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

by Horace Fletcher

A mass of unmasticated food may lodge in the throat and cause fatal suffocation.—This may seem to be a very exceptional kind of evil, but I am informed by one whose experience makes him an authority on the ways of the British soldier that it is by no means uncommon for soldiers in barracks to die from this cause. Usually it is when they are under the influence of alcohol that fatal results occur, post-mortem examination disclosing large undigested masses of food in the stomach. A like experience is also frequently met with in the case of men killed by accident.

The presence of masses of imperfectly masticated food in the stomach may cause disturbance either mechanically or by reason of their imperviousness to the gastric juices.—We have already seen that the digestibility of a food is largely determined by its consistence, and that many articles of diet, such as cheese, hard-boiled egg, cocoa-nut, lobster, and new bread, which have the reputation of being very indigestible, can, if finely comminuted by chewing or otherwise, be rendered quite digestible. Such articles are indigestible essentially by reason of their compactness; the compact lumps, but little pervious to the gastric juice, tend to undergo abnormal chemical change in the stomach, and may in this way cause violent local irritation, even to the extent of setting up acute gastritis; or they may paralyse the nerves of the stomach and check gastric secretion and movement, and thus remain in loco wholly undigested for hours or even days; or, again, more distant nervous effects may be produced, such as frontal headache, which may be felt almost immediately after ingestion of the peccant substance, being of reflex rather than toxic origin, and presumably in some cases, at least, due to the mere mechanical irritation of the stomach. The passage of imperfectly digested food into the bowel may still further aggravate matters. It does not seem improbable that the habitual bolting of food, by the prolonged local irritation to which it gives rise, may predispose to cancer of the stomach: Napoleon was a notorious fast eater and it is well known that he died from this disease.

While, however, the bolting of food readily sets up disturbance in some, it must be conceded that in many it seems to cause little or no inconvenience; especially is this the case in the young with vigorous muscular stomachs capable of triturating the food, and thus doing duty for the teeth. The human stomach is, indeed, a long-suffering organ, and wonderfully tolerant of ill-treatment, sometimes almost rivalling in its hardiness the gizzard of the bird. Nor is this surprising when we reflect that it is, in the ordinary course of nature, constantly exposed to the entrance of noxious substances. In this respect it stands in marked contrast to the intestines, for not only are highly irritant substances often vomited rather than passed onwards, but in ordinary circumstances the gastric contents are not allowed to pass the pylorus, until they have been duly prepared by the stomach; the pylorus, in fact, stands guard over the entrance to the bowel and is jealous of anything passing it which is likely to injure that canal.

And just as the pylorus protects the bowel so, in exceptional cases, may the œsophagus protect the stomach, regurgitating, after the fashion of the ruminants, insufficiently masticated bits of food, in order that they may be re-masticated. I have myself met with cases in point. Sometimes, in cases of this kind, the œsophagus may be dilated into a sort of proventriculus, which is capable of temporarily lodging a large quantity of food. Such a proventriculus is said to have developed in an apprentice who, not being allowed sufficient time for his dinner, rapidly bolted it, to regurgitate it after working hours and to chew the cud at leisure. Whether in these cases the food is ever returned from the stomach itself I am unable to say.

While the stomach is the organ especially liable to be injured by the swallowing of lumps of unmasticated food, the bowel may also suffer, especially the cæcum and vermiform appendix. And here we come to one of the most serious indictments against the bolting of food; though man has doubtless always suffered from appendicitis, there can be little doubt that this malady is more common now than it used to be; and there is equally little doubt, in my own mind at least, that the cause of its greater frequency is related to his food. I do not propose to discuss here in detail how food is capable of causing appendicitis, but will merely refer to one of the ways in which it may do so. I had already come to the conclusion that the habit of bolting food is a potent cause, when I read Sir Frederick Treves’s Cavendish Lecture in which he makes that contention. Sir Frederick Treves points out that in this rushing age people, especially business men, are apt to hurry over their meals and to take them at irregular times and often while standing at a bar; even when there is more leisure, food is rarely masticated nowadays in the same thorough way that it was in the old time, when it was of a coarser nature: hence solid lumps, especially in the case of such articles as pine-apple, preserved ginger, nuts, tough meat, and lobster, are apt to pass beyond the pylorus and, escaping intestinal digestion, to lodge in the cæcum and precipitate an attack of appendicitis, the most common predisposing cause of which is a loaded cæcum, often preceded by constipation. Sir Frederick Treves contends that this distended state of the cæcum encourages catarrh of the appendix by dragging upon it and blocking its orifice, as well as by twisting it and thus interfering with its blood-supply.[22]

An excess of starch is apt to pass into the stomach.—We have just seen that inefficient mastication tends to promote over-eating, and what has been said on this head applies to all kinds of food, starchy foods among others. It leads, however, to a further evil as regards these latter; not only does it tend unduly to increase the quantity of them consumed, but it too often causes the stomach and intestines to become flooded with starch in a wholly undigested form. I cannot too frequently repeat that in ancient times, especially in the pre-cooking age, laborious mastication was needed in the case of all starchy foods, partly because they were coarse and fibrous, but chiefly because the starch and other nutritive ingredients had, in order to become available for nutrition, to be liberated from their undigestible cellulose envelopes. In these days of prepared, soft, starchy foods, however, mastication is very little required for these purposes, but in other respects it is as needful as ever, indeed more needful, if the large quantities of starch which are now consumed are to be insalivated effectually. The laborious and sustained mastication to which primitive man was compelled to subject his limited supplies of uncooked starchy food, went far to effect complete digestion of the starch within the mouth, for raw starch is freely digested by the saliva,[23] and hence in his case very little passed into the stomach in a wholly undigested form. How different is the case with us moderns. Since the opening of the era of agriculture and cooking, man has enormously multiplied his supplies of saccharide, and he now consumes large quantities of starch which has been freed from its cellulose framework by cooking, milling, grinding, and the like, and reduced to a soft or pappy form, such as milk puddings, porridge, boiled potatoes, and new bread, all of which can be swallowed with little or no preliminary chewing; and when food can be swallowed easily, without mastication, few will take the trouble to masticate it. In these circumstances the starch does not undergo adequate salivary digestion, and a large quantity passes wholly undigested into, and out of, the stomach, not beginning to be digested until it reaches the bowel. Small wonder that the latter should rebel again this invasion and that flatulence, pain, and other dyspeptic evils should result.

It is especially in young children that these evils are observed. Too often the stomach of the child, semi-carnivorous, remember, by its ancestry, is literally deluged with pure starch. At the seventh or eighth month, or even earlier, for many of the patent infant foods contain it, this substance is poured into the stomach without being afforded any opportunity of undergoing salivary digestion; and for a long time after infancy large quantities are given in the liquid or pultaceous form, such as rusks soaked in milk, puddings, and mashed potatoes. This practice of deluging the digestive organs with starch, besides leading to the more immediate troubles connected with flatulent dyspepsia, gives rise to abundant formation of toxins which, by irritating the alimentary mucous membrane, set up gastro-intestinal catarrh; this, again, intensifies the dyspepsia already existing and causes a still further production of toxins, so that the motions become intensely fœtid. These poisons being absorbed into the blood the tissues become saturated with them and the nutrition of the entire organism is disturbed, the faulty metabolism manifesting itself by a diminished resistance to pathogenic agencies, by a tendency on the part of the tissues to inflame (as shown by a liability in children thus fed to bronchitis, rhinitis, naso-pharyngitis, and tonsillitis), by their proneness to tuberculosis, and finally by a disposition to rickets, which I little doubt is essentially of toxæmic origin.

Besides the above-mentioned troubles an excess of starch in the stomach may set up hyperchlorhydria—i. e., that form of dyspepsia in which there is excessive secretion of hydrochloric acid. This affection occurs during the most vigorous years of life and is apparently due to excessive activity on the part of the gastric glands. The excess of acid does not give rise to any symptoms so long as there is any unsatisfied proteid in the stomach to unite with it, but directly all the proteid is satisfied and free acid is present in the stomach, pain, heartburn, and distention are apt to be felt; hence these symptoms are generally removed temporarily by a meal, the food ingested seizing upon the free acid, and tend to recur in the course of an hour or two. Other symptoms are mental and bodily lassitude and great mental depression, while, if the condition is long-continued, gastric catarrh and dilatation ensue. Eructation of the acrid mass, its removal with a tube, or its dilution or neutralisation by an alkali, causes relief of the symptoms. Now Dr. William Russell, who has recently studied this form of dyspepsia, has shown, and the fact is most significant from our present point of view, that in it starch is the last constituent to leave the stomach; that when this organ has so far emptied itself as to contain but one or two ounces of very acrid material the residue consists chiefly of finely divided undigested starch, which continues to stimulate the gastric secretion; “and, there being no more proteid with which to combine, the secretion accumulates and leads to hyperacidity.”[24] Inasmuch, then, as inefficient mastication leads to an excess of starch in the stomach, we see how it may predispose to hyperchlorhydria and we shall presently see that there is yet another reason why it should do so.

It will be gathered from the foregoing that thorough mastication is the most effective way of securing efficient starch digestion. This simple fact has been most strangely overlooked. Thus “van Valzah considers that not a little of the difficulty of the digestion of starches and cereals can be overcome by more thorough cooking. Patients who cannot eat potatoes after ordinary cooking are [he urges] often able to digest them very readily if they are doubly cooked before being served. Cereals, as a rule, should [he contends] be allowed to simmer all night and then be thoroughly cooked for a half hour in the morning before being eaten.”[25] This is an admirable illustration of the modern tendency to cheat the mouth of its proper work. A much more rational way of facilitating starch digestion in those who experience a difficulty in this respect is by efficient mastication.

Evils resulting from an insufficient quantity of alkali in the stomach.—I doubt if it is adequately realised what a large amount of alkaline saliva passes into the stomach as the result of prolonged mastication. Its presence there serves the useful purpose of prolonging the period of starch digestion within the stomach, while it further aids gastric digestion not only by exciting the secretion of gastric juice, but also by its influence on the reaction of the gastric contents; it can scarcely be doubted that the effect is on the whole one favourable to digestion in general. We have just seen that defective mastication may predispose to hyperchlorhydria by allowing an excess of pure starch to pass into the stomach, and I suggest that it may further operate in the same direction by cheating the stomach of its due supply of alkaline saliva. Now the saliva in this affection is apt, as was pointed out by Sir William Roberts, to be superalkaline, and for this reason he recommended his acid-dyspeptics to excite the flow of it by chewing gum-mastic with the object of neutralising the gastric hyperacidity. That relief can thus be obtained there can be no doubt; but it is surely more rational to get the patient to stimulate his salivary glands by masticating actual food, by which we secure the additional advantages accruing from its complete insalivation and comminution as well as from the reflex gastric effects. Actuated by these considerations, I have long been in the habit of recommending hyperchlorhydriacs to subject their food to prolonged mastication, this being, in my belief, the most rational and effective way of breaking the stomach of its vicious habit. In extreme cases we must insist that each morsel of food should be chewed at least one hundred times and not permit any relaxation of this severe discipline, until the stomach has been schooled into healthier ways. Evils in connection with the jaws and their appendages and the adjacent structures: the nasal passages, naso-pharynx, and faucial tonsils.—In those who do not masticate properly in early life these parts fail to develop as they should, and they are on this account alone predisposed to disease; their resistance to disease is still further lowered by the fact of their blood and lymph flow not being adequately stimulated by the vigorous exercise of the masticatory muscles. Now we have seen that the great cause of defective mastication in children is the softness of the food given them and that the feeding of them upon an excess of soft food, especially the starchy kind, disturbs digestion, induces toxæmia, and in this way evokes a catarrhal tendency. In children thus fed we have therefore several conditions which make for disease in the parts under consideration—defective development, sluggish circulation, and toxic saturation. Is it any wonder that the modern child should be liable to disease in these regions, that he should so frequently suffer from rhinitis, naso-pharyngitis, tonsillitis, and from hypertrophy of the pharyngeal tonsil (“adenoids”) and of the faucial tonsils?