In many cases of chronic gastritis the first stage of increased acidity is of short duration, and in a very few cases may be wanting entirely. When free hydrochloric acid is much diminished or entirely absent from the stomach, the following symptoms are present: The patient may seem plump, or at least not excessively thin, although he eats little. Appetite is diminished; sometimes a disgust for food is felt. The stomach is not much distended except when abnormal fermentation in the stomach-contents is excessive. The liver remains normal, unless abnormal gastric fermentation produces irritation, provoking its congestion. Constipation may be habitual, but regular movements and even diarrhea are not uncommon. Gastric discomfort, sometimes acute pain, is felt immediately after meals. The pain disappears three or four hours later. If vomiting occurs, it happens immediately after meals. These symptoms are modified when acid fermentation is constant and excessive. The syndrome then presented by the patient more nearly resembles that of one in whom an excess of free hydrochloric acid is produced by the stomach.

If the gastric juice is reduced only in quantity, the diet that has just been advised for those with an excess of hydrochloric acid in the stomach may be used, but bouillons, broths, meat, and spices, especially salt and pepper, will be found useful stimulants. Often salt and smoked meat carefully shredded or chopped are both grateful and best borne. They not only have sufficient taste to whet the patient's flagging appetite, but are also less likely to undergo abnormal fermentation than other foods. Creamed codfish and minced lean ham are the best of these foods. Condiments of a peppery kind are useful, for they stimulate a better secretion of gastric juice.

The food should not be of a bulky character, nor be taken in other than moderate portions; and it is best to eat only three meals a day, so as to allow time for the digestion of each. Milk is not so useful as in the earlier stage of the malady, or when there is an excess of free hydrochloric acid in the stomach. It is too bulky, often very slowly digested, and therefore liable to lactic or butyric acid fermentation; at least it should not be used unless the stomach is intolerant of all food or much pain is experienced continously. It may, under these circumstances, be given a tablespoonful at a time.

When the digestive juice is only lessened, fish, eggs, meat-juice, minced meat, oysters, bouillons, and broths with salt and pepper freely added, are the best staples. These may 18 be varied by the addition, in small portions, of such vegetables as lettuce, spinach, tomatoes, peas, string-beans, and celery. Butter, cream, and olive oil in moderate amounts are also permitted, as are fruits in moderation, except the very acid ones, such as strawberries, currants, gooseberries, some cherries, and blackberries, and the sweetest, such as bananas, melons, and some grapes. Tea and coffee are allowable during convalescence, but they are usually not well borne earlier. A sour wine or whisky much diluted with water will act as a condiment and increase the formation of gastric juice, providing congestion is not great, inflammation active, or abnormal fermentation marked. Under any of these latter conditions - and one or another is usually present - they are counterindi-cated, as, on the one hand, they will increase congestion and inflammation, and, on the other, the wine will spoil and produce acetic acid. Water is the best beverage. It is often most beneficial if it is taken hot, two teacupfuls at a time, a half-hour before meals. It will help to wash from the stomach the remnants of the last meal and to dislodge and remove any excess of mucus, leaving the stomach in the best possible condition for the reception of the next meal. Carbonized waters, such as plain soda, Vichy, Apollinaris, and effervescent natural or artificial lithia waters, are useful in mild cases, as the gas stimulates normal gastric secretions. Carlsbad, Marien-bad, Kissingen, and Homburg, among European waters, Saratoga and West Baden among those of America, are useful when the bowels are constipated, though these waters undoubtedly accomplish more good if taken at the springs, when the climatic effects, the rest from business or home cares, the change of diet, the out-of-door life, and general regime of the spa play an important part in improving the patient's condition. Out-of-door life, regular, gentle exercise, and freedom from mental strain are conditions in many cases essential to successful treatment.