Within the past ten years important facts have been discovered which are of the greatest value in the treatment of diseases of the stomach, and the influence of which can be perceived like a red thread through the whole chapter of dietetics. It has been shown by von Noorden 1 and others that emaciation in chronic diseases of the stomach is caused in the largest majority of cases - if not, perhaps, in all - not by specific poisons circulating in the organism, but by a smaller amount of food being taken. On the other hand, one might expect, judging from the universal law existing in the plant and animal kingdom of vicariousness or replacement in case of inability of the work of one organ by another similar one, that in grave disturbances of the digestive functions of the stomach the intestines would do the work instead. This has been experimentally, as well as clinically, proven in the most infallible way. Several authors (Leube, Ewald, von Noorden) have observed that, in cases of atrophy of the mucous membrane of the stomach in which the gastric secretion has entirely ceased, the patients can maintain their usual weight.

In my paper on "Achylia Gastrica"1 it is clearly shown that the patients can do very well without gastric secretion; under a proper regimen they can even gain in weight, and live long without any discomfort whatever. That means that even after the loss of the entire chemical action of the stomach, the gut is completely able to replace the function of the stomach.

1 Von Noorden: Berliner Klinik, Heft 55.

These two facts - (1) that the emaciation in chronic diseases of the stomach is caused by too small a quantity of food; (2) that even in grave lesions of the gastric functions the gut appears to perform vicariously the digestive work in a complete way - are of vital importance for the doctrine of dietetics. For it is seen at a glance that the main object of nutrition of the sick consists in giving them sufficient quantities of food.

As people with disturbances of the stomach have to replace for their existence no smaller losses than under physiological conditions, they will therefore need: 1. Just as large amounts. 2. The same kinds of foodstuffs as described for the normal state. The only difference possible will have reference to the selection of the various articles of food and to their form and special preparation.

Thus the question arises, What qualities should the food of the stomach patients possess?

In the treatment of a diseased organ one can often make use of two methods. One consists in sparing the diseased organ and giving it perfect rest, the other consists in strengthening the same by methodical adaptation for more work and practice. Both principles are in fact realized in the treatment of diseases of the stomach. The first method is ordinarily applied in acute diseases and but very seldom (and then only for a short time) in chronic affections of the stomach. In these latter the second principle, as a rule, is used. The stomach can be spared, firstly, by not introducing into it any food whatever (greatest degree of saving or rest). Secondly, by administering food substances which, during their stay in the stomach, do not impose much work upon this organ, and do not greatly irritate it. Here the main object will be to give the patient easily digestible food. In turning from the saving principle to that of strengthening the organ by methodical adaptation for work, it will be quite natural to change the diet, not suddenly, but gradually, into such as requires more work on the part of the stomach for its digestion. It is therefore absolutely necessary to have an exact table of the digestibility of different foods.

In prescribing or changing a diet we shall have to act according to it. Such a scale has been arranged by different authors. The main sign of digestibility was gauged as mentioned above by the rapidity with which the various food-stuffs passed out of the stomach into the intestines. Beaumont, in many trials on his patient with the gastric fistula, determined the length of time the different victuals remained in the stomach and constructed a scale according to the figures obtained.

1 Max Einborn: Medical Record, 1892.