Among the laity, as well as often among medical men, there are prejudices against certain forms of food. Thus, for instance, until recently one forbade all kinds of fat, even butter, in all dyspeptic conditions. Fat, however, belongs to the group of foodstuffs which has the largest number of heat-units, and, besides, is not bulky as a nourishment (butter). Undecomposed fat passes the stomach without molesting the same, and is digested in the small intestine. There is, therefore, no reason for forbidding butter, which should, on the contrary, be highly recommended. Fearing fermentative processes the partaking of bread and other food rich in carbohydrates is very often greatly limited or even totally forbidden. Although it is true that the carbohydrates easily undergo fermentative processes, yet those cases in which considerable fermentation exists in the stomach are quite rare, and as a rule are found only where there is considerable stagnation of food in the stomach. In these cases, to be certain, a diet consisting principally of animal albumin (meat) for a short period is very useful. By means of lavage of the stomach and other appropriate treatment one soon succeeds in checking the fermentative processes, and one can then administer carbohydrates.

An adult, according to Koenig,1 daily consumes one-third to three-fourths kilo of bread; fifty to sixty per cent of the total food substances, and fifty to seventy-five percent of the carbohydrates are taken in the form of bread. This clearly shows the important part bread plays in diet. Its use is, therefore, as a rule advisable. It is ordinarily said that crust of bread, stale bread, and zwieback are easier to digest, on account of the starch contained in them being largely converted into dextrose. Although I am of the opinion that too fresh bread must be avoided, I nevertheless rarely find much difference in the digestibility of the crust or other parts of well-baked fine white bread, judging from experience gained from my own patients.

Articles of luxury (wine, beer, coffee, tea) are, as a rule, permissible. It is, however, necessary to give them in small amounts and in appropriate form. Strong liquors must be avoided, likewise all strong spices.

Appetizers, as a small amount of caviare, sardellen, or anchovies, on a small slice of bread or cracker, taken one-quarter of an hour before the meal, are not only allowed but frequently directly commendable.

In reference to the special rules for the different diseases of the second class, we shall have at times to reduce the quantity of meat taken in all conditions accompanied by a diminished secretion of HCl (gastritis chronica glandularis, atony + subacidity); on the other hand, the quantity of richly carbohydrate vegetable food will be increased. Kumyss, matzoon, milk with cognac (7 to 10 c.c. of cognac to 200 or 250 c.c. of milk) may be taken with crackers either during or between meals.

1 Koenig: "Die menschlichen Nahrungs- und Genussmittel," Berlin, 1883, p. 430.

In all the conditions with superacidity the quantity of albuminous food should be increased; here one may give a great deal of meat (venison included). In superacidity with hypersecretion frequent and small meals containing consistent food are most appropriate. If there is a feeling of hunger between meals, the white part of hard-boiled eggs may be taken (as is well known, albumin combines with acid and makes it, so to say, inert). The quantity of beverages must be greatly limited; most suitable in this instance are small quantities of vichy water. In dilatation of the stomach and in gastroptosis it is also advisable to give small and frequent meals and to restrict the quantity of liquids taken. As a rule, milk and beer do not agree well in these cases. Small quantities of wine or imported dark beer or porter may be allowed.

In nervous dyspepsia and gastralgia our main object will be systematically to increase the quantity of food -here milk and its derivatives (kumyss, matzoon, bonny clabber, buttermilk, cream), taken between meals, play a prominent part (Weir-Mitchell treatment).

In achylia gastrica it is of utmost importance to give at first liquid or very well-triturated (pulverized) food. For here the chemical action of the stomach has entirely ceased, and vegetable (on account of the albuminous membrane enclosing the starch granules) as well as animal foods pass from the stomach unchanged, and not converted into small particles, into the intestines and irritate them, unless there has long been formed a sufficient adaptation for these conditions. Vegetable food, on count of its containing chiefly carbohydrates, should predominate in the diet of this affection. Thus achylia gastrica, in reference to diet, stands midway between the first and second classes. It approximates to the first class in so far that it necessitates liquid or a mechanically minutely triturated or pulverized food, the second class in allowing a richly carbohydrate diet. After a short period of this diet, bread, gruels, soft-boiled eggs, cottage cheese may be added. Later on I usually allow also tender meats once daily.

Some readers may miss in my paper exact bills of fare for chronic affections of the stomach. They have been omitted, as it is always necessary to individualize, especially in diet. We must guide ourselves more by the patients than by theoretical conclusions. Our main object must be to care for a sufficient nutrition. Only the above-given principal rules on diet must be observed, although at times even they have to be modified. In reference to this point Hippocrates1 said: "Dandum aliquid tempori, regioni, aetati et consuetudini."

At present, with our more exact knowledge, we have come to appreciate this conclusion to a still greater degree.