WAS LUIGI CORNARO RIGHT?
>A PAPER READ BEFORE THE PHYSIOLOGICAL
SECTION OF THE BRITISH MEDICAL
ASSOCIATION, AUGUST, 1901, BY
ERNEST VAN SOMEREN
Mr. President and Gentlemen:
Being a general practitioner, it is with
some trepidation and an apology that I present
myself before this section. The reasons
for my doing so are: First, that I
believe that a hitherto unsuspected reflex
in deglutition has come to light which has
an important bearing on health, the prevention
of disease and on metabolism. Second,
that any theory whatever, based on a possible
physiological function, claiming to diminish,
as this does, the amount of sickness
and suffering now existent, should have serious
investigation. Third, that I desire to
enlist your skilled help in the consideration
of the theories I have doubtless crudely
erected on my premise.
According to the "Encyclopædia Britannica,"
"Luigi Cornaro (1467-1566) was a
Venetian nobleman, famous for his treatises
on a temperate life. From some dishonesty
on the part of his relatives, he was deprived
of his rank and induced to retire to Padua,
where he acquired the experience in regard
to food and regimen which he has detailed
in his work. In his youth he lived freely,
but after a severe illness at the age of forty,
he began under medical advice gradually to
reduce his diet. For some time he restricted
himself to a daily allowance of 12 ozs. of
solid food and 14 ozs. of wine. Later in
life he still farther reduced his bill of fare,
and he found that he could support his life
and strength with no more solid meat than
an egg a day. So much habituated did he
become to this simple diet that when he was
about seventy years of age the addition, by
way of experiment, of 2 ozs. a day had
nearly proved fatal. At the age of eighty-three
he wrote his treatise on the 'Sure and
Certain Method of Attaining a Long and
Healthful Life.' And this work was followed
by three others on the same subject,
composed at the ages of eighty-six, ninety-one,
and ninety-five, respectively. 'They
are written,' says Addison ('Spectator,'
No. 195), 'with such a spirit of cheerfulness,
religion, and good sense, as are the
natural concomitants of temperance, and
sobriety.' He died at the age of ninety-eight."
Some say of 103!
Now, was Luigi Cornaro right? Did he
make use of a physiological process unknown
to us of the value of which he was
not cognisant? To live to an advanced age,
must we be as temperate as he, reducing the
quantity of our food to a minimum required
by Nature?
That we all eat more than we can assimilate
is unquestionable. How can we determine
the right quantity? Instinct should
guide us, but an abnormal appetite often
leads us astray. Nature's plans are perfect
if her laws are obeyed. Disease follows
disobedience. Wherein do we disobey?
We live not upon what we eat, but upon
what we digest; then why should undigested
food, recognisable as such, be deemed a normal
constituent of our solid egesta?
Something like the following must be a
common experience to general practitioners,
especially to those practising on the Continent.
The patient comes to see us and volunteers
the information that he or she has
the "gout," "rheumatic gout," or "dyspepsia."
Symptoms are asked for. The
case is gone into carefully for causation.
An appropriate diet and an appropriate
bottle of medicine prescribed. As the
patient leaves the room, we may, or may
not, call attention to the fact that
both teeth and saliva are meant to be
used. The patient returns, better, in statu
quo, or worse. If better, he remains so
while under treatment, and relapses
when he returns to ordinary habits. If
unaffected, or worse, we try again and
again, until we despair, then take or send
him to a consultant. Temporary benefit,
possibly owing to renewed hope, results; but
finally the unfortunate gets used to his sufferings,
and, if he can afford it, is sent to
join the innumerable hosts that wander from
one Bad to another, all Europe over, trying,
praising, and damning each in turn. Their
manner of living is, of course, at fault.
Nature never intended that man should be
perpetually on a special diet and hugging a
bottle of medicine, nor did she ordain that
he should go wandering over the map of
Europe drinking purgative and other waters.
Though early yet to speak with certain
voice, it would seem that we are provided
with a Guard, reliance on which protects
us from the results of mal-nutrition. There
seems to be placed in the fauces and the
back of the mouth a Monitor to warn us
what we ought to swallow and when we
ought to swallow it. The good offices of
this Monitor we have suppressed by habits
of too rapid eating, acquired in infancy or
youth.
Last November my attention was called
by Mr. Horace Fletcher, an American author
living in Venice, to the discovery in himself
of a curious inability to swallow, and a closing
of the throat against food, unless it had
been completely masticated. My informant
stated that he noticed this peculiarity after
he had begun to excessively insalivate his
food, both liquid and solid, until all its
original taste had been removed from it.
Any tasteless residue in the mouth, being
refused by the fauces, required a forced
muscular effort to swallow. He further
told me that since adopting this method of
eating he had been cured of two maladies,
adjudged chronic, the suffering from which
rendered him ineligible for Life Insurance.
His weight now became reduced from 205
lbs. to 165 lbs. He had practised no abstemiousness,
had indulged his appetite, both
as to selection and to quantity, without restraint,
and for the last three years had enjoyed
perfect health.
After his cure, he was accepted without
difficulty for insurance, the last examination
finding him an unusually healthy subject
for his age. Having leisure, he had
spent three years in investigating the cause
of his cure, had pursued experiments upon
others, and had extended his inquiries, both
in America and Europe, until our meeting
in Venice. He had also published a statement
and inquiry in book form, entitled
"Glutton or Epicure," which had been reviewed
by the "Lancet."
For nearly a year I also had been experimenting
on myself and others with various
diets, and was ready to believe that in the
manner of taking food and not altogether
in its varying matter lay perhaps its protean
effects on our system. I at once
adopted the same method of eating. At the
end of six weeks, I noticed that not only
did the fauces refuse to allow of the passage
of imperfectly prepared food, but that such
food was returned from the back to the
front of the mouth by an involuntary,
though eventually controllable, muscular effort
taking place in the reverse direction to
that occurring at the inception of deglutition.
What actually happens is this: Food, as
it is masticated, slowly passes to the back of
the mouth, and collects in the glosso-epiglottidean
folds, where it remains in contact
with the mucous membrane containing the
sensory end-organs of taste. If it be properly
reduced by the saliva it is allowed to
pass the fauces,—a truly involuntary act
of deglutition occurring. Let the food,
however, be too rapidly passed back to these
folds, i. e., before complete reduction takes
place, and the reflex muscular movement
above referred to occurs. The process of this
reflex is as follows: The tip of the tongue
is involuntarily fixed at the backs and bases
of the lower central incisor teeth by the anterior
fibres of the geniohyoglossi muscles.
With this fixed point as fulcrum, the lower
and middle fibres of these muscles, aided by
those of the stylohyoid and styloglossi muscles
raise the hyoid bone, straighten out the
glosso-epiglottidean folds, passing their contents
forward, by the fauces, the opening
of which is closed by approximation of its
pillars and contraction of the superior constrictor.
The tongue, arched postero-anteriorly
by the geniohyoglossi, palato, and
styloglossi muscles, laterally, by its own intrinsic
muscles, is approximated to the
fauces, soft and hard palates in turn, and
thus, the late contents of the glosso-epiglottidean
folds are returned to the front of
the mouth for further reduction by the
saliva preparatory to deglutition.
The word reduction is used for the reason
that all foods tested, without exception, give
an acid reaction to litmus, when served at
table. The reflex muscular movement occurs
in the writer's case from five to ten
times during the mastication of each mouthful
of food, according to its quantity and
its degree of sapidity. As often as it recurs,
the returned food continues to give an acid
reaction, while food allowed to pass the
fauces is alkaline.
Saliva, flowing in response to the stimulation
of taste, seems more alkaline than
that secreted in answer to mechanical tasteless
stimulation. It is found that the removal
of original taste from any given bolus
of food coincides with cessation of salivary
flow and complete alkaline reduction. The
fibre of meat, gristle, connective tissue, the
husk of coarse bread and cellulose of vegetables
are carefully separated by the tongue
and buccal muscles and rejected by the
fauces. To swallow any of these necessitates
a forced muscular effort, which is abnormal.
Adult man was not originally intended to
take his nourishment in a liquid form, consequently
all liquids having taste, such as
soup, milk, tea, coffee, cocoa, and the various
forms of alcohol, must be treated as
sapid solids and insalivated by holding them
in the mouth, moving the tongue gently, with
straight up and down masticatory movements,
until their taste be removed. Water,
not having taste, needs no insalivation and
is readily accepted by the fauces.
In explanation of the phenomenon described,
the following theory is advanced:
The fauces back of the tongue, epiglottis, in
short, those mucous surfaces in which are
placed the sensory end-organs of taste and
"taste buds" (the distribution of which, by
the way, has yet to be explained), that these
surfaces, readily becoming accustomed to
an alkaline contact by excessive insalivation
and consequent complete alkaline reduction
of the food, afterwards resent an acid contact
and express their resentment by throwing
off the cause of offence by the muscles
underlying them.
This phenomenon must not be confused
with the cases of rumination and regurgitation,
which from time to time are recorded.
The food in this case is not swallowed, nor
does it pass any point from which it can be
regurgitated. Eighty-one individuals of
different nationalities and from several
classes of society whom we have studied are
now in conscious possession of their reflexes.
These seem readily educated back to normal
functions by all who seriously and
patiently adopt the habit of what seems only
at first to be excessive insalivation.
The dictum "bite your food well" that
we so often use, has no meaning to those
suffering from the results of mal-assimilation
and mal-nutrition, especially should
they have few or no teeth of their own. I
make so bold as to state that dyspepsia et
morbi hujus generis omnis will cease to
exist if patients be persuaded to bite their
food until its original taste disappears, and
it is carried away by involuntary deglutition.
The important point of the whole question
seems to be this alkaline reduction of
of acid food before it passes on to meet
subsequent digestive processes elsewhere,
which then become alternately acid and alkaline.
In the first few months of infant life,
when saliva is not secreted, Nature ordains
that mammary secretion be alkaline. With
the eruption of teeth come an abundant flow
of saliva and a synchronous infantile capacity
for managing other foods. This flow of
saliva depends on a thorough demand and
use to maintain its generous supply. It is
just at this time that children learn to bolt
their food,—the demand fails, with a consequent
detriment to the salivary glands,
digestive processes, and the system generally.
A, B, C, and D were placed on an absolute
milk diet. A drank his milk in the
ordinary way, and at the end of three days
begged to discontinue the experiment owing
to disgust at the monotony of the diet. B,
C, and D continued the experiment for seventeen
days, insalivating the milk, but to a
varying extent, B the least and D the most.
Though D took most milk, he excreted least
solid egesta, C excreting less than B. Can
one infer that increased insalivation of a
non-starchy food insured its better digestion
and assimilation? Each subject took as
much milk only as his appetite demanded,
D taking the most, which never exceeded
two litres daily. The weights of the subjects
after the usual sudden drop of the first
three days remained remarkably even until
the end of the experiment. B, C, and D
all relished the diet, and it satisfied the requirements
of their appetites, but they experienced
an increasing monotony.
As long ago as the seventeenth century,
before the transformation of matter into
energy by the animal organism, known as
Metabolism, was understood, the fact was
recognised that by the lungs, kidneys, skin,
and intestines, substances no longer useful
to the organism were eliminated, the retention
of which proved harmful. The nature
of these substances was unknown, but it
was noted that however much the food was
increased the weight of the body remained
the same. In other words, a state of complete
nutritive equilibrium was maintained.
The following table contains the résumé
of two experiments in which a state of complete
nutritive equilibrium was maintained
by individuals of about the same weight, on
widely different quantities of food similar
in quality. The subjects of the experiments
were a laboratory assistant of Dr. Snyder,
of the U. S. Department of Agriculture, and
the writer. The experiment of the former
was made primarily to show the relative
digestibility of the several articles of diet,
potatoes, eggs, milk, and cream:
| Dr. Snyder's Experiment. Published in Bulletin 43 | Writer's Experiment. |
| Age of subject | 22 years | 30 years |
| Duration of experiment | 4 1/3 days | 5 days |
| Number of meals | 13 | 10 |
| Weight at beginning | 62.5 kilos | 57.3 kilos |
| Weight at end | 62.6 kilos | 57.5 kilos |
| Potatoes (daily average) | 1587.6 grammes | 159.4 grammes |
| Eggs (daily average) | 411.08 grammes | 124.7 grammes |
| Milk (daily average) | 710 c.c. | 710 c.c. |
| Cream (daily average) | 237 c.c. | 237 c.c. |
| Daily urine | 1108 grammes | 1098 grammes |
| Daily fæces | 204 grammes | 18.9 grammes |
The daily diet of Dr. Snyder's subject
consisted of three and one-half pounds of
potatoes, eight eggs, a pint and a half of
milk, and half a pint of cream. The writer's
diet of twelve ounces of solid food (like
Luigi Cornaro) consisted of three eggs, the
remainder of the twelve ounces in potatoes,
and an equal quantity of similar liquid food
to that taken by Dr. Snyder's subject. The
exercise of the laboratory assistant comprised
his daily routine of laboratory work,
while that of the writer consisted of six
sets of tennis, or an hour and a half on
horseback, with an hour to an hour and a
half's walk or climb daily, in addition to
much reading and writing.
In each case complete nutritive equilibrium
was maintained, although the author
subsisted on three-seventeenths of the solid
food taken by the other subject.
Again, cannot one infer that better assimilation
and less waste resulted from the better
preparation of the smaller quantity of food
by insalivation? Surely, too, there must be
less daily strain on the intestinal canal, and
body generally, in getting rid of 18.9
grammes of inoffensive dry waste, than in
getting rid of 204 grammes of humid, decomposing,
and offensive matter.
"Considerable importance has been attached
to the normal action of the bacteria
in the intestines; and it has even been supposed
that the presence of bacteria is essential
to life. Such a view has recently been
shown to be erroneous by an elaborate and
painstaking research carried out by Nuttall
and Thierfelder, who obtained ripe fœtal
guinea-pigs by means of Cæsarean section
carried out under strict antiseptic precautions.
They introduced the animals immediately
into an asceptic chamber through
which a current of filtered air was aspirated,
and fed them hourly on sterilised milk day
and night for over eight days.
"The animals lived, and throve, and increased
as much in weight as healthy normal
animals subjected to a similar diet for the
purpose of controlling the results. Microscopic
examination at the end of the experiment
showed that the alimentary canal contained
no bacteria of any kind, nor could
cultures of any kind be obtained from it.
"The same authors, in a subsequent paper,
described the extension of their research
to vegetable food. This was also digested
in the absence of bacteria. Under such
conditions cellulose was not attacked.
Hence they consider that the chief function
of this material is to give bulk and proper
consistency to the food so as to suit
the conditions of herbivorous digestion."
(Schäfer's "Text-Book of Physiology," vol.
i., p. 465.)
Now, inasmuch as bacterial digestion has
no place in the animal economy, surely it
can only occur at the expense of the organism?
Can micro-organic action take place in the
intestines without the production of toxins
and the consequent absorption of these toxins
into the blood?
We know that the metabolism of a cell is
determined by the general physical environment
of the whole organism, by supplies of
oxygen and water, on nervous impulses,
and, what chiefly concerns this argument, on
the nature and amount of the pabulum supplied
to it. This pabulum is derived from
the alimentary canal.
Are not even those of us who may be
enjoying seemingly the best of health supplying
to our tissues pabulum containing
mild toxins, thus causing an increased katabolic
action to occur in each individual cell
of our bodies?
Are not the blood elements, floating in a
plasma containing such toxins, rendered resistant,
weaker, less capable of fulfilling
their functions as carriers and combatants
of disease?
Are not their and our lives, in consequence,
more painful and shorter than they
need be?
Would not the elimination of these toxins
render us less liable to disease? And is not
their presence an important element in predisposition
to disease?
When this reflex is restored micro-organisms
get no further than the stomach. They
are destroyed there by the acid gastric juices,
then only stimulated to their full and normal
secretion by the presence of a sufficiency of
alkaline substance. Undigested matter having
been eliminated, micro-organisms, still
existing in the intestines, deprived of their
means of subsistence, decrease, and, in
time, may cease to exist. The body no
longer absorbs the toxins these produced.
To this fact may be ascribed the increase of
mental energy, the general physical betterment,
the cessation of morbid cravings for
food and drink and of those of a sexual
nature, which are noticed and experienced.
What has just been stated is based not
entirely on experimental evidence but somewhat
upon inference. The inference seems
justified because the excreta, more especially
of the intestines, but also of the kidneys
and skin, become almost odourless and
entirely inoffensive. The solid egesta are
voided thickly covered with mucus, leaving
the end of the bowel dry and clean. The
sense of cleanliness can only then be appreciated
to the full, for it is internal as well
as external. Flatus is no longer produced.
The urine is inoffensive and seems to be materially
changed in quality, as shown by
chemical analysis. Uric acid, the chlorides,
and, more markedly, aromatic sulphates are
reduced in quantity.
Owing to deliberation in eating, necessitated
by this new habit, satiety occurs on
the ingestion of considerably less food. By
carefully studying one's self I believe it
possible to cultivate an instinct which will
regulate not only the quantity but the quality
of food that the body may need, and that in
the normal health of a full-grown body, no
more food either in quantity or quality
should be supplied than suffices to supply
diurnal waste. Any excess must result in
pathological processes.
Although there results enhanced pleasure
in the taking of all foods, rich and simple,
and especially in the appreciation of good
wines, the quantities of these foods and
beverages that suffice to fully satisfy the
appetite are much smaller than before, while
there is a marked preference for the simpler
kinds of food. The writer now can imagine
no more pleasurable meal than one
consisting of good brown bread, eggs, butter,
cheese, and cream. These, with fresh
vegetables and a very little fruit, form his
staple diet. This tendency and preference
for simple foods is the general experience
among those who have recovered their reflexes
of deglutition.
Following on the ingestion of a lessened
quantity of food and on its better assimilation,
there is less waste, the egesta are
voided less frequently, sometimes only once
in five to eight days.
The lower bowel is not the reservoir it
formerly was. So hæmorrhoids cease from
troubling and constipation cannot exist.
For this same reason the body, at the beginning
of the practice, commences to approximate
to its normal weight, increasing or
decreasing as the individual's environment
demands.
A few more words only need be said. It
has been easy to state the results of experiments
and observations: but the acquiring
of this new reflex, while pursuing daily occupations,
is not easy, and needs more than
a little patience and much serious thought.
The habits of a lifetime cannot be changed
in a few days or weeks. The shortest time
in which the reflex has been re-established
is four weeks, and this only by avoiding
conversation at meal-time and concentrating
the attention on keeping the food in the
mouth until complete alkaline reduction has
taken place and sapidity has disappeared.
In closing I wish to maintain as a fact,
gentlemen, of the truth of which you will
only be convinced by actual experience, that
by the restoration of this reflex and in complete
dependence on its use, there lies true
health, the establishment of a condition of
stable nutrition and the possible abrogation
of two great predisposing factors of disease,
mal-assimilation and mal-nutrition. Unless
there be among you, as in the "Cities of
the Plain," a parlous minority who possess
this reflex and take your food as you ought,
none of you are in the enjoyment of such
health as you might have. A like punishment
will be meted out to you as was visited
on those cities, for you will all be consumed
long before your day by the unnecessary
combustion in your bodies caused by the
circulation in them of toxins, the product of
undigested and decomposing food.
The writer, bearing in mind the warning
suggested by the Frenchman whose donkey
died as soon as he had reduced his food to
a single wisp of straw, finds that he is taking
less and less food. While his mind
is open as to his arriving at the final diet
of Luigi Cornaro, yet it is easily conceivable
that living a similar life of retirement in
a placid environment, it would be quite possible
to do as he did. Hence the title of
this paper and the queries at the commencement.
The objects in publishing and distributing
this paper are twofold: to make the subject
as widely known as possible, and to solicit
the aid of colleagues in investigating it more
fully.
There is ready at the service of the general
practitioner an important and potential
therapeutic agent in the saliva of his patients
and in the use ad finem of their salivary
digestions.
Editor's notes. (1) Confirmatory evidence
of the correctness of the deductions
made in this paper has begun to come in
from many professional sources and notably
from a famous child specialist who avers
that children would follow the natural requirements
in eating were it not for artificial
food, bad example, and bad teaching.
(2) In a report of a paper read before
the Société de Biologie, Paris, France,
March 15th, 1902, by M. Max Marckwald,
of Kreuznach, "On Digestion of Milk in
the Stomach of Full-grown Dogs,"
the following appears: "Hence these experiments
confirm those of Horace Fletcher
and Ernest H. Van Someren on the importance
of prolonged mastication" (translation).
Referring, as the latter statement
does, to mastication (insalivation) of liquid,
it gives an important suggestion relative to
some probable causes of uncertain or defective
digestion in human nutrition.