In the administration of alkalies, it should be remembered that, in general, an acid or alkali tends to reduce a secretion of its own reaction and to increase one of the opposite reaction, if given before the normal time of secretion but that we can usually count on this rule working when we do not wish it to and vice versa. Hence, neither acids nor alkalies should be given before meals but alkalies should be given 1 - 3 hours after meals, often in several doses. Magnesium oxid, hydroxid and lime water are the best. Carbonates should not be given on account of the stimulation of the mucosa by bubbles of carbon dioxid gas.

Hyperchlorhydria does not manifest any marked tendency, as commonly taught, to eventuate in ulcer but still this possibility must be borne in mind. It is commonly stated that the gastralgia of hyperchlorhydria is relieved by eating, and that of ulcer made worse. This is not a positive rule, either way. Hyper-chlorhydric gastralgia does not usually develop on an empty stomach, i. e., the secretion does not begin till food is taken, unless too long a time is allowed to elapse between meals. It usually develops 1 - 3 hours after a meal and while it may usually be relieved by taking more food at this time, there is an objection to superimposing one meal upon another not yet fully removed from the stomach, so that it is better to relieve the pain by water or alkalies. Continuous acid secretion has been demonstrated to occur almost invariably as a result of gastric ulcer.

The time at which pain begins after the stomach may be considered or has been demonstrated to have emptied itself, is a guide to the frequency of meals. Many patients do well with three, a few with two meals a day. If, four or five hours after a meal the pain begins again, it is an indication for another meal. Rarely is it advisable to feed oftener than five times daily. All of the meals should be rather hearty, since a light meal stimulates acid secretion almost as much as a full one and does not sufficiently absorb the acid secreted. In most of these patients, leanness exists so that there is no marked contraindication to overnourish-ment.

As a rule, one should go to one extreme or other in feeding. In certain cases in which ulcer is feared or known to exist, or in which each meal serves to excite secretion and does not properly neutralize it, the opposite plan of physiologic rest for the stomach should be instituted, giving both food and water by the bowel or subcutaneously, for several days, up to a week or two. Not even water should be allowed by the stomach except enough to wash down bismuth and the alkalies mentioned, which may be given at the same time.

Gastric atony and hypertony are often mentioned as independent neuroses and they do occasionally occur apart from corresponding secretory abnormalities. The diet appropriate for atony has been described. It is questionable whether the too rapid passage of food through the stomach does any harm, except by occasionally frustrating attempts to secure gastric contents for examination. At any rate, the dietetic treatment of hypertony is a difficult problem. Mere increase of the size of the meal usually causes sufficient delay for the abstraction of a test meal but there are obvious contraindications to the routine increase of ingesta. Moreover, if we attempt to increase the bulk without increasing the nutritive value of food, the hypertony frequently causes exactly the reverse result to that desired, the indigestible residue which tends to remain in the stomach in atonic states, often stimulating gastric peristalsis in hypertonic states.

Acute Gastritis of the grade produced by irritant poisons, and very hot water - which is rarely swallowed by a conscious person in sufficient amount to injure the stomach - requires, after the appropriate treatment of the poisoning, physiologic rest of the stomach for several days. Mucilaginous drinks, with antisep-ties, alkalies and bismuth, may be employed and rectal nutrition or, at least, the administration of saline solutions, may be necessary. Subacute Gastritis, of the grade produced by alcohol, overloading (lie stomach with indigestible or tainted food, occasionally by "taking cold," especially when the circulation is already impaired by hepatic sclerosis, or due to endogenic poisons, requires purgative treatment and rest of the stomach for one to several days.

The after treatment of these two conditions is the same but is begun after a delay proportionate to the severity of the inflammation. At first, peptonized milk, then the milk-cereal diet appropriate to fevers, is used. After a week or two, a bland, easily digested, ordinary diet is instituted and it may be necessary to avoid pastry, fried foods, coarse vegetables etc, for a month. Digest ants may be used as indicated - remembering the superiority of the vegetable digest ants over pepsin - but it is usually wise not to at tempt to restore hydrochloric acidity for two or three weeks, since its abeyance is conservative.

Chronic Gastritis, without dilatation, marked atony or mucus excess, is to be treated according to the state of the secretion, mainly hypochlorhydria. If there is much mucus - and the normal oesophageal mucus must be discounted - it should be removed by lavage or by drinking a glassful of hot water containing 1 - 2% of sodium bicarbonate and borax, !> -1 hour before meals. Or 5 20 c.c. of hydrogen peroxid or some analogous preparation, may be used but this often causes vomiting, although it does not seem to produce any lesion of the mucosa.

The food should be practically sterile, as by recent cooking, and while hot biscuits, pan cakes, waffles etc., and even fresh bread are liable to become doughy masses in the stomach, it is well to toast crackers and stale bread. By the way, the word stale as applied to bread stuffs in dietetics, does not imply the beginning of putrefactive or fermentative changes but merely partial drying so that the freshness and tendency to resume the doughy consistence on chewing, have been lost. The food should be bland, nutritious and relatively concentrated, though gastro-intestinal atony is relieved by the use of legumes, tender, finely cut lettuce, creamed cauliflower, boiled and well masticated onions etc., in moderation, of fruit etc. It is a safe rule never to allow any one meal to exceed a quart in total bulk and a pint is the ordinary limit.

The administration of water or other liquids with the meal is a moot point. On account of the general tendency in chronic gastritis to scanty, viscid secretion, it would seem that a moderate quantity of water, say a glassful (200 c.c.) should be allowed at meal time.