The dietetic treatment of gastric ulcer has already been fully discussed (p. 330). The dietetic treatment of duodenal ulcer is essentially the same as that for gastric ulcer; when associated with hyperchlorhydria, as it frequently is. the dietetic treatment must be adapted accordingly.

Tuberculous Ulceration

The dietetic treatment of tuberculous ulceration of the bowel is often one of great difficulty. When marked ulceration of the bowel has developed, the general condition of the patient is usually a very grave one. Milk and milk foods should form the basis of the dietary, and it is often necessary to give the milk peptonised and diluted with lime-water. Whey, skim milk, and koumiss are useful forms of administration. Extra nourishment may be given by fortifying the milk with white of egg, Plasmon, or Allenbury food, with the addition of a little Extract of malt. Beef-teas are useful if they do not induce diarrhoea, and chicken jelly may be given. (See also diet on pp. 433 and 441).

Intestinal Obstruction

The treatment of intestinal obstruction is essentially surgical, unless in cases due to constipation. In acute cases, all foods should be withheld until after the operation. Thirst may be allayed by sipping ice, or washing out the mouth with hot water, or water acidulated with a few drops of lemon. In cases where the operation is deferred longer than twenty-four hours, it may be advisable to administer salines, glucose solutions, and other foodstuffs by the bowel.

In chronic cases the aim is to give a diet that will be easily digested and largely absorbed, leaving little residue. The food should be given in small amounts, and at frequent intervals - every two and a half to three hours. The following foods are of special value in these cases: - Milk, plain, diluted, or peptonised, and strengthened by the addition of Plasmon, white of egg, or invalid food, Bovinine, chicken or veal jelly, beef or mutton tea, Panopeptone, Brand's chicken jelly. (For post-operative treatment, see p. 345).