 
 child to swallow without mastication it would contract 
 the habit of swallowing even lumps when these at times 
 got into its food. Nor was it imagined that the teeth 
 thus deprived of their natural function would decay and 
 give rise to all the troubles to which we shall refer. It 
 vas not expected that this interference with the first stage 
 of digestion would disturb nutrition and consequent 
 healthy development. 
 
 It was not anticipated that this disturbance of the 
 health and nutrition of growing children would lead to a 
 craze for more nutritious food. It was not seen that this 
 craze for nutritious food would lead to a still further 
 elimination of the innutritious fibre which demands masti- 
 cation, and is commonly associated with natural and 
 unprepared foods. Nor that this would appear still 
 further to necessitate refinement of the food, and make it 
 seem a necessary accompaniment of civilization. 
 
 All these considerations are naturally intimately asso- 
 ciated with the physical development of the body, but 
 they do not end here. The lowered vitality associated 
 with weak digestion leads to susceptibility to other
 
 CO PHYSICAL DETERIORATION 
 
 diseases, one of the most interesting and common to which 
 we may refer being adenoids. I do not here intend, how- 
 ever, to trace the causes of adenoids. The problem is in 
 itself complex and would require a separate paper for its 
 elucidation. Suffice it to say that constipation and mal- 
 assimilation, with consequent emaciation and disturbance 
 of the perspiratory function, together with insufficient 
 mastication and development of the tongue, predispose to 
 irregularity of the teeth, narrow palate, narrow nasal 
 passages, chronic colds, mouth-breathing, and adenoids. 
 
 It may be said that the pap-feeding of children is the 
 outcome of years of practical experience, and that it 
 might be a fatal or dangerous experiment to venture upon 
 a new method of feeding. All possible theories may be 
 advanced against feeding children with food which demands 
 much mastication, but the system has already been put to 
 the test over and over again. In many cases it has been 
 carried out more or less by chance or by force of circum- 
 stances, but recently it has been put into deliberate 
 practice in several parts of the kingdom, and from all I 
 hear, with the most excellent results. I know of one 
 child who, since he was weaned, seldom got any food which 
 did not require a very considerable amount of mastication, 
 and before he was three years old he sat down to his 
 Christmas dinner, and had a liberal supply of turkey, 
 boiled ham, greens, and potatoes, two helpings of plum 
 pudding, some nuts, and an apple. He was not in the 
 slightest way upset, and was happy to go through the 
 same meal on the following day, except that the turkey 
 was cold. Needless to say, his teeth do not show the
 
 IN RELATION TO THE TEETH 6l 
 
 slightest signs of decay, although nowadays, at the age he 
 now is, it is quite usual to find decay more or less advanced, 
 in several teeth. 
 
 It is scarcely realized that the masticatory apparatus of 
 a child of two to two and a half years of age is relatively 
 very large. It is much larger than an adult's in proportion 
 to the size of the child, and considerably larger in pro- 
 portion to the amount of food consumed. Nor is the 
 significance of these anatomical facts realized by those 
 who advocate porridge and milk, milk pudding, and bread 
 and milk as staple articles of a child's daily diet. 
 
 An interesting corroboration of these views is to be 
 found in the well-known fact that children brought up in 
 towns have generally a worse physique and worse teeth 
 than country-bred children. This, no doubt, arises from 
 the fact that the town-bred child has meals largely con- 
 sisting of, or supplemented by, the products of pastrycooks 
 and confectioners ; while the country-bred child has meals 
 largely consisting of, or supplemented by, the fresh and 
 natural foodstuffs from the kitchen-garden and the orchard. 
 It should be noticed, however, that there is no necessary 
 connection between town life and dental caries. A class 
 illustration of this is to be found in the fact that certain 
 Jewish children who are brought up on food better adapted 
 for the preservation of the teeth and body in general, have 
 much better teeth and ampler dental arches than the 
 equally town-bred Gentile. So, too, the growth and 
 general physique are correspondingly better. 
 
 Another convincing corroboration of these views is to 
 be found in a consideration of the increased prevalence of
 
 62 PHYSICAL DETERIORATION 
 
 certain diseases. In a general way it may be said that we 
 are in less danger of disease than were our ancestors. The 
 advances of sanitary science, the steady progress of medicine, 
 and the control and conquest of one disease after another, 
 together with the general increase in comfort in which we 
 find ourselves, all tend to physical well-being and freedom 
 from disease. But notwithstanding this general ameliora- 
 tion there has been an appalling increase of those very 
 diseases which have their origin in the soft, refined, and 
 highly nutritious foods, which stimulate the muscular 
 activity neither of the jaws nor stomach nor intestine. 
 Dental caries was once an almost unknown disease ; now 
 in England, at least, it is the most prevalent of all diseases. 
 Indigestion and constipation have become so common that 
 they are almost looked upon as necessary concomitants of 
 civilization. Increased mortality is caused by diarrhcjea 
 resulting from undue lodgment and consequent fermenta- 
 tion of food in the intestine. Appendicitis, from the 
 lodgment of faecal or other matter which the weak or 
 sluggish intestine is unable to pass on, is an alarmingly 
 fashionable disease. Neurasthenia, arising from gastric 
 and intestinal insufficiency, is now quite common, although 
 a generation ago even the name of the disease did not 
 exist. Adenoids have become so common that a new class 
 of surgeons is kept busy removing them. Lastly, anaemia 
 and rickets, presumably from malassimilation and oral 
 sepsis have increased. Yet, in spite of these terrible facts, 
 the nutritious pap system of feeding children is gaily 
 advocated by intelligent and responsible physicians ! 
 
 We may now say a few words with regard to the
 
 IN RELATION TO THE TEETH 63 
 
 methods by which the conditions which lead up to the 
 deterioration of the teeth and general physique may be 
 combated. 
 
 The inspection of school children's teeth by a qualified 
 dental surgeon would be of much use, but my belief in the 
 complete success of such inspection as a means of prevent- 
 ing dental troubles is not very great. The teeth are most 
 liable to be attacked by caries before the child goes to 
 school, and by the age of five many children are amply 
 supplied with carious teeth and septic roots which 
 seriously jeopardize development, if indeed they have not 
 already more or less ruined the constitution. Thus it is 
 that the natural method of combating the troubles will 
 always remain the most important. Mothers ought to 
 know or learn how to rear, and more especially to feed, 
 their children. I do not seriously propose this, but I 
 believe it will soon be seriously proposed that before a 
 woman shall be granted a certificate of marriage she will 
 be required to pass an examination on hygiene and dietetics. 
 Perhaps a political agitation on the subject might have a 
 beneficial moral effect. Unfortunately there seems to be 
 but little organized desire on the part of the public to 
 know how to prevent the disease, and no inducement is 
 given to medical men to investigate the subject. Doctors 
 and dentists are seldom consulted on how to prevent 
 disease. They are consulted and paid for their skill in 
 curing it, and naturally devote their best attention to that 
 for which they are paid. Perhaps a society for the pre- 
 vention of disease might do much good. 
 
 Another point of importance is the formation of healthy
 
 64 PHYSICAL DETERIORATION 
 
 ideals. At present the ideals are weak and unwholesome. 
 A mother's intention or ideal nowadays is to avoid giving 
 her child any food which it will be unable to digest ; and 
 so it is kept on what is essentially an infant's diet for years 
 after it should have been able to eat practically anything. 
 Unfortunately, this ideal is often apparently encouraged 
 by the medical practitioner. When he is consulted with 
 regard to digestive troubles he almost invariably tells his 
 
 O O J 
 
 patient to stop eating this or that food. He seldom tells 
 the patient how to strengthen the digestion so as to be 
 able to eat the foods which were found to disagree. 
 Naturally the patient wants to eat what he likes, and 
 sometime or other does so ; but nothing having been done 
 to increase his digestive capabilities, the eating of the 
 forbidden food leaves him worse than ever. This process 
 of forbidding articles of diet while nothing is really done 
 to strengthen the digestion often gets carried further and 
 further until the miserable patient is limited to little more 
 than breadcrumbs, boiled fish, and milk. 
 
 It should surely be realized that the process of digestion 
 has arisen to extract nutriment from more or less in- 
 nutritious foodstuffs, while the wholly innutritious part is 
 passed along the intestine to be evacuated. The present- 
 day belief would appear to be to take in nourishment by 
 the mouth, and by the aid of pills render the intestine 
 capable of extracting excrement from it. 
 
 The continual increase of highly-prepared and nutritious 
 foods is a matter to cause grave apprehension to anyone 
 who is convinced that it is a necessity to eat the natural 
 foodstuffs to which the alimentary canal, from mouth to
 
 IN RELATION TO THE TEETH 65 
 
 anus, has through countless generations become adapted. 
 Almost every day we have thrust upon our attention 
 some new extract of beef, or some predigested or malted 
 preparation, or some proprietary food imitating all the 
 disadvantages of milk. It should be impressed on every- 
 one that all these highly assimilable preparations are 
 most dangerous, in that they are sure to leave a small 
 residue in the intestine which is bound, sooner or later, 
 to ferment and give rise to ptomaines and other highly 
 poisonous products. Unless such foods are taken with a 
 large amount of chemically inert matter, such as certain 
 forms of cellulose, which will cause a regular, at least daily, 
 evacuation of the bowels, they should only be taken after 
 having had the advice both of a consulting physician and 
 a dental surgeon. 
 
 Physical training and gymnastic exercises have been 
 advocated as a means of preventing physical degeneration, 
 but until the body is properly nourished, and the diseases 
 which cause physical degeneration have been eradicated, 
 they will be of little avail. Moreover, as it is writ large 
 in Fletcher's collection and epitome of some valuable con- v 
 tributions to the subject,* "Do right in the feeding of 
 your body, and an irresistible desire for physical exercise 
 
 will follow as a matter of course. 11 
 
 Above all, however, it is necessary that there should be 
 something approaching unanimity of opinion among the ' \As^ ^ 
 members of the medical and dental professions. If doctors vV ~ ^ 
 
 differ, how can we blame parents for ignorance ? Many 
 mothers are anxious to learn, and take all reasonable 
 * " The A. B. Z. of our own Nutrition." 
 
 M
 
 66 PHYSICAL DETERIORATION 
 
 trouble to do what is right, but on that very account 
 they fall into error from following erroneous teaching. I 
 believe I am correct in saying that there are the most 
 fundamental differences of opinion in the dental profes- 
 sion as to the methods to be employed to prevent dental 
 caries, nor is the medical profession unanimous as to the 
 correct methods of feeding children. Some few advocate 
 hard or fibrous food demanding mastication. Others, 
 such as an American authority who has recently written 
 on the subject, contend that children should be allowed 
 nothing but soft food till the age of six, lest the teeth 
 should be injured ! 
 
 It may be said that I, at least, have little justification 
 in urging unanimity of opinion, as but for the views 
 advanced in my investigation into the " Cause and Pre- 
 vention of Decay in Teeth " and of those few who have 
 followed on similar lines, there is as perfect unanimity as 
 could well be expected. Perhaps so ; but this very unan- 
 imity of opinion and consequent identity of the methods 
 advocated and adopted, together with greater prevalence 
 of the disease in the class which used the methods most, 
 led me to doubt the wisdom of the procedures, and it was 
 only after mature consideration that I ventured to make 
 known my views. 
 
 Recent changes of opinion both in the dental and 
 medical professions amply justify the position we have 
 taken up. If what we read is accurate, then, indeed, a 
 revolution would appear to have come over the dental 
 profession. Last year Mr. Hopewell Smith said : " Ask 
 a hundred per cent, of the members of the British Dental
 
 IN RELATION TO THE TEETH 67 
 
 Association to name the two great remedies against the 
 initial commencement of caries of the teeth, and all with 
 one voice will exclaim, 'The use of the tooth-brush and 
 the use of antiseptic mouth- washes. 1V> This year we read 
 in the Dental Annual that "interest has been aroused by 
 iconoclastic opinions ventilated in medical periodicals as 
 to the efficacy of tooth-powders and the artificial opera- 
 tion of brushing the teeth and gums. There has been a 
 remarkable consensus of opinion as to the superiority of 
 early mastication, the use of hard and resisting food, and 
 the general exercise of the jaw muscles ... as compared 
 with soft feeding and artificial cleansing." 
 
 I doubt if converts to a new truth are so speedily got 
 unless both the older beliefs are hopelessly insufficient, and 
 the new ones are obviously in accord with known facts. 
 
 Surely the time has come when we might advocate 
 something which would really prevent caries of the teeth 
 and those other diseases which are at present doing so 
 much to ruin the national physique. We must not be 
 misled or discouraged by those who in spite of the most 
 convincing evidence, still maintain that " the cause of the 
 prevalence of dental caries has yet to be discovered. 11 
 Dental caries is preventable, and we know enough to 
 explain how this may easily be done. We know also 
 quite enough of the physiology of digestion to warrant 
 us in condemning the pap system of feeding children.* 
 
 In conclusion I would remind you that it is not only a 
 dental question, it is not only a medical question, it is not 
 
 * "Observations on Mastication," by Harry Campbell (Lancet, 
 July, 11, 18, 25, and August 8, 1903). 
 
 52
 
 68 PHYSICAL DETERIORATION 
 
 only a national question, but it is probably the most im- 
 portant of all questions affecting the physical well-being 
 of humanity throughout the length and breadth of the 
 civilized world. It may be urged that the civilized world 
 may not follow our principles, and the success which other- 
 wise might have been achieved will not be got. It may 
 not be possible for us to make the deaf hear or the dull 
 appreciate, yet a system which allows a more liberal, a 
 more varied, and a more natural if less nutritious diet, may 
 at least be acceptable to the great majority. 
 
 Certainly 1 believe we can and will do much to prevent 
 the increase of dental caries, and those diseases of kindred 
 origin to which we have referred ; but if " "'tis not 
 in mortals to command success, we can do more, we 
 can deserve it."
 
 CHAPTER VII. 
 
 COMMENT ON PHYSICAL DEGENERATION IN 
 RELATION TO THE TEETH. 
 
 THE attractiveness of the title, or the general interest 
 taken in the subject caused the foregoing paper to be 
 abstracted and commented upon in a great number of 
 journals. On most of these criticisms I do not intend to 
 make any comment, but one or two which suggested that 
 physicians would probably have good reason for upholding 
 the system of feeding which I attempted to condemn, 
 compel me to quote somewhat fully a leading article in 
 the Medical Press : 
 
 " A paper was read by Dr. Sim Wallace at the recent 
 annual meeting of the British Dental Association at 
 Aberdeen, on the connection between physical degeneration 
 and dental caries, in which an original line of reasoning 
 was followed with the object of showing that it is to the 
 food of the people that their dental troubles must be 
 attributed. Without committing ourselves to Dr. Sim 
 Wallace's conclusions, we may say that his paper was 
 suggestive, and deserves to be well pondered. He began 
 by pointing out that there is no evidence that the ill- 
 developed classes of society have teeth more susceptible to 
 decay than those of good physical development, but that 
 
 69
 
 70 COMMENT ON PHYSICAL DEGENERATION 
 
 admittedly conditions of malnutrition and emaciation act 
 prejudicially to the proper growth of the teeth. So long 
 as the teeth are defective it is hopeless to expect physical 
 development to go on satisfactorily. The two developments 
 are intimately correlated. He then dealt with the evils 
 resulting from infected cavities in the teeth, and from 
 vitiation of the oral secretions by the products of bacterial 
 action, and showed that much as these undoubtedly 
 lowered the resistance of the mouth and throat to disease 
 onslaughts, an even more serious result is the chronic 
 absorption into the blood of septic matter. In these 
 ways the lower classes, even though they set out better 
 equipped dentally than their superiors, suffer greater 
 impairment of health, for they are far less careful of 
 their mouths than their more fortunately circumstanced 
 fellows. But the most interesting part of Dr. Wallace's 
 paper was that which discussed the cause of the modern 
 inferiority of teeth to those of our forebears. Dr. Wallace 
 had often been struck by the superior quality of the teeth 
 of those who ate the least soft and refined food, and by 
 the fact that such people possessed better digestions than 
 those brought up on refined and apparently physiologi- 
 cally digestible food. It is his deliberate opinion that 
 food demanding thorough mastication in the mouth is 
 not only best for the teeth, but for the stomach and intes- 
 tines also, and that the early decay of teeth and the 
 sluggish action of the alimentary canal, which is evidenced 
 by indigestion and constipation, are the direct outcome ot 
 the habit of eating refined, soft food. Such foods allow 
 the function of mastication to fall into desuetude, and the
 
 IN RELATION TO THE TEETH 71 
 
 child, when he finds a lump in his food, falls into the 
 habit of swallowing it whole ; the teeth decay, and the 
 digestive functions become perverted. All these circum- 
 stances lead to a demand for still softer and more 
 nutritious foods, and the evils are perpetuated in geo- 
 metrical progression. Dr. Sim Wallace is prepared to 
 attribute to this unnatural tendency not only dental 
 caries, but also diseases such as appendicitis, rickets, 
 neurasthenia, adenoids, and anaemia. We are inclined 
 to agree with him that the preparation and quality of 
 food used at the present day are some of those circum- 
 stances of civilization that operate differently to what 
 have been expected. It is a well-known fact that the 
 physiologically perfect products of the laboratory com- 
 bined in theoretically perfect quantities frequently fail 
 to nourish those to whom they are administered, whilst 
 natural foods that contain much that appears unnecessary 
 and harmful, agree well. No one can regard with pleasure 
 the consumption, now so fashionable, of artificial, concen- 
 trated food products, and it is quite possible that the 
 indigestible parts of natural food may have a useful 
 function to perform in the economy. One of these func- 
 tions may certainly be that of keeping the teeth in 
 healthy order, and, if this be so, while the present 
 dietetic arrangements in the community persist, it is 
 not likely that any amelioration in the teeth of the 
 race will take place. Evidence telling in favour of 
 Dr. Sim Wallace's theory should be eagerly sought, for 
 there must be a good deal capable of being brought
 
 72 COMMENT ON PHYSICAL DEGENERATION 
 
 forward if it be the true one. At any rate, the whole 
 subject is one of so much moment that no efforts to 
 ascertain the facts should be neglected. Dental caries 
 has been lightly regarded far too long ; it is now assuming 
 dimensions that are more or less alarming."
 
 CHAPTER VIII. 
 SPECULATIONS AND SUGGESTIONS. 
 
 A MIXED meal is generally regarded as physiologically 
 correct, and there is no doubt that certain combinations 
 are distinctly advantageous while the separate component 
 parts may be actually harmful. Thus sugar, cellulose, 
 vegetable acids and bitter principles, combined as they are 
 in many fruits, are admittedly beneficial, while each one 
 separately may be actually harmful if indulged in freely. 
 Most vegetable foods, especially fruits, very generally 
 associate cellulose, sugars, acids, and acrid principles, and 
 it is scarcely right to consider the effects of any one of 
 them when dissociated from the others. They naturally 
 supplement each other. Thus, while the cellulose, on 
 account of its physical nature is arrested in the mouth, 
 and disintegrated by the teeth, the acid and acrid princi- 
 ples stimulate the flow of saliva and help to loosen the 
 cellulose framework. Further, the acrid taste often re- 
 mains in the mouth and continues to stimulate the flow 
 of saliva even after the food has been swallowed. Then, 
 again, the sugars stimulate the secretion of saliva. The 
 mucous glands are likewise stimulated, and so the cellu- 
 lose, and even any ligneous shreds which may accompany 
 it, are coated with mucus and rendered fit for passage 
 
 73
 
 74 SPECULATIONS AND SUGGESTIONS 
 
 along the alimentary canal. Moreover, this copious 
 secretion of saliva helps the more thoroughly to convert 
 the starch and sugars, and the prolongation of the stage 
 of alkaline digestion in the stomach has a certain 
 importance in further disintegrating cellulose. 
 
 It is not only on account of the effect on the cellulose 
 that I would refer to the collateral benefits of bitter and 
 acrid tastes. I would refer to them because the orthodox 
 habit of giving young children almost nothing but soft, 
 bland, generally alkaline food has disastrous effects that 
 are never dreamt of. Thus, being for prolonged periods 
 deprived of these bitter and acrid substances, when 
 opportunity affords, children very generally over-indulge 
 in quite unripe and acrid fruits or acid drinks. If, 
 however, the taste for bitter principles is allowed, or, 
 better, gradually stimulated to develop, then such excesses 
 are not indulged in. Similarly, a liberal supply of fresh 
 ripe fruit helps to prevent the craving for, and excessive 
 indulgence in, sugar or sweets. At first, strongly acrid 
 flavours, generally and advantageously, act as deterrents 
 in the selection of foods, but by experiment and by 
 following the example of the parents, the taste for these 
 bitter principles becomes largely acquired. Frequent 
 association of acrid with irritant principles, however, has 
 naturally prevented a pronounced development of the 
 instinct for bitter principles, which, when fully developed, 
 is somewhat antagonistic to the desire for sweets. The 
 supply of sugar which was available for our ancestors 
 was very limited, and therefore prevented an excessive 
 indulgence in it however strong the craving for it became.
 
 SPECULATIONS AND SUGGESTIONS 75 
 
 It is important to recognise this fact, not because the 
 ruin of the teeth gives rise to many more serious troubles, 
 nor because the injury to the teeth means ruin to the 
 power to digest and relish some of the most luscious 
 foods, but because it has become the fashion to belaud 
 the dietetic value of sugar and to look upon it as an 
 important food, while in reality it should be sparingly 
 used and regarded rather as a condiment. What does 
 it matter whether we can turn sugar into so many units 
 of energy, if at the same time it ruins the teeth and 
 -irritates the stomach to such an extent that healthy and 
 vigorous digestion is lost ? 
 
 It is just possible that the considerable exclusion of 
 fruit and vegetable juices, together with the sugar, 
 aromatic, acid and bitter principles which they contain, 
 may give rise to an excessive indulgence in alcohol. In 
 European countries, at least, where fruits are most freely 
 consumed, drunkenness is rare, whereas in countries in 
 which fruit is not freely consumed, and more especially 
 in those countries in which the cereal and animal foods 
 form a large part of the daily dietary, excessive indul- 
 gence in drink is much more frequent. Even in England 
 the amount of drunkenness is markedly low in fruit- 
 growing counties such as Kent and Devon, whereas in 
 Northumberland, especially in mining districts where the 
 vegetable food is almost solely of a cereal nature, drunken- 
 ness is particularly common. Another factor which may 
 possibly prevent fruit-eating people from an undue 
 craving for an alcoholic stimulant, is to be found in 
 the fact that fresh vegetable food, when thoroughly
 
 76 SPECULATIONS AND SUGGESTIONS 
 
 masticated, gives rise to a feeling of activity, whereas a 
 meat meal tends to give rise to a feeling of lassitude, 
 and an alcoholic stimulant may then be naturally desired 
 to counteract the feeling. 
 
 In precibicultural times man had to subsist upon what 
 he could find, and as the vegetable substances were not 
 of a highly nutritious nature, it was necessary for him to 
 be continually in search of food when only vegetable 
 products were available. No doubt those in whom a 
 vegetable diet produced a feeling of energy survived, for 
 such a diet required of them almost continuous activity. 
 This forms a contrast with the effect produced by a 
 large meat meal ; for following this the most beneficial 
 state is one of repose, in which the ample supply of 
 albuminous nutriment may most readily and quickly be 
 utilized in the rebuilding of the tissues. In all parts 
 of the world and at all times it seems to have been 
 the custom for adults to increase the energetic feeling 
 by the consumption of various vegetable extracts or 
 stimulants of various descriptions, and under the condi- 
 tions which we have suggested, the beneficence of such 
 stimulants may be recognised. If this be so the desire 
 for stimulants cannot be regarded as an accident or as 
 a by-product of evolution, but rather as a beneficient 
 instinct under certain environmental and dietetic condi- 
 tions. Without saying more at present, it may be noted 
 that the origin and cause of such cravings suggest that 
 they might be mitigated by certain dietetic changes. 
 Firstly, in the adoption of a less highly nutritious diet, 
 whether of an animal or of a cereal nature. Parti-
 
 SPECULATIONS AND SUGGESTIONS 77 
 
 cularly an avoidance in the routine dietary of those 
 highly nutritious foods which are found to produce a 
 feeling of lassitude. Secondly, in a more liberal supply 
 of acid fruits, of bitter, pungent, and stimulating princi- 
 ples, and in general a more careful appreciation of the 
 value of condiments, not only in the diet of adults, but 
 even in the diet of children. 
 
 I would also advocate another form of mixed meal, 
 namely one in which the food contained a large amount 
 of solid matter, stimulating or demanding ample mastica- 
 tion. The reasons for this are so obvious that one 
 wonders why it has become possible for physicians to 
 advocate the giving of bread well soaked in milk to young 
 children. Perhaps it is advocated so that the clot formed 
 of the curded milk may be broken up and one of the dis- 
 advantages of milk avoided, but it is doubtful if the 
 present-day maxim of milk at any cost justifies the 
 deluging of children's stomachs with unconverted starch. 
 
 The recommendation in otherwise excellent treatises of 
 a diet consisting almost wholly of " bread well soaked " in 
 milk and the like,* shows a complete disregard not only of 
 the physiology of mastication, but also the whole of that 
 important part of digestion which takes place in the 
 mouth. Meat, fish, and poultry, tender or otherwise, 
 according to the age and capabilities of the stomach, 
 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 
 
 * " Food and the Principles of Dietetics," Hutchinson, p. 457.
 
 78 SPECULATIONS AND SUGGESTIONS 
 
 minced, little or no mastication is called forth. With 
 young or delicate children the most tender meat may be 
 given, and in order to have it specially easily digestible, 
 yet of a consistency necessitating mastication, it may be 
 given more or less raw. If the child tends to swallow 
 without mastication, cut the thin pieces larger. Only in 
 extreme cases is the giving of raw meat juice a necessity, 
 and then it should only be a temporary expedient. The 
 harmfulness of inefficient mastication as regards gastric 
 digestion has long been recognised, and, curiously enough, 
 in order to make things right, food, at least for children, 
 is generally practically masticated before introduction into 
 the mouth, but to my mind this only augments the cause 
 of the evil for which it is intended to make amends. In 
 other words, this preparation of food as exemplified, for 
 example, in minced meat, or gravy and mashed potatoes, 
 only further induces the child never to acquire the habit 
 of mastication. 
 
 This is not all. The physiology of digestion is not a 
 piecemeal business. All parts of the process are intimately 
 co-ordinated. To illustrate this fact, which physiologists 
 have not fully appreciated until recently, we may mention 
 that if the oesophagus of a dog is cut, and arranged in 
 such a way that food swallowed is passed out at the cut 
 end instead of passing into the stomach, the psychic 
 effect caused by the mastication of the food, produces a 
 very considerable flow of gastric juice, definite in amount. 
 The entrance of food into the stomach, too, causes a 
 definite amount of gastric juice to be secreted. Food 
 introduced into the stomach unaccompanied by mastica-
 
 SPECULATIONS AND SUGGESTIONS 79 
 
 tion and concommitant psychic effect, only stimulates a 
 partial secretion of the gastric juice.* 
 
 Then, too, the amount of saliva secreted has its effect 
 on gastric digestion. Not only does it promote the 
 digestion of starch in the early stages of its lodgment 
 in the stomach, but probably the permeation of the proteid 
 with the alkaline saliva renders such food more subject to 
 the ingress of the gastric juice. The saliva does not 
 contain mucus, carbonate and phosphate of soda, etc., for 
 idle purposes. Perhaps our semi-atrophied salivary glands 
 may predispose to indigestion. I have heard that the 
 alkali in the masticated food allows the propepsin secreted 
 by the gastric glands to permeate the food, and form pepsin 
 in the substance of the food in the nascent and therefore 
 most active condition. However, to administer to children 
 with teeth, food which does not require mastication, is to 
 ignore a primary fundamental and important stage of 
 digestion. This point need not be elaborated, for it is 
 hardly necessary to insist upon the fact that good digestion 
 waits not only on appetite but on mastication, and if we 
 swallow food without mastication active digestion is not 
 stimulated, and the seeds are sown of indigestion, irregu- 
 larities and caries of the teeth, appendicitis, etc. 
 
 The impoverished and decreasing power of lactation 
 with which the modern mother is afflicted is no doubt the 
 result of a weak and impoverished digestion, but this does 
 not require to be dwelt upon. It is only necessary to 
 glance at the dental armamentarium and observe the 
 
 * "The Work of the Digestive Glands," Pawlow and Thompson, 
 Chapter IV.
 
 80 SPECULATIONS AND SUGGESTIONS 
 
 deranged positions of what teeth remain, not to speak of 
 the diseases which may probably be progressing, to ob- 
 serve the legacy which modern dietetics has bequeathed to 
 her. This is, of course, only an index of the general 
 derangement of the entire length of the alimentary canal. 
 
 Akin to these considerations is the fact, lamented alike 
 by the medical profession and all those who have the 
 welfare of the nation at heart, that there is a progressive 
 increase of sterility. 
 
 The causes of sterility are well known ; impaired 
 nutrition, with local manifestations either associated with 
 derangements of secretions or with certain displacements, 
 is responsible for much, and the latter often defeats the 
 object devoutly to be wished even though impregnation 
 has taken place. Lastly it should be mentioned that 
 artificial sterility is connected in perhaps the majority of 
 cases with circumstances which we can readily understand. 
 It is well known that the child-bearing period involves a 
 considerable and perhaps usually a very severe strain upon 
 the healthy mother ; what then must it be to one with a 
 weak digestion and impoverished health, the result of 
 dietetic errors commenced early and continued more or 
 less throughout the whole of life ? If in addition to this 
 we contemplate the " time " these delicate mothers have 
 with an ill nourished child, reared on foods which are a 
 constant source of trouble, we may grant at least that 
 there are extenuating circumstances. Moreover it should 
 be remembered that the instincts and concomitant 
 gratifications of maternity may be perverted by weak 
 health and impaired nutrition, for the demands are of a
 
 SPECULATIONS AND SUGGESTIONS 81 
 
 material nature, and correspondingly require a healthy 
 body and a thoroughly efficient digestive apparatus, while 
 those who have a weak digestion and weak health are 
 more likely to be satisfied by gossip and light literature, 
 which tax the material output much less severely. 
 
 The value of milk in the diet of children is at the 
 present day largely overestimated, and it should be dis- 
 tinctly recognised that it is an extremely unnatural food 
 for children over about the age of two years. It is a 
 form of food which does not even approximately resemble 
 any of the foods to which the alimentary canal of children, 
 with twenty functional teeth, has through thousands of 
 generations become adapted, and it will not surprise us if 
 a consideration of the effects of a milk diet leads us to 
 deprecate its continuance. 
 
 " Being a complete food, milk may form an exclusive 
 diet, a purpose for which it is frequently employed, as in 
 the systematic treatment of renal affections. In a person 
 thus nourished one frequently finds the tongue coated, the 
 breath 'foul, and a condition of habitual constipation. 
 The diet makes no demand on the functional activity of 
 the muscles of mastication nor on the salivary, lingual, 
 and mucous glands ; moreover, apart from the absence of 
 stimulus to secretion, the mucous surfaces become lined 
 with a thin film of milk, which blocks their orifices, and 
 forms a nidus for the growth of saprophytes. Hence a 
 foul mouth, coated tongue, and acidity, betraying func- 
 tional inactivity and initiating structural decay. The 
 liquid meal pours into the stomach unheralded by nervous 
 reflex and unmingled with stimulating salivary secretion. 
 
 6
 
 82 SPECULATIONS AND SUGGESTIONS 
 
 Consequently no preparation has been made for its recep- 
 tion, its visit is unexpected, and its behaviour renders its 
 presence unwelcome. The liquid garb of innocence is 
 discarded and discloses masses of solid curd, difficult of 
 access to the gastric juices, causing an irritative flow of 
 mucus and affording a soil favourable to the growth of a 
 varied pathogenic flora. The fermenting mass of curd 
 struggles through the pyloric orifice, disturbs the hepatic 
 function, irritates the bowel, evolves gases and refuses to 
 move on without the aid of mercurial or saline purgation ; 
 in a word, it acts the part of the rabid and iconoclastic 
 social reformer. 
 
 " Such is often the effect of whole liquid milk taken as an 
 exclusive food. Now, however, it is rarely given without 
 dilution or admixture with other ingredients which serve 
 to break up the curd or otherwise prepare it for absorp- 
 tion. But in whatever form taken liquid milk retains the 
 essential disadvantages of liquid foods in general viz., 
 that it passes direct to the stomach without making any 
 demand on the complex mechanico-physiological processes 
 of mastication. 11 * 
 
 This quotation refers to pure, fresh milk, uncontaminated 
 with the various foul products for which it is well known 
 to have special affinity. The cows themselves may be 
 diseased, thus tuberculosis in dairy-fed cattle is extremely 
 prevalent ; " due to these factors, overcrowding, absolutely 
 inadequate ventilation and want of sunlight and exer- 
 cise. The disease occurs in t 20 to 40 per cent, of such 
 animals. . . . Apart from the condition of the animals, 
 * Stuart Tidey, M.D., (Lancet December 17, 1904).
 
 SPECULATIONS AND SUGGESTIONS 83 
 
 the method by which the milk is collected is utterly in- 
 sanitary. Absence of any attempt to groom the cows, or 
 to remove the hardened faeces which encrust their flanks, 
 absence of any facilities for the milkers cleansing their 
 hands or wearing clean overalls, and finally, the fact that 
 on the same employe devolves the duty of cleansing the 
 byre as well as milking the kine. These considerations 
 lead one to be surprised, not at the filth the milk contains, 
 but at the fact that it does not contain more."* 
 
 When we consider this state of affairs we are not sur- 
 prised to learn " that during the sufferings and starvation 
 connected with the Siege of Paris in 1870-71, while the 
 general mortality was double, that of infants was said to 
 have been reduced by about 40 per cent., owing to mothers 
 being obliged to suckle their infants." The same increase 
 of adult and diminution of infantile mortality was seen 
 during the Lancashire Cotton Famine, when Newsholme 
 notes " mothers were not at the mills." It cannot be 
 doubted that if cow's milk were totally unprocurable for 
 infants and children the death-rate would be largely de- 
 creased. But notwithstanding this it may be granted that 
 under certain stringent regulations, honestly and intelli- 
 gently carried out, and under certain conditions, cow's 
 milk may be advantageously supplied to children for a 
 time. It should, however, be distinctly observed that the 
 administration of milk, or a milk-soaked diet to children 
 with twenty teeth, shows as much regard for the anatomical 
 
 * "The Milk Supply of Edinburgh: With Suggestions for its 
 More Stringent Control/' by Aitcheson Robertson, M.D. Edin. 
 Read before the Edinburgh Medico-Chirurgical Society, January 18, 
 1905. 
 
 62
 
 84 SPECULATIONS AND SUGGESTIONS 
 
 and physiological requirements of the child, as would the 
 administration of potatoes and mutton, with or without 
 milk, to the toothless infant. 
 
 It is not only the milk-soaked diet and pap-feeding 
 which is recommended for children that we object to, but 
 the number and arrangement of the meals. What, for 
 example, could be more disastrous to a child's teeth than 
 " a little milk and a plain biscuit, or a piece of bread and 
 butter 11 * at bed-time? This, be it observed, is preceded 
 by a meal at 4.30 p.m. consisting of " cocoa or milk with 
 bread and butter or a stale sponge cake." Further com- 
 ment is unnecessary. It may be asked what would you 
 substitute for the recognised practices ? The anatomical, 
 physiological, and instinctive peculiarities of the child 
 furnish us with an easily recognised guide to their correct 
 feeding. At about the seventh or eighth month the 
 incisor teeth cut the gum. This is accompanied by an 
 increased secretion of saliva and a desire on the part of 
 the child to gnaw. Theoretically on the eruption of 
 incisor teeth it should be given some more or less nu- 
 tritious vegetable, such as sugar-cane, to gnaw and suck, and 
 thus supplement the milk diet which at this age decreases 
 in strength and amount. Practically it may be given a 
 stale crust to " cut its teeth upon," or, perhaps better, a 
 small uncut bread roll, preferably cigar-shaped. This 
 should be supplemented by fruit juice. Another imitation 
 of the theoretically correct method of introducing infants 
 with incisor teeth to solid food may be made by giving 
 them a little fruit juice or the pulp of grapes, and allowing 
 * Chavasse's "Advice to a Mother," 15th edition, p. 148.
 
 SPECULATIONS AND SUGGESTIONS 85 
 
 them to satisfy their sucking and gnawing propensities on 
 some such substance as leather or indiarubber. The fruit 
 juices are beneficial and so also is the gnawing and sucking, 
 moreover, as the physiological requirements of children are 
 unprovided for in the present generation, it is impossible 
 always to procure fresh sugar-cane and fruit which can be 
 gnawed and from which the juices can be sucked. I 
 mention this method not as a counsel of perfection, but 
 rather to show that certain customs which are somewhat 
 prevalent, approach more nearly to what is, in my opinion, 
 theoretically correct, than are the principles and practices 
 of our modern authorities on dietetics. As the teeth 
 increase in number so must the amount of food which it is 
 allowed to gnaw and suck. When about the fourteenth 
 month the molar teeth come into position the gnawing 
 and sucking must give way to, or rather be supplemented 
 by, true mastication. At this age, then, toasted bread and 
 butter from which the crust has not been removed, or 
 rusks, may be given, and as the solid food is increased so 
 proportionately should the milk be diluted, or even at this 
 age be superseded more or less fully by water. 
 
 It should be recognised that solid food when first given 
 to children should be distinctly different in consistency 
 from the liquid food to which they were previously 
 accustomed, so that at an early age they may come to 
 recognise the difference between solid and liquid food and 
 to treat it accordingly. If this is done, the choking and 
 spluttering which is such a frequent result of giving more 
 or less soaked food to children is obviated. 
 
 After the eruption of the incisor teeth the milk should
 
 86 SPECULATIONS AND SUGGESTIONS 
 
 be more and more diluted till the eruption of the molar 
 teeth, and when these have come into full functional 
 activity, the milk, if it is cow's milk, ought always to be 
 boiled and used rather to flavour the water, if it is used at 
 all, than as a source of nutriment. With the increase of 
 solid food requiring longer to digest, the intervals between 
 the meals should, of course, be correspondingly lengthened. 
 At the age of two years, or at most, two years and a half, 
 only three meals daily should be allowed. While this 
 ought to be a strict rule, the drinking of water between 
 meals should be allowed. At an early age, certainly after 
 the eruption of the first temporary molars, there should be 
 sufficient variety in the meals of the child to allow of the 
 arranging of the menu ; thus the toast and butter or 
 cereal food, whether taken alone or with a small amount 
 of light animal food, together with simply boiled green 
 vegetables, should be followed by fresh fruit, sugai'-cane, 
 or, at least, fruit juice. Should sweets or bonbons be 
 allowed they must in all cases be followed by fresh fruit. 
 
 When we recognise the philosophy of the natural 
 methods advocated, we see that everything seems to link 
 up with charming simplicity. Thus when there are no 
 teeth the child should have no solid food, and its instinct 
 to suck should be allowed gratification at its mother's 
 breast; when the front teeth appear, together with the 
 instinct to gnaw, it should be allowed to gnaw as well as 
 to suck ; when the first molar teeth appear it should be 
 allowed to supplement the gnawing and sucking and to 
 use them to grind or masticate its food. When it gets 
 its second molars it should be allowed to bite off' its food
 
 SPECULATIONS AND SUGGESTIONS 87 
 
 with its front teeth and masticate it with its molars, for it 
 has a complete set of teeth and they are there to be used. 
 Nothing could be simpler, nothing could be more easily 
 learned both by mother and child, and nothing could, I 
 believe, be more excellently arranged for the transition 
 from a milk diet to the natural foods for which the human 
 organism is so well adapted. 
 
 Eaillilre, Tindall <k Cox, 8, Henrietta Street, Covent Garden, London.
 
 WORKS BY 
 
 J. SIM WALLACE, D.Sc., MD., LD.S. 
 
 THE CAUSE AND PREVENTION OF DECAY 
 IN TEETH. 
 
 2nd Edition. Price 5s. 
 
 PRESS OPINIONS. 
 
 " We believe the conclusions are fair, and the day is not far distant when 
 the dental world will come to believe them as he believes them. We believe 
 no progressive, up-to-date practitioner of dentistry ought to be without the 
 book, to at least get the measure of himself by it, or to model his views upon 
 it." Dental Headlight, U.S.A. 
 
 " Mr. Wallace ably champions his own views, and the work has many 
 points to stimulate thought." Dental Record. 
 
 " Some excellent advice finds place in the concluding chapter as to the diet 
 best suited to lead to that great and rare blessing a good set of teeth. . . . 
 Mr. Wallace has certainly written a readable manual, and, further, has 
 brought forward a theory to account for dental decay, now so prevalent, 
 which seems novel, and likely to ' hold water "... and we have no hesita- 
 tion in recommending this short work to the attention of those who are 
 interested in this important question." Dublin Journal of Medical Science. 
 
 " If not absolutely convincing, is none the less of great importance in call- 
 ing attention to the dental dangers arising from our civilized methods of 
 preparing food." Journal of the British Dental Association. 
 
 DR. WALLACE'S brochure entitled " Solution of the Problem 
 of Susceptibility and Immunity to Dental Caries " is at 
 
 present out of print. It may, however, be obtained in The 
 Dental Record for November and December, 1903, and 
 January, 1904 ; or in The Dominion Dental Journal, March, 
 1904 ; or translated in the Tijdschrift voor Tandhulkunde, 
 XI e Jaargang, Afl. 1.
 
 ESSAY ON 
 
 THE IRREGULARITIES OF THE TEETH. 
 
 Demy 8vo., 162 pp., cloth. Price 5s. net. 
 
 PRESS NOTICES. 
 
 ' ' Dr. Wallace's book is full of interest, and will well repay perusal. As a 
 writer he is courageous and clear, his thoughts are forcibly expressed, he 
 stimulates the literary appetite, and never wearies his readers." Ash's 
 Quarterly Circular. 
 
 " The previous works by this author, showing in themselves such original 
 avenues of thought, prepare us in some measure for the present volume. In 
 it the author more than sustains his well-won reputation for originality, inas- 
 much as the theory advanced as to the causation of dental irregularities is a 
 distinct departure from the beaten track, and, as such, worthy of note. 
 Moreover, the careful perusal of this book, if it does not at once convert the 
 sceptic, certainly must turn his mind into fresh scientific channels from 
 which much may evolve." Commonwealth Dental Review. 
 
 " To those dentists who puzzled by the phenomena they daily witness 
 desire to consider causes, this work will well repay perusal. . . . We hail 
 Dr. Wallace's thoughts on the subject. . . . Some of us are even putting his 
 theories into practice. Dr. Wallace ... is combative, and is never happier 
 than when tilting at certain accepted theories enshrined in the text-books of 
 Tomes, Smale, and Colyer." The Dental Record. 
 
 " He also takes occasion to emphasize his well-known theory on the preven- 
 tion of irregularity. Dr. Wallace writes very convincingly on this topic, and 
 his conclusions are well worth studying." The Dental Review. 
 
 " The results of insufficient mastication, such as adenoids, irregularities and 
 caries of the teeth and 'indigestion,' are so common that we are apt to accept 
 them as a matter of course ; but when one realizes the amount of suffering 
 and of financial loss that they entail on the community, one recognises the 
 urgent necessity of finding a means of prevention, and it is because we believe 
 that Dr. Wallace has pointed out the means of very largely, if not entirely, 
 preventing these evils, that we heartily commend the book to the attention 
 of the profession." Scottish Medical Journal. 
 
 "... This theory of his is so well supported by his arguments as to make 
 out a very good case. . . . He thinks food ought to be more fibrous, and 
 after children have cut their deciduous teeth there should be no ' soft pap, 
 liquid extracts, and refined foods.' This is well worthy of consideration by 
 medical men as well as dentists. His classification of irregularities is entirely 
 a new one, and is consequent upon his theories of their causes. The sugges- 
 tions as to treatment, prophylactic and otherwise, will well repay perusal. 
 The essay is well written, and we can strongly commend the book to anyone 
 interested in the subject." Birmingham Medical Review. 
 
 " Finally, we say with confidence that any dentist carefully reading 
 Dr. Wallace's handbook will find it exceedingly interesting, and will be 
 sure to benefit by its perusal." British Dental Journal.
 
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