1. Gastric atony, a simple fault of innervation, often accompanied by paretic constipation and usually by hypochlorhydria.

2. Degenerations of the gastric muscle, not sharply distinguishable clinically from atony, due to infections, hyperpyrexia, endogenic and exogenic chronic intoxications, malnutrition, local or general.

3. Vertical stomach, a developmental condition usually found in slender waisted women, usually accompanied by movable kidney and general visceral inadequacy, sometimes by more or less general splanchnoptosis. In this condition, there is a primary tendency to too rapid discharge of the stomach contents into the bowel but the rather acute angle between the axis of the stomach and of the first part of the duodenum tends, sooner or later, to cause delay of stomach contents or even a dilatation of the lowest part of the stomach.

4. Gastroptosis. A. Of mild type, the axis of the stomach approaching the horizontal with tendency to atony and true dilatation. (Note. There is a very general tendency to confuse dilatation and ptosis. Although having many etiologic, symptomatic and therapeutic points in common, it should be remembered that ptosis means the sagging of a whole organ, dilatation the enlargement and hence, as referred to a hollow organ, the sagging of the lower portion only.)

4. B. Gastroptosis of severe type, the stomach being banana-shaped, with the convexity downward, and occupying a position at or even below the umbilical equator.

5. Atonic dilatation, the logical result of any of the preceding conditions, the stomach being moderately enlarged and relaxed, but with no obstruction at the pylorus.

6. Obstructive dilatation, due to pyloric cancer or other tumor, cicatrizing ulcer or an open ulcer or fissure the passage of food over which causes marked tonic spasm, pressure by peritoneal bands or growths of various kinds exterior to the stomach. Gastroptosis, especially of type B., may cause sufficient angulation to produce organic obstruction. In obstructive lesions, there is a primary tendency, more or less adequate, toward compensatory hypertrophy of the muscular coat so that, especially if diet is carefully regulated and other appropriate treatment instituted, dilatation may not develop. However, practically all cases of marked gastric dilatation are due to obstruction of some kind, at or near the pylorus. Obviously, in spite of tables of differential diagnosis, gastric dilatation is usually complicated with catarrh, and by various other functional and organic conditions.

It is highly important to know, not only the motor state and size and position of the stomach in this group of cases but also the secretory and digestive function and the actual organic lesion present, if any. Gastroptosis of type B. is liable to be complicated by stretching and partial compression of the oesophagus, with dilatation above the cardia, where food and mucus may accumulate so as to require occasional lavage of the lower oesophagus and even gavage through a tube. Otherwise, the dietetic management of the first 5 conditions of this group is about the same, and has already been discussed.

Marked dilatation of the stomach is a condition to be diagnosed with rather than from other gastric diseases. For dietetic purposes, it may be divided into the following types which, however, are not entirely distinct and which are subject to modification during the progress of any individual case.

A. Dilated, catarrhal stomachs, with depressed hydrochloric acidity, moderate stagnation and fermentation. The food should be concentrated, so as to administer an adequate ration in three or even two meals a day, with long periods of rest. Indigestible residue and hard or chaffy particles, or unmasticated soft portions should be avoided, in order to facilitate the passage of food through the pylorus. Antiseptics, digestants and hydrochloric acid should be used p. r. n. Water should be given three to five hours after meals to aid in washing remnants through the pylorus and lavage may also be practiced at this time, but usually not oftener than once a day. If there is much mucus, hot water with soda and borax or hydrogen peroxid etc., may be administered before meals, as already mentioned for chronic gastritis.

B. Ischochymia, mainly due to Ulcer at or near the pylorus with hyperchlorhydria and, on account of the stagnation, a paradoxic occurrence of fermentation, mainly of carbohydrates in spite of the antiseptic action of the acid. The hyperchlorhydria acts in a vicious circle to maintain the ulcer and the pyloric spasm. In these cases, intermittent physiologic rest of the stomach should be practiced, with rectal and hypodermic alimentation for a week or two at a time, to secure contraction of the stomach, healing of the ulcer and asepsis. While fed by the stomach, the meals should be as small and as far apart as possible, should be pultaceous and unirritating and, at the same time should be low in carbohydrates. On account of the hyperchlorhydria, there is an indication to reduce proteins also but this is balanced by the need of nutriment. On the whole, the best diet consists of milk combined with wheat cereals of a soft nature when moist, and with some egg, well comminuted, and expressed meat juice. Non-effervescent alkalies and antiseptics are usually needed. Lavage late after meals is usually required. Purpetrol may facilitate the passage of food through the pylorus.

C. Dilatation due to cancer at the pylorus, with depression of hydrochloric acid secretion, marked lactic acid fermentation, and putrefaction of proteins, including perhaps the cancer itself, and rancidity of fats when cancer has advanced to this stage. While there is a theoretic indication to establish and feed through a superior enterostomy, life can seldom be prolonged sufficiently to make this operation worth while. The dietetic indication is to cleanse the stomach thoroughly and nourish as well and as long as possible by the bowel and by hypodermic injection, inunction etc. When the rectum becomes intolerant, peptonized milk, cereal gruels etc., with digest ants and antiseptics may be employed for a few days, practicing lavage every day or two late after a meal. In these cases, water may usually be supplied by the stomach throughout both periods. When the stomach becomes markedly intolerant, rectal alimentation may be resumed and this alternation may be repeated several times before death occurs. The stomach and rectum should not both be used at once.