not hold good, for here the dietary must be modified according to the diathesis of the patient, the condition of his different organs, and the disease from which he is suffering. For example, when the eliminative processes are hampered, albuminoids must be cut down; and, on the other hand, when the system is unable to deal with the carbo-hydrates, they must be reduced to a minimum, and so on. Again, take, for instance, functional disorders of the digestive organs. In these cases the times of giving food and the intervals between the supplies, the amount given at a time and the mode of preparing the food, are details of almost equal importance with the consideration of the kind of food to be given.: In health the regulation three meals a day are found, by the majority of people, to be the most convenient division, but the sick man cannot take a sufficient supply at a time to last for five or six hours, and consequently he must have his smaller supplies at shorter intervals. The length of the interval will depend on the quantity that can be taken at a time, the kind of food that is given, and the rapidity with which absorption is carried on.

Plain, simple cooking should be the rule in health, and much more does this apply to invalid cookery. It cannot be too good, it cannot be too simple, nor for invalids can the food be too daintily served. The surroundings and circumstances under which food is taken have a great deal to do with the comfort of the patient. The fitful, fastidious appetite of the invalid is whetted by the appearance of a little meal daintily served, while the presentation of a large quantity turns him, for the time, against all food. Sickroom cookery is now much better understood than it used to be, but it is to be feared that many nurses and atten dants on the sick, not to speak of medical men, hardly yet appreciate fully the help that attention to such details will bring to those under their care..

CHAPTER I.

DISEASES OF THE STOMACH.

GENERAL CONTENTS: Chronic Gastric Catarrh (Chronic Gastritis: Irritative Dyspepsia: Inflammatory Dyspepsia)-Atonic Conditions of the Stomach (Atonic Dyspepsia)-Ulcer of the Stomach-Cancer of the StomachHæmatemesis-Inflammations of the Stomach (Acute and Subacute Gastritis Acute Gastric Catarrh).

CHRONIC GASTRIC CATARRH (=CHRONIC GASTRITIS : IRRITATIVE DYSPEPSIA: INFLAMMATORY DYSPEPSIA).

THESE are all different names given to varying degrees of a condition, or to several closely allied conditions, that frequently come before us in patients who complain that they are suffering from indigestion.

Symptoms. On questioning such patients, they tell us that their appetite is variable and uncertain. They complain of acidity, heartburn, and pain after eating; of pyrosis; of sickness at times, coming on soon after meals, and especially after indulging in any rich or indigestible articles of diet; of thirst, and a sense of gnawing, heat, and soreness at the epigastrium; in some cases, also, there is slight epigastric tenderness on pressure. The tongue is red at the tip, furred at the base, or, in cases of long standing,, it is bare, often scored and fissured. Sleep is broken and disturbed, and there is usually some loss of flesh and strength. The bowels are constipated, but constipation may, every now and again, give place to an attack of diarrhoea.

Origin and Causes.-The condition indicated by the foregoing brief outline of symptoms may have its origin

in gastric congestion and catarrh, resulting from disease of liver, heart, or kidneys. It may be induced by overindulgence in alcoholic stimulants, and it is especially common in those who are in the habit of taking spirits on an empty stomach. In persons in whom the predisposition exists, frequently recurring or continued irregularities in diet, such as eating things of known indigestibility, hurrying over meals, working close up to and immediately. after a full meal, are sufficient to induce an attack. Worry and anxiety are also common causes; and we have not infrequently seen this condition, which is undoubtedly often connected with the gouty state, alternating with outbursts of eczema.

Irritability of the Mucous Membrane. From what has been said of the symptoms, it is evident that the condition we are here called upon to deal with is one in which there is great irritability of the mucous membrane. In these circumstances, if the food be bulky, so as to distend the stomach; if it be harsh, lumpy, and coarse, so that it irritates this tender surface; if it be highly seasoned with spices and condiments, the hyper-sensitive stomach will turn against it, the vessels will contract, the follicles will refuse .their contents, mucus will be poured out; and if that be not sufficient to protect its walls and to allay the increased irritation, vomiting will ensue, and the whole contents of the stomach will speedily be rejected. Even if the stomach. does not thus summarily get rid of its burden, the food will remain for a long time undigested, giving rise to flatulence, weight at the epigastrium, and a sense of fatigue and depression in place of strength and refreshment will ensue.

Small Quantities of Food at Short Intervals. In such circumstances as these, food must be given in very bland, easily digestible forms, in smaller quantities at a time than in health, and at shorter intervals of time. Moreover, the food must be partaken of very slowly. If the symptoms be severe, the rules will be the same as for a case of gastric

ulcer or gastric erosion (see p. 17), but in less severe cases the following dietary will be suitable :

Dietary.—In all but comparatively slight cases it will be better for the patient, at first at least, to have his breakfast in bed, as he is sure to feel somewhat tired after the exertion of dressing. If he is sufficiently well to be up and about, let him take before rising a teacupful of milk, with enough hot water in it to take the chill off, and let breakfast follow very shortly after he is dressed. It may be here repeated that strict injunctions must be given the patient to take all food very slowly by teaspoonfuls, and at a temperature rather cool than hot, but not actually cold. A typical breakfast will consist of, a breakfast-cupful of "tops and bottoms," or unsweetened rusks, made as for infants' food, or a cupful of any prepared farinaceous food.

Some patients can go on taking the same things with relish for a considerable time, while others very soon get tired of one thing, and require a change. As much variety as possible should be introduced into the dietary, and, in addition to the alternatives already given, another change may be made by substituting for plain milk, weak cocoa nibs or peptonised cocoa, made with boiling water, with some milk added in the cup.

10.30-11.—A small glass of milk with the chill taken off, and a teaspoonful of malt extract added, to it, or a teacupful of chicken tea with a plain biscuit or thickened with some farinaceous material.

I o'clock. A breakfast-cupful of good beef-tea ("whole beef-tea," i.e., with some of the meat. dried, pounded, and mixed with the liquid), or a breakfast-cupful of strong mutton broth with a finger of toast dipped in it.

4 o'clock. A cupful of milk flavoured with tea, or a cupful of cocoa nibs with a slice of thin bread and butter.

6.30-7.-A meal like that at one o'clock; some variety of broth or beef-tea.

9.30-10.—A teacupful of water arrowroot with a dessert

or a tablespoonful of brandy stirred into it, or a cupful of Mellin's food.

Food at Night.-If the patient sleeps well throughout the night, there is no necessity for him to have food; but if he wakes up, a glass of milk and water, or gruel, or farinaceous food made thin, and kept in a covered jug under a cosey, should be within reach ; or some meat-jelly, and a few spoonfuls of the jelly, or a teacupful of the other food, will often help to procure sleep.

Alcohol.--It will be observed that the only admission of alcohol into this dietary is the small quantity permitted at bedtime, and, as a rule, these patients are better without Some, however, either from age or from feebleness of constitution, are so weak that it is necessary to allow a small amount during the day as well, and it will usually then be found best to give it in the form of old spirit, in quantities varying from a teaspoonful to a tablespoonful, either in the food at the midday and evening meals or in a claret-glassful of water, sipped just after the food.

Treatment of Severe Cases.-Severe cases of the kind now under consideration will at first require the same treatment as cases of acute gastric catarrh, or of gastric ulcer, and there will be found many gradations between such cases and the slight ones. It will frequently be necessary to begin treatment on the strictest plan, and as the condition of the stomach improves, to advance gradually to a dietary similar to the one just given.

Food in the Convalescent Stages.-As convalescence progresses, a further step will then be to substitute plain purées (see Appendix) of chicken or game, or panada of chicken, or boiled sole, or whiting, for the liquid at the midday and evening meals. Next, a lightly boiled egg, or a poached egg, with dry toast or stale bread and a little butter, and a cup of cocoa, may be given at breakfast. If that be well borne, go on to boiled white fish of the lighter kinds at breakfast, continuing the pounded meat for dinner.