The condition of general debility which underlies atony of the stomach must be attacked. This is the more important in all those cases which are not the direct result of the abuse of food and drink. Remedies which will improve the tone of the body, increase vital power, and stimulate the activity of the muscles, will also increase the motor activity of the stomach, and improve the quantity and quality of the gastric juice. The indications for treatment are (1) to remove the cause of the disease; (2) promote general nutrition by proper exercise of the mind and body; (3) and render easy the process of digestion by proper selection and preparation of food,

The food is exceedingly important. The amount consumed must be within the power of the stomach to deal with it Sufficient time must be given for the weakened organ to do its work. The selection and preparation of the food must be suited to the condition of the organ. But it is useless to pamper the appetite or yield to the cravings of the stomach. In mild cases of atony, modified ordinary diet, such as that previously detailed for chronic gastric catarrh, may be given. In more severe cases a mixed milk and ordinary diet would be useful. In either case too much starch or sugar must be avoided; the food must not be too concentrated, and it must always be well and carefully cooked. As the general condition improves, the amount and quality of the food may be improved. Any article which disagrees by occupying a long time in digestion, causing much pain or considerable flatulence, must be removed from the diet.

In chronic cases the change of food had better be brought about gradually rather than suddenly. A sudden cessation from all the agreeable articles of food is not likely to be permanent. Therefore, while cutting off at once well-known indigestible articles, such as pickles, pork, and pastry, it is better to gradually reduce the food until a suitable permanent diet has been reached. The object of treatment is best attained by means of a spare diet, consisting chiefly of animal foods and the restriction of fluids. The avoidance of bulky meals, consumption of food without drinking, and careful mastication assure the material being swallowed in a state of fine subdivision and that the stomach is not overloaded. If the appetite fails, abstinence (within reason, of course) is better than pampering the stomach with dainty fare or stimulating it with wine or spirits. When the appetite is good the patient should cease eating before the feeling of satisfaction is reached, for it is better to eat too little than too much. The meals should be only three, and they should be six hours apart. A moderate use of salt, pepper, mustard, horse-radish, and other aromatic condiments is commendable. An average patient might have a dietary similar to the following: -

Breakfast

A cup of coffee or tea with milk or cream, but very little sugar. One or two eggs, boiled or poached, and some fish of the lighter kinds must form the principal part of the meal. A few slices of stale bread, very dry toast, or "pulled" bread may be eaten.

Dinner

No meat or fish at this meal. It may consist of macaroni and tomatoes, boiled rice with gravy or extract of meat, spinach, vegetable marrow, tender green peas, kidney beans, mashed potato and cream, and either cabbage, savoy, or carrots in the form of puree, milk pudding, apple sauce, or a few stewed plums. At the end of the meal one-quarter pint of pure water, or a glass of claret or burgundy.

Supper

Clear soup, about three ounces, any kind of light fish, tender lean beef or mutton, rabbit, poultry, pheasant or partridge, one tablespoonful of mashed potato or boiled rice, or a slice of dry toast or "pulled" bread. No pudding or sweets. At the end of the meal a small glass of water alone or with a tablespoonful of whisky, or two glasses of claret or burgundy.

Thus the patient will have two meals consisting chiefly of Animal food and one of vegetables; the meals are small; eaten dry they will be well masticated, and being six hours apart will not over-tax the stomach.

In simple atonic dilatation the indications are similar- namely, to improve the tone of the stomach, to avoid distension as much as possible, to promote the propulsion of the food into the bowels, and discourage any tendency to fermentation. These indications are met by a dietary such as the foregoing. That is to say, the food should be of small bulk and eaten dry, the total amount of liquids should not exceed one and a half to two pints, and may advantageously be reduced to one pint for two or three weeks. As the sufferer may have been a big drinker previous to the treatment, this limitation of liquids is often rather difficult to enforce; but it is a necessity for successful treatment. The distension of the stomach is also avoided by forbidding the consumption of fresh salads or raw fruit and heavy vegetables such as cabbage, savoy, turnips, swedes, and carrots, except a small amount in the form of puree. The avoidance of much bread and potato, of all sweet cakes, pikelets, crumpets, muffins, etc., of excess of milk puddings, custard, or junket tends to reduce the fermentation. The avoidance of fat meat, pork, bacon, ham, duck, goose, mackerel, herring, salmon, eel, halibut, lamprey, alewife, and other greasy foods is beneficial. All dried and seedy fruits must be avoided, such as currants, raisins, figs, candied fruit or peel, strawberries, raspberries, and gooseberries, partly because of the seeds and skins, and partly because of the acids in them. All acid substances ought to be avoided.