If the medical attendant decides to exclude all starch, sugar, and other forms of carbohydrate food from the diet, there are several courses open to him. He may prescribe the Salisbury diet, consisting solely of lean meat and hot water, for a period of six or eight weeks. This diet has proved exceedingly useful in men who have a decided tendency to gout. Where this dietary is not prescribed the food may still be of a protein character, and something like the following will answer the purpose: -

Breakfast

Two boiled eggs, Protene biscuits,1 and a cup of milk-tea.

10.30 a.m. - Boiled ham (mostly lean) 4 ounces, a slice of gluten bread, and a glassful of hot water.

Dinner

Beef-steak 4 or 6 ounces, two tablespoonsful of mashed potatoes, and a wineglassful of burgundy or claret diluted with water.

Afternoon

China tea with a tablespoonful of cream in each cup, and a Protene biscuit.

Supper

Two scrambled eggs or 4 ounces of cold meat, and Protene biscuits.

10 p.m. - A tumblerful of hot milk.

The meals should be small and frequent; hot water should be taken between the meals or just before them, and the total allowance of gluten bread and Protene biscuit should not exceed 4 ounces.

If the patient is very bad an exclusive milk diet may be ordered for one month. In this case the patient should retire to bed, and be fed with a tumblerful of milk every 1 1/2 or 2 hours, making a total of 5 pints a day. But I have seldom found it necessary to resort to such extreme treatment.

1 These biscuits are made from milk-powder by the Protene Company; they are similar to Plasmon biscuits, and they may be used alternately.

On the other hand, I have found it advisable in some cases to reduce the amount of animal food for a time, and order a corresponding increase of fat and carbohydrates. In such a case the diet must consist of light and easily digested foods: milk, milk puddings, junket, custard, eggs, jelly, blancmange, arrowroot, bread, and an abundance of butter, boiled fat bacon or ham. After a time the diet may be improved by the addition of tender meat, poultry, and steamed fish, such as sole, plaice, or whiting. All kinds of sweet foods, soups, broth, strong tea, condiments, spices, and alcohol (except a glass of red wine, well diluted) should be forbidden until the recovery is complete.

It has been observed that the amount of acid in the gastric juice can be reduced by keeping salt out of the food; therefore salt should be avoided or reduced to a minimum. For a long time after the cure is complete the patient must continue to exercise great care over his food, keep the allowance of tobacco, and especially of alcohol, down to a minimum. The latter should consist of lager beer, a glassful of hock, claret, or burgundy, well diluted, or a small amount of whisky in a lot of water.

In the second form of acid dyspepsia the analysis of the gastric contents, while showing a very high degree of acidity, often shows that there is a deficiency of hydrochloric acid (hypochlorhydria), and the digestive power of this secretion is very weak. The acidity is due to the formation of organic acids.

One of the commonest causes of this condition is long-continued irregularity in the quality or quantity of the food or food accessories (spices, condiments, alcohol). Such a course leads first of all to hypersecretion - the stomach responds to the demand for a larger supply of gastric juice as long as it can. Nature always does respond freely and give abundantly when we ask more than usual from her; this generosity often leads to hyperchlorhydria (the condition which was considered above). But the long-continued irritation leads to changes in the gastric glands, and Nature is no longer able to respond to our demands for gastric juice, because the instrument through which she replies, the gastric glands, are exhausted by overwork; the quality of the secretion becomes poorer and less effective. This condition of hypochlorhydria may occur from irregular living and feeding, anaemia, chlorosis, catarrh of the stomach, infectious diseases, and chronic wasting diseases. In acute catarrh of the stomach the amount of gastric juice sinks to nothing, there not being sufficient to digest a small meal of ordinary food; during convalescence the pepsin reappears before the acid. In typhoid and other fevers the hydrochloric acid sinks to a very small amount, while lactic acid and other acids rise in proportion. In anaemia the hydrochloric acid is deficient when the patient suffers from chronic indigestion; in other cases there is an excess of hydrochloric acid. The most important cause of hypochlorhydria, however, is catarrh of the stomach; as the amount of gastric juice diminishes other acids increase, so that the condition of organic acidity is almost sure to follow hypochlorhydria. Microbes grow in the stomach, as they do in all other cavities; but hydrochloric acid is a disinfectant, and keeps them down. The stomachs of healthy people are almost free from microbes; the gastric contents of thirty healthy persons revealed the presence of only three kinds of micro-organisms; two were moulds and one a bacillus. But in persons who suffer from hypochlorhydria, as in catarrh of the stomach, dilatation, or cancer, various micro-organisms readily flourish and multiply abundantly, thereby causing acid fermentation, alcoholic fermentation, and putrefaction of the food.

In consequence of the deficiency of hydrochloric acid, the digestion of the food is delayed, and the undesirable microorganisms have ample time to work their will upon all kinds of carbohydrates and produce therefrom butyric, lactic, and acetic acids, and various gases. These unpleasant changes cause a depreciation of the appetite; the tongue becomes coated, flabby, and sometimes marked around its borders with an impression of the teeth. In spite of the poor appetite, a sense of fullness follows the meal, with flatulence, nausea, occasionally vomiting, and either constipation or diarrhea. Thus we find that meat, fish, milk, and eggs are badly digested, because of the deficiency of hydrochloric acid in the gastric juice; while sugar, bread, milk puddings, and other starchy foods are decomposed by bacteria and give rise to organic acids. The organic acids do not assist in the digestion of food; on the other hand, they irritate the stomach, hinder digestion, and weaken the motor-power of the organ, so that dilatation often follows a long course of organic acidity.