A lady who has the catering for a large number of girls gives the bread in this way, and she tells me that there is keen competition for the most crusty portions.

I do not say that starch in the liquid and pappy form should find no place whatever in man's dietary at the present day, for this would imply the prohibition of porridge, boiled potatoes, milk puddings, and the like. We cannot put back the hand of time and return to the food of our primitive ancestors, nor is it desirable that we should; but we can, at least, arrange matters so that a large proportion of the starch we consume shall be in a form inviting mastication, such as crusts, stale bread, stale cake, biscuits, and so forth. The less children eat of pastry, or, indeed, of any luxurious foods, the better; if brought up on a healthy dietary and under healthy conditions generally, they will relish their simple fare more than the choicest dishes of the epicure. I do not, I say, object to the child consuming a certain proportion of starch in the liquid or pultaceous form, for if, by bringing him up on a rational dietary, his instinct to masticate be afforded due opportunity to develop he will be likely to subject even soft vegetable food to something like adequate mastication; this will tend to mitigate the evils associated with such food, not only by facilitating the digestion of starch, but by flushing the mouth and promoting the health of the teeth and buccal mucous membrane.

The question how far children should be allowed to crack nuts may here be considered. If the child has been brought up on pappy food, and has in consequence brittle and ill-developed teeth, the cracking of hard nuts will be likely to injure them, and this is a fortiori true if any of the teeth are carious or "filled." And not only nuts but hard food of any kind, such as ship's biscuits, may in these circumstances injure the teeth, as many of those who went through the recent South African campaign can testify. But if, on the other hand, the child has from the beginning been fed on coarse, hard foods, so that the teeth have been allowed to grow dense and strong, no harm is likely to ensue from cracking such nuts as filberts and Spanish nuts. If a squirrel or a monkey weighing a few pounds can do so with impunity, surely the young human should be able to also. The cracking should, however, be done by the molars, while such hard nuts as Brazils had best not be tackled at all.

Animal food does not need the same amount of mastication as vegetable food, since it is not digested in the mouth, though some contend that the mixture of proteid with alkaline saliva facilitates its subsequent peptoni-sation. Cooked animal food is, however, all the better for some mastication, owing to the coagulation of the proteids, and, in order to insure the efficient mastication of meat, fish, and poultry, Dr. Sim Wallace recommends that they should be given in large pieces cut thin. " Flat pieces about one inch square generally necessitate a certain amount of mastication. It is difficult to swallow large flat pieces of meat without mastication, but when finely minced little or no mastication is called forth." The younger the child the more underdone should the meat be.

Examination Of The Mouth And Adjacent Parts

If a child be brought up on the lines indicated and under healthy conditions generally, it is tolerably certain that the maxillary apparatus will develop normally, that the teeth will be strong and well opposed, and show little tendency to disease; but, inasmuch as the methods advocated are but seldom put into practice, disorders of the teeth, more especially caries and irregularities, are common, and hence with a view to promote more efficient mastication it is always advisable to examine our patient's teeth.

Each individual tooth should be inspected in a good light for the presence of caries, and careful note should be taken of the "bite," a normal bite implying not only a proper opposition of the two rows of teeth but the capacity of the lower ones to move freely across the upper; mere vertical movement of the mandible does not constitute efficient mastication. In this connection it must not be forgotten that an unopposed molar is useless for purposes of mastication, and it is by no means rare to find in a mouth several sound unopposed molars which are for this reason absolutely function-less. Nay, more than this, it may happen that teeth, perfectly sound ones, too, far from helping, may actually interfere with mastication; thus, among the poor, we sometimes find all the teeth gone save the upper canines and the lower incisors, and the teeth and gums being alike unable to come into contact, nothing worthy of the name of mastication is possible; it would be far better to be without any teeth whatever, for the toothless gums would then be permitted to come into contact along their entire extent, under which condition they gradually harden and come to be quite efficient grinding agents.

Next the gums, the alveoli, and the roots of the teeth must be examined, especially for the presence of erosion, tartar, and pyorrhcea areolaris, this latter condition being evidenced by the welling-up of pus upon pressing the gums against the sides of the teeth.

If our examination of the mouth discloses anything likely to interfere with mastication the aid of the dentist should at once be sought, but every physician should be so far acquainted with disorders of the teeth as to be able to say, in the majority of cases, at all events, when this is necessary. I am convinced that far more illness than is generally supposed is attributable to dental defects, and this even among the more leisured classes. With regard to pyorrhcea alveolaris, it has to be remembered that it not only does harm by causing loosening, lengthening, and shedding of the teeth, and thus interfering with mastication, but also by contaminating the stomach and the blood and thus upsetting the digestion and causing constitutional diseases, such as anaemia and arthritis; and inasmuch as poisonous discharges from the nose, the nasopharynx, the pharynx, and the tonsils may act in a similar way, these parts also should be inspected in connection with the examination of the teeth. In the dust-laden atmosphere of towns they are very liable to disease, and even when healthy are necessarily dirtied; some go so far as to advise all town dwellers daily to wash out the nasal passages and to gargle the throat; but, whatever may be thought of this, it is certain that under existing dietetic conditions special means are needed in order to keep the mouth and teeth clean.

When man fed on raw food this was not necessary, the food itself and the copious flow of saliva, induced by prolonged mastication, effectually cleansing these parts; but, under present conditions, food tends to remain within the mouth, especially between the teeth and in their crevices, and therefore special means are needed to remove it. This is done by "cleaning the teeth" and by rinsing the mouth.

The Tooth-Brush

Probably the ideal method of cleaning the teeth is that adopted by many primitive and not a few semi-civilised peoples - viz., rubbing them with a twig of wood which has been teased out at one end so as to form a sort of brush by means of which the teeth can be burnished and food dislodged from them. The modern tooth-brush requires to be used with great caution, as it is capable of doing much harm, not only by removing the mucoid film, which, according to Dr. Wallace, protects the teeth from corroding agencies,1 but probably also by injuring the edge of the gum and the neck of the teeth, and thus setting up the condition known as "erosion." Certain it is that some of the best sets of teeth I have encountered have been wholly unacquainted with the toothbrush. In any case the brush should be employed with great care; it should be soft, and should always be drawn away from the gums both on the inner and outer aspect of the teeth towards the biting surface, as well as across the latter, never transversely across the outer surfaces, as so frequently is done. The object of these procedures is to dislodge any particles of food that may have collected between the teeth or in their crevices. For this purpose the toothpick may also be employed judiciously.

In order to render the enamel of the teeth white it is better to rub each tooth carefully with some soft material, such as chamois leather, rather than to scrub them with a brush. Tooth-powders should not be used as a matter of routine, but only occasionally and for appearance rather than for cleanliness, and should consist of some simple non-irritant material. Antiseptic powders and washes are to be scrupulously avoided, for it is neither desirable nor possible to render the buccal cavity aseptic; myriads of bacteria flourish within it, many of which play a useful part as scavengers. The time of all others for cleaning the teeth is just before going to bed, so that the food shall not be allowed to decompose in the mouth during the night. There will then be no need to use the tooth-brush in the morning.

1 This film can be felt by the tongue as a somewhat rough covering, which gives place to a smooth surface after the use of the tooth-brush.

Rinsing The Mouth

The mouth should be rinsed out as a matter of routine after each meal and on rising, and care should be taken to do this before the early cup of tea, so as not to contaminate the stomach with the buccal secretions which have accumulated during the night. Inasmuch as raw vegetable food has a cleansing effect on the teeth, it is often a wise plan, especially in the case of children, to finish a meal with some kind of fruit, such as an apple or an orange. It hardly seems necessary to insist upon the necessity for keeping all artificial dentures thoroughly clean.