While in acute diseases of the stomach we pay most attention to giving rest to the organ - for here even an insufficient nutrition and the loss of several pounds of bodily weight are not of much importance, as the quickly recuperating organism replaces the losses caused during the sickness by taking increased quantities of food - in the chronic affections it is of utmost and vital importance to see that sufficient quantities of food are taken.

The greatest number of stomach patients consulting the physician, after the disease has been progressing quite a while, have lost more or less weight. The principal reason for this lies in the fact that the body has received too small a quantity of nourishment in order to replace the waste.

The ordinarily insufficient appetite, the early appearance of a feeling of satiation, the pain often appearing after meals, and less frequently vomiting, are the principal factors of subnutrition.

At this point it becomes necessary to divide the patients with stomach troubles into two large classes:

1. Into those with organic lesions of the stomach. 2. Into those with functional disturbances.

The first class comprises, (a) the malignant diseases of the stomach itself or its orifices (carcinoma ventric-uli, cardise, pylori); (6) cicatricial strictures of the cardia or pylorus; (c) absence of secretory work of the stomach: achylia gastrica.

In this whole first class, with the only exception of group c, which lies, so to speak, between the first and second class, we are unable to accomplish much either by medicinal treatment or dietetics. In existing strictures of the cardia or pylorus it will be necessary to seek surgical aid. Even in cancer of the stomach wall the resection of the affected part is advisable whenever the operation is possible. I cannot refrain from calling attention at this place to the splendid results of the recent stomach surgery, which of late has been frequently practised in our own country (F. Lange, N. Senn, B. Abbe, Willy Meyer, McBurney, Weir, Bull, Gerster, Roswell Park, Murphy, and others). In carcinomatous strictures a new passage can be established, either for bringing food into the stomach, by a gastric fistula, or for allowing it to pass into the intestines, by gastroenterostomy. In this way we succeed at least in temporarily giving these unfortunates relief and in ameliorating their nutritive condition.

In the cicatricial strictures we are warranted in promising to the patients, nowadays, perfect recovery by undergoing operative treatment. (In strictures of the cardia a methodical dilatation with bougies may sometimes also suffice.) The pyloroplasty operation (of Heincke-Mikulicz) and the cardiotomy or cardio-fissure (Abbe) belong to the most beautiful and blissful operations which have ever been practised. After the operation the patients are enabled to eat everything, and to live without any trouble whatever, i.e., they are perfectly cured.

Before the operations, or if such are unfeasible, one should administer light, very slightly irritating nourishment, and always endeavor to make the patient partake of a larger quantity of food. If there is obstinate and constant vomiting, it is necessary to employ nutritive enemata.

Group (c) achylia gastrica will be advantageously discussed in regard to diet under Class 2.

The second class of functional disturbances includes the largest number of all dyspeptics. Here stand uppermost chronic gastric catarrh, atony of the stomach, dilatation of the stomach, gastroptosis, superacid-ity, with or without hypersecretion, nervous gastral-gia, nervous dyspepsia, and as an intermediary between the first and second class, achylia gastrica.

It appears advisable to discuss first the whole class, and thereafter to give special rules for the different groups. Liquid food or partly predigested substances (as all peptone preparations) are not in place here. By making the stomach work too little, the weakened condition of this organ is retained and aggravated in time. We must always bear in mind the principle of strengthening the organ by means of appropriate work.

A well-known clinician is said to express himself in his lectures in the following way regarding the dietetics of the dyspeptic:

When a dyspeptic patient asks you the question, "What shall I eat?" reply, "Eat what you like." If he asks, "How much shall I eat?" say to him, "Eat as much as your appetite demands." If he still asks, "When shall I eat?" answer, "Eat when you are hungry".