We may now return to our subject. If it be at all admitted that human instinct is the outcome of an every-day experience, which has led to the unconscious adoption of the most favourable conditions for life, it is particularly so with regard to the phenomena of digestion. The expression that physiology merely confirms the precepts of instinct is justified here more than anywhere else. It appears to me also that, in relation to the foregoing facts, instinct has often made out a brilliant case when brought before the tribunal of physiology. Perhaps the old and empirical requirement, that food should be eaten with interest and enjoyment, is the most imperatively emphasised and strengthened of all. In every land the act of eating is connected with certain customs designed to distract from the business of daily life. A suitable time of day is chosen, a company of relatives, acquaintances, or comrades assemble. Certain preparations are carried out (in England a change of raiment is usually effected, and often a blessing is asked upon the meal by the oldest of the family). In the case of the well-to-do a special room for] meals is set apart, musical and other guests are invited to while away the time at meals - in a word, everything is directed to take away the thoughts from the cares of daily life, and to concentrate them on the repast.

From this point of view it is also plain why heated discussions and serious readings are held to be unsuitable during meal-times. Probably this also explains the use of alcoholic beverages at meals, for alcohol, even in the lighter phases of its action, induces a mild narcosis, which contributes towards distraction from the pressing burden of the daily work. Naturally this highly developed hygiene of eating is only found in the intelligent and well-to-do classes, first, because here the mental activity is more strained and the various questions of life more burning; and secondly, because here also the food is served in greater quantity than is required for the wants of the organism. In the case of the poorer classes, where mental activity is less highly developed, the greater amount of muscular activity and the constant lack of more than sufficient nourishment insure a strong and lively desire for food in a normal manner, without recourse to any special regulations or customs. The same conditions explain why the preparation of food is so choice in the case of the upper classes and so simple in that of the lower.

Further, all the accessories of the meal, which are foretastes of the actual repast, are obviously designed to awaken the curiosity and interest, and to augment the desire for food. How often do we see that a person who begins his customary meal with indifference afterwards enjoys it with obvious pleasure when his taste has been awakened by something piquant or, as we say, appetising. It was here only necessary to give an impulse to the organs of taste, that is, to excite them, in order that their activity might be later maintained by less powerful excitants. For a person who feels hungry such extra inducements are, of course, not necessary. The quelling of hunger in his case affords of itself sufficient enjoyment. It is not, therefore, without reason that it is often said that "Hunger is the best sauce." This dictum, however, is only right up to a certain point, for some degree of appetising taste is desired by everybody, even by animals. Thus, a dog which has not fasted for more than some hours will not eat everything with equal pleasure which dogs usually eat, but will seek out the food which it relishes best.

Hence the presence of a certain kind of spice is a general requirement, although naturally individual tastes differ.

This short discussion as to how different people behave with regard to the act of eating is of itself testimony that care should ever be taken to keep alive the attention and interest for food and to promote enjoyment of the repast - that is to say, that care should be taken of the appetite. Every one knows that a normal, useful food is a food eaten with appetite, with perceptible enjoyment. Every other form of eating, eating to order or from conviction, soon becomes worse than useless, and the instinct strives against it. One of the most frequent requests addressed to the physician is to restore the appetite. Medical men of all times and of every land have held it to be a pressing duty, after overcoming the fundamental illnesses of their patients, to pay special attention to the restoration of the appetite. I believe that in this they are not only animated by an endeavour to free their patients from troublesome symptoms, but also by the conviction that the return of appetite of itself will favour the restitution of normal digestive conditions. It may be said that to the same extent to which the patient wishes back his appetite the physician has effectively employed measures to restore it.

Hence we have not a few remedies which are specially named "gastric tonics," and whose action is to promote appetite. Unfortunately medical science has latterly deviated from this, the correct treatment of the appetite, and that which corresponds to the real conditions. If one reads current text-books on disorders of digestion, it is remarkable how little attention is paid to appetite as a symptom or to its special therapy. Only in a few of them is its importance indicated, and then merely in short, parenthetic phrases. On the other hand, one may meet statements in which the physician is recommended to adopt no special means for counteracting so unimportant a subjective symptom as a bad appetite! After what I have said and demonstrated to you in these lectures, one can only designate such views as gross misconceptions. If anywhere, it is precisely here that symptomatic treatment is essential. When the physician finds it necessary, in disorders of digestion, to promote secretory activity by different remedies, this object can most certainly and completely be achieved by endeavouring to restore the appetite.