In that group of cases in which free hydrochloric acid is found in excess the following symptoms are usually present to indicate it. The patient is generally thin and pale, though his appetite is good, perhaps excessively so; his gastric distress, relieved for a time by eating, usually becomes intense two or three hours afterward; the abdominal walls are flaccid; the epigastrium is tender, but full and rounded by the distended stomach. Gastric peristalsis can frequently be seen through the abdominal wall. As a rule, the liver is enlarged and tender. Constipation exists in almost every case, and fecal accumulations can often be felt in the colon. In the stomach-contents free hydrochloric acid and usually combined chlorids are increased. Secondary fermentation is the rule. This commonly produces lactic acid; less frequently, acetic and butyric acids. Albuminoids are imperfectly digested, remaining in a form coagulable by heat. Starches are also digested with difficulty.

It is in this stage of gastritis that alkalis given in large doses some time after eating do good. It is rarely necessary to wash the stomach, except when there is considerable and prolonged stasis. A milk diet will afford the greatest relief. In the severest cases milk should be the exclusive diet. Later, as improvement takes place, the diet may be varied. In the milder cases milk should be used as the staple food, but one may begin with a diet such as is adapted to the second stage of the severe ones. When milk only is used, it should be taken warm, every two hours during the waking part of the day, one-half to two-thirds of a glass at a time. It is surer to digest easily if it is at first taken in small amounts, and sipped, not drunk rapidly. Those to whom milk is not palatable often take it easily when diluted with lime-water or Vichy.

When improvement is established, the milk should be continued, but the following and similar foods may gradually be added and given at the meal-times usual for one in health; gruels, Mellin's food, tapioca, farina, boiled rice, a milk soup with peas or other simple vegetable to flavor it, peas, spinach, a baked potato, bread, scraped meat, fish, oysters, broths, which may be strengthened advantageously with peptones, somatose, or egg; stewed prunes or a little marmalade. At first a very small portion of these foods should be taken. If, on trial, no ill effects are felt, more generous portions may be eaten. As the diet at meal-times becomes more generous in quantity and variety, milk need not be taken so often. Instead of eight times daily, as at first, it may be taken at ten in the morning, at three in the afternoon, and at bedtime. It must especially be remembered that changes in diet should be made slowly, and that only small quantities of food should be eaten. An exclusive milk diet should always be maintained for a week or ten days. The additions just enumerated should be made gradually during the ensuing ten to twenty days. No rich gravies or sauces should be used on fish or meat. When meat is first tried, it should be chewed slowly, the juice extracted, and the fiber and pulp rejected. When it is first to be swallowed, a little broiled steak should be scraped to a fine pulp or put through a meat-chopper. The meat should be broiled or boiled. All fried food should be forbidden. Bread may be permitted only in small amounts, and it must be stale. Pulled bread, Zwieback, and crackers are to be preferred. Bouillons and broths should be used sparingly, as they stimulate the secretion of gastric juice, but it is well to give them when convalescence is well established. Alcoholic beverages are counter-indicated. Coffee and tea must be forbidden. Not until convalescence is well begun may a little weak tea be permitted. Before this the patient's beverages should be milk and water only. When the patient is so nearly well that the amount of free hydrochloric acid in the stomach is normal and peristalsis is vigorous, the diet should be chiefly an albuminous one, varied by those vegetables that are not rich in starches. A little bread and fruit may also be allowed. In all these cases carefully made wheat bread is better than bread made from coarser flours, such as Graham and corn meal.