named class of meats are therefore most suitable in conditions of hyperchlorhydria. In addition, Fleischer mentions the following articles of foods capable of binding large quantities of muriatic acid: pork, cheese, sausage, ham, Graham bread, milk, and cocoa. Farinaceous foods are not well tolerated in this condition, and must be given either in a very digestible form or, best, combined with protein food. Only the more digestible vegetables are to be allowed, such as mashed potatoes, spinach, asparagus, peas, and carrots, strained and eaten in the form of purées. Fats tend to lessen the acidity of the gastric secretion, and are therefore to be recommended; they are best given in the form of butter, cream, olive oil, and the like. Of the fluids, alkaline mineral waters, such as Apollinaris, Vichy, and Seltzer, are especially useful; the carbon dioxid contained in these waters produces a sedative effect and lessens the secretion of acids. These waters may be used to dilute milk or wine. The table on p. 403, taken from Fleischer, shows the ability of various foods to combine with muriatic acid : In arranging the diet for patients with hyperchlorhydria it has been found best, in the authors' experience, in dealing with patients taking but little nourishment, to allow them to eat at frequent intervals; if, however, large meals are consumed, it is advisable to permit only three meals a day, allowing the stomach to rest during the intervals. The following diet has been used with advantage by the authors in cases of hyperchlorhydria : DIET IN INTESTINAL DISEASES. The diet plays quite as important a rôle in the treatment of diseases of the intestine as it does in the treatment of gastric disorders. In many intestinal disturbances, such as acute intestinal catarrh, diarrhea, etc., cures can often be effected by diet alone, when without this mode of treatment the disease might become intractable. The diet in intestinal diseases, as in gastric disorders, must be such as will produce no annoying symptoms. The process of digestion in the intestine is exceedingly complicated, and therefore the digestibility of foods in this part of the alimentary tract is most difficult to determine. This subject was studied by Rübner,' who determined the degree of absorption of various foods in the intestine. The following table gives his results : It is thus shown that certain forms of foods contain very large proportions of protein matter, but that their absorbability is so slight that their nutritive value is far lower than that of foods containing less protein. Thus, while peas contain considerably more protein (7 per cent.) than does milk (3.7 per cent.), a much smaller proportion of protein is absorbed in the case of the former than in that of the latter; on the other hand, the absorbability depends greatly on the mode of preparation of the food; when vegetables are mashed and then strained so as 1 Zeitschr. f. Biologie, vol. xv., p. 115. to rid them of their cellulose envelopes, they are much more readily absorbed than when eaten with the cellulose. The digestibility of certain foods in the intestine varies greatly with different individuals. For this reason exact rules cannot be formulated in any case, but the diet must be varied according to individual peculiarities. Boas has expressed his opinion on this subject as follows: "1. In a number of intestinal diseases a change of diet is unnecessary or may even be harmful. "2. In some cases special dietetic restrictions are directly indicated, but these should be as few as possible. "3. In another series of cases an abundant, heavy, not easily digestible or absorbable diet is indicated. "4. The general aim of our treatment should always be to so manage the case before us that digestion of a normal diet will always occur in the alimentary canal without any subjective or objective disturbances. Under these circumstances only can the case be considered cured." According to their effect on intestinal peristalsis, foods may be divided into three classes: those inducing constipation; those producing a laxative effect, and those exerting no especial effect in either direction. In the first class are those foods containing an astringent, such as tannin; among these may be mentioned certain red wines, cocoa, and tea. Rice, tapioca, barley, sago, macaroni, and potatoes have a tendency to produce constipation in many individuals. Among the laxative foods may be mentioned fruits and certain vegetables, as cucumbers, tomatoes, and cabbage; cider, buttermilk, beer, and the carbonated waters also exert a laxative effect. In the third class, foods that have no especial effect on the intestinal movements, may be placed meats, fish, eggs, toasted bread, and zwieback. It must be remembered, however, that certain foods that prove laxative in one individual may be constipating in another, so that no precise rules can be formulated; in each case individual tendencies must be consulted. In severe forms of intestinal disturbances rectal alimentation must often be resorted to. For a further consideration of the technic and forms of food to be utilized in this method of feeding the reader is referred to the section on Rectal Feeding. In those cases in which food cannot be given either by the mouth or by the rectum subcutaneous feeding becomes necessary; for this 1 Diseases of the Intestines, p. 141. purpose olive oil may be used; one ounce may be injected twice daily under the skin, best in the region of the thigh; in some cases normal salt infusions are indicated. DIET IN INTESTINAL DYSPEPSIA. In intestinal dyspepsia food should be given frequently and in very small quantities. At first only the liquid forms should be used, such as weak tea, peptonized milk, malted milk, bouillon, and egg-albumin; after a few days the patient may gradually be placed on the following diet: calves' brains, sweetbreads, broiled steak or lamb chops, soft-boiled eggs, boiled fish, such as mackerel or rock, baked potatoes, spinach, asparagus, and stewed fruits. The following list gives the general plan of a diet used by the authors in this condition : 8 A. M.: 150 gm. milk with tea. 1 soft-boiled egg 60 gm. toasted wheat Calories. 101 80 bread (155) with 20 gm. butter (163) 218 100 gm. scraped beef (118) 10 A. M.: Scraped-beef sandwich 50 gm. wheat bread (178) 12 M.: Bouillon with 5 gm. Armour's Soluble Beef 100 gm. broiled chicken or 100 gm. broiled steak (209). or 100 gm. lamb chop (220). 50 gm. mashed potatoes or 100 gm. spinach (166) 296 10 106 100 gm. apple sauce. 50 gm. wheat bread, stale or as toast 3 P. M.: 200 gm. milk 7 P. M.: 200 gm. milk with rice 1 soft-boiled egg 100 gm. wheat bread and 50 gm. butter DIET IN ACUTE INTESTINAL CATARRH. 64 88 130 135 253 80 666 2227 As in acute gastric catarrh so also in acute intestinal catarrh the regulation of the diet is probably the most important factor in the treatment of the disease. The patient should be kept in bed; after the bowel has been thoroughly emptied by a cathartic, liquid foods, such as clear broths,-at first without, and then with eggs,-thin gruels, light tea, cocoa cooked in water, and egg-albumin, should be given exclusively for several days. In this condition milk should not, as a rule, be given. When there is extreme thirst, the carbonated waters may be allowed, but only in small quantities. The thirst is best relieved by placing bits of crushed ice in the patient's mouth. After the pain and discomfort have disappeared, toast, crackers, stewed chicken, |