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]