In the severest cases, when there is a complete lack of gastric juice and the churning movements of the stomach are very sluggish, that organ must be treated as a receptacle in which artificial digestion is to be carried on, rather than as a digesting structure. The food should be almost exclusively nitrogenous and enough hydrochloric acid and pepsin should be given to assist its digestion. When sugars and starches are administered, they ought to be in liquid form and of no greater bulk than the stomach is able to empty into the intestines before abnormal fermentation can occur in them. Milk may often be administered in small amounts, a wineglassful or so at a time; likewise kumiss or matzoon, meat-juice, meat powder, somatose, scraped meat, creamed codfish, finely chopped lean ham, a little gruel of oatmeal or wheat flour, a custard made of egg and milk, a raw or soft-boiled egg, Mellin's food or malted milk, or Robinson's barley and granum. In extreme cases it may be necessary to resort to predigested foods. They may be given in part by the mouth and in part by the rectum.
Exercise, active and passive, is essential because it is a stimulus to more active muscular effort. Hydrotherapy is often useful. Electricity will sometimes also prove efficacious in exciting gastric peristalsis. Constipation must be prevented by the use of laxatives, as diet alone will rarely relieve it. Buttermilk sometimes helps as a laxative. Stewed fruits and plums, prunes, dates, figs, pears, or apples will help when the stomach tolerates them. Honey, too, is a mild laxative for many persons and is less liable to undergo abnormal fermentation than most other sweets.
Daily menus can be prepared for average cases of gastric incompetency and gastritis by selecting from the following list of foods.
Drink four to eight glasses of water daily, milk, buttermilk, Vichy, Apollinaris.
Breads, wheat (stale), toast, crackers.
Potatoes (baked), beans (string or wax), peas, corn, spinach, lettuce, asparagus.
Stewed fruit (especially prunes), fruit jelly, blueberries, grape-fruits, oranges, pineapple, grapes.
Butter, olive oil.
Eggs (soft cooked, boiled or poached, omelette.
Meat, beef (steak, roast), lamb (chop, roast), sweet-breads, chicken, pigeon.
Fish, whitefish, perch, trout, shad, oysters, clams.
The patient should be instructed to avoid fried foods, rich gravies or sauces, candies and very sweet things: to eat only a small portion of each article, to eat slowly, and chew well.
The following is a sample menu for a mild case or for one which is improving:
One or two eggs and Zwieback or toast, with tea, coffee, or bouillon. In the milder cereal is permissible.
Bouillon with vegetables. Fish boiled, with a simple sauce, such as cream and egg. Roast beef, lamb, or broiled chicken. Baked potato, peas, string-beans, or corn. Stale bread. Lettuce salad with oil and vinegar dressing. Fresh fruits, or a custard, for dessert.
Squab, breast of chicken, or a small portion of steak. Bread. A green vegetable. Stewed fruit, or rice or corn-starch pudding.
Coffee or tea may be taken at two of these meals, but only a single cup should be permitted at a time. If there is much flatulence or sour stomach, both must be forbidden. To prevent flatulence and acid fermentation, only small amounts of food should be eaten at a time. The bowels should be emptied regularly, and the following foods should be eschewed: Cabbage, cauliflower, baked beans, beets, articles served with much oil, pork, preserved meat, game, fat fish, like salmon, shell-fish, cheese, fat foods or those that are fried or cooked with much fat or lard, wine, beer, cider, coffee with milk, chocolate and cocoa, pastries, pancakes, or other very sweet foods or articles eaten with syrup or much sugar.