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,1 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.

1 Gilbert Barling also traces the relationship between appendicitis and diet. "In a considerable number of cases," he writes, "the attack of appendicitis can be directly attributed to unsuitable food - pork, mackerel, over-ripe or under-ripe fruit, uncooked vegetables " (Brit. Med. Jour., vol. i., I903, p. 61).

1 My friend, Dr. Thompson, undertook, at my suggestion, some experiments to test the digestibility of raw starch within the mouth; he found that raw potato yields abundant sugar when subjected to long-continued mastication.

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 gastrointestinal catarrh; this, again, intensifies the dyspepsia already existing and causes a still further production of toxins, so that the motions become intensely foetid. 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 prone-ness to tuberculosis, and finally by a disposition to rickets, which I little doubt is essentially of toxaemic 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."1 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." 1 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.

1 TTie Lancet', March 21st, 1903, p. 806.