Acute indigestion, for instance. Some one has taken too large a dinner, has fever, and vomits. What will you do with the patient? The best thing is to do as little as possible. Leave him alone. He has no appetite, and does not eat for a day or two. That is all right. There will be no bad consequences. In a day or two the bad condition will be over and he will begin to eat again. If, however, the patient is in a much reduced condition, and not well nourished, you will have to give some nourishment - clam broth, milk, tea and sugar. Give them light nourishment, and they will get better.

The same obtains in diseases of the bowels for instance, in severe diarrhea. Leave the patients alone. Give them a little tea, warm soup, until the acute attack has subsided, and then begin to nourish them again.

The chronic diseases of the digestive tract may be divided into two large groups - one in which there is organic disease present, like ulcer or cancer; and the other in which there are mild inflammatory conditions, catarrh, etc., or functional disturbances present.

In regard to organic disease, ulcer of the stomach, for instance, there we make a division between the two stages - the acute state of the ulcer where there are more pronounced symptoms, severe pain and vomiting; and the chronic stage, the period of acquiescence, where the condition is not so active. The treatment must be different in the two periods. In the acute stage, again rest is the principal thing. If the patient has a hemorrhage, keep him on rectal alimentation - practically starvation, and saline injections; some of the fluid is taken up by the system; perhaps one-third or a quarter of the nutritive material introduced through the bowel can be taken up, but it is essential that the digestive tract should rest for five or six days.

Then begin with mild liquid diet by mouth, or duodenal feeding. That represents a method of feeding which covers the losses and gives rest to the stomach.

But when the acute stage is over and the chronic form has begun, then you have to look out for a sufficient amount of food. The food should not, however, be too irritating to the system. In cancer of the stomach we have to look out that the patient is well nourished, and we give him fine articles of food, and if it is impossible to put the food in the stomach normally, as in cancer of the pylorus, a gastroenterostomy is done to make nourishment possible; but again we have to see that the food given does not irritate the particular disease. A patient with cancer cannot stand the ordinary food, but we have to give him as much of a light food as we can, and as long as we can.

In the second group of cases, the functional diseases of the stomach and intestines, it is very important to feed them properly. Formerly the principle prevailed that all dyspeptic individuals should be put on a diet, and by that was meant very little of the finest food - a milk diet, or soup, or perhaps a little meat. There was a physician in the city who used to give his patients meat and broth, and perhaps a few slices of toast - nothing else; and that particular diet was carried out with a great many patients, sometimes with some benefit, but oftentimes with a great deal of harm. In Germany to-day that theory of dieting a patient still prevails, more so than I like. I often have such patients come to me, and I tell them to go ahead and eat like other people, only to exclude this or that; and by and by they come to me and ask if they should not be put on a diet, - meaning to be kept away from food. But in my opinion, that is the worst thing for them to do.

It is my conviction that the principle that prevailed in former years of putting every - patient with dyspeptic symptoms on a restricted diet - was a wrong one. A great many persons who suffer from minor ailments of the digestive system keep away from food. Many physicians think that starchy foods are harmful for such patients, and forbid them to take bread and potatoes. All vegetables contain starchy food, so they are allowed only a little bread and perhaps only a little meat, and they do not enjoy their food, and symptoms of inanition develop, and many of these invalids ultimately die of improper feeding.

The proper principle is not to forbid anything but what is sure to cause harm. Everything else should be allowed. These patients should be given great liberty in their diet, because it is of the greatest importance to look out that these chronic dyspeptics get a sufficient amount of food. That is the principle upon which I act, and the more I practice it the more am I convinced that it is the right way of treating these patients.

One of my patients was a physician from Texas who had some dyspeptic troubles, and he got worse and worse, until he had lost forty pounds of flesh, and finally had to give up his practice on account of his inability to take food. He came to this city, where he had a good friend, a nerve specialist, who invited him to stay with him at his summer residence in Greenwich and offered to look after him; but the man continued to grow worse. He could not take any food, and still lost flesh, and having had to give up his business he was constantly worrying, and his nervous symptoms did not improve. Finally he came to me for advice, and began by telling his story. He could not take any toast, for that caused symptoms right away; he could not take meat, for it made him vomit; he could not take that, for it gave him a headache, and so on - he could not take anything. He thought that I was going to be guided by his opinion, but he was mistaken; if I had done that, he would be dead now. I told him that if he wanted to be treated by me, he would have to do as I directed, and leave his own opinions alone. So we began. His disease as such did not amount to much. He had an atonically dilated stomach, and was in a run-down condition, but had no organic disease. We began to feed him, and I had to make him eat contrary to his own convictions. I had to give him bromides at first, to act as a sedative, but he did as I said, and began to eat, and he regained his flesh, and is now practicing as before, and is convinced that he can eat everything.

A great fear of food - "sitophobia" - develops in many of these dyspeptics, perhaps because of some disturbances they had experienced and because they have been told to keep away from all kinds of food, and when they do take it that fear gives them more symptoms, so that the patient is worse if he has to eat something; he is afraid to sit at the table, and certainly he must suffer. That condition must be combated - the aversion to the sight of food and the fear of it. You must tell them that even if there is some pain, they must take the food and get out of that condition. It is better to eat and suffer than not to eat and not to suffer. You cannot live without food. That is the first and foremost principle.