Diarrhea, if due to a condition of hyperchlor-hydria, will have to be managed quite differently. Here meats, a richly albuminous diet, will play an important part. These patients will do well on plenty of meat and eggs, and very little starchy food - just the opposite of those suffering from achylia - and also an alkali.

In the first group, achylia gastrica, it is not essential to administer hydrochloric acid, but in the second group, hyperchlorhydria, we will have to give alkalies.

We shall proceed now to the larger group of chronic diarrhea, due to abnormal conditions in the small intestine. This is the more difficult group to handle outside of the group due to intestinal obstruction (which we can only cure by an operation; otherwise we have to keep to liquid diet). This group, in which there is a chronic catarrh of the small intestine, comprises perhaps more than half the cases suffering from diarrhea. Here diet plays a very important part, and we will have to discuss a little more minutely how to handle them and what we should do.

There is no unanimity of opinion among physicians nowadays as to the kind of diet to be given to such patients. Some say that these patients will do well on an exclusive meat diet; others again will say that patients get well on a strict milk diet. Others again say that milk is the worst thing. Among the latter is Professor Rosenheim, who recently wrote an article on this group of diarrheas. He says that he always failed with milk in such cases, because the milk sugar easily breaks down into lactic acid, which upsets the patient. He therefore excludes milk from the diet of these patients. He even goes so far as saying that the admixture of milk to cacao or to soup, and a little cream will also upset the patient.

So far as I am concerned I must say that I am not so much afraid of milk and I am rather of the opinion that while we should exclude all fruits, salads, highly spiced dishes, all irritating substances and cold beverages (all things which have a tendency to increase peristalsis should be carefully avoided), we should still try to give a sufficient quantity of nourishment to these patients even if their actual condition of diarrhea should apparently grow worse through the diet. I am of the opinion that if we are timid and give these patients very little food, they will, notwithstanding the improvement of their diarrhea, perhaps having only two or three movements a day, soon suffer in their nutrition and the body weight will decrease. The great danger is that if such a condition of subnutrition is kept up, after a while we cannot cure such patients at all. This is the case with a great many of these patients.

In reality it is advisable to give rest to an organ which is diseased and it will then recuperate and do well later on and do more work. You may, in severe cases of diarrhea, try such treatment. We may give the patient very little nourishment, perhaps egg albumen water, but if so one should always bear in mind not to restrict the patient to this diet for more than a week or ten days. After this period we must reestablish the amount of nourishment, and put the patient on a regime which will build him up. It is important to consider that even though the patient feels improved and the chronic diarrhea gets better on the restricted diet, he may be getting too little nutrition and a state of inanition results. The organs are weakened and the disease instead of growing better becomes aggravated. In this weakened state the organism is not able to recuperate. For this reason I say that in these cases of chronic diarrheas, after having tried a very short period of time with little nutrition or no nutrition at all, we must give them plenty of food, plenty of eggs - eggs are indeed very good in these cases - six or eight eggs a day I generally give. We give them plenty of gruels and barley. You may try decoctions of barley, oatmeal and rice, and later on give them porridges, and then bread and butter, and then meats. I do not exclude meats. I do not give them any fruits, salads or any cold drinks or anything of an irritating nature. Nourish them well.

What will you do if the diarrhea is kept up? How will you manage that? Here certainly we must take recourse to some medicinal treatment. We may give them a tannic acid preparation, tannin-agar; we may administer an opiate. It is much better to make the patients eat and keep them on some remedy, so that they are able to keep up with feeding and check the diarrhea a little, than not to allow them to eat and not to take medicine.

I have found by experience that a great many patients soon begin to gain in weight, in fact in most of these cases you can achieve a gain in weight if you give them sufficient nourishment, more than enough to keep the body in balance. They will add flesh too, and as soon as they are stronger they are able to fight the disease and do not require so much medicine. I have seen such cases. I particularly remember a patient who lost fifty to sixty pounds from chronic diarrhea. She did not eat anything that was forbidden her, and she thought that milk increased the diarrhea, also bread, and she did not wish to eat. Ultimately she took nothing. Her condition was so bad that she was almost a skeleton, but after I allowed her to eat and gave her in addition some slight remedy, after a few weeks she picked up and in two or three months recovered.

It is thus with a great many other patients, and I think it is very essential to bear in mind how important a part nutrition plays in prolonging life and curing disease.