The chief causes of gall-stones are inflammation of the bile-passages and gall-bladder, with resulting stagnation of bile. This inflammation of the bile-passages is usually the sequel to a catarrh of the duodenum, which has resulted from long-continued errors in feeding. In some cases it is not so much the amount and nature of the food that is at fault, as other conditions associated with that system of feeding, and more especially a sedentary life and constipation. The dietetic conditions which predispose to duodenal catarrh are excess of food, and more especially a rich, varied dietary containing a too liberal supply of sweets and starchy foods. The digestive powers in these patients are generally more than usually limited, and the first essential is that the diet must be simplified. The amount of fat in the dietary has to be reduced, because in these cases fat impedes digestion. Care has to be taken with the carbohydrates on account of the special role which the liver - the bile-producing organ - plays in their metabolism. All foods liable to putrefaction, such as over-ripe cheese, shellfish, and the like, should be avoided, because of the unfavourable influence on the growth of pathogenic bacteria in the bowel. Stimulants are better withheld, and water-drinking should be encouraged.

The meals should be given at regular intervals, not too far apart, since the introduction of solid food into the stomach promotes the flow of bile - four or five meals in the day. Too long fasting is therefore injurious. The following regime is adapted for a case of gall-stone disease in a middle-aged woman of stout tendency. Special mention may again be made of the value in treatment of exercise in the open air, exercises to promote the action of the abdominal muscles, and the judicious use of laxative salines.

7 a.m. - Tumblerful of hot water, with I dram of sodium phosphate dissolved in it; or A Carlsbad mixture. (A useful Carlsbad mixture can be made by dissolving 22 grains of sodium sulphate, 12 grains of sodium bicarbonate, and 10 grains of sodium chloride in a pint of water. Take 2 to 4 ounces at a time, once every fifteen minutes; repeat three times).

8 A.M. - One cup of tea, with little or no sugar.

One course of fish, ham and egg, or tongue.

One or one and a half slices of toast, or roll, with butter (jam and marmalade should only occasionally be taken). 11.30 a.m. - Tumblerful of water (either plain, carbonated, or alkaline water). I P.M. - Fish or chicken souffle.

Stewed fruit passed through a sieve, or bread and cheese. 4.30 P.M. - Cup of tea, with little sugar.

Thin slice of bread and butter; no sweet cakes. 7 P.M. (Plain three-course Dinner). - Either Soup, Meat, Pudding; or Fish, Entree, Pudding; or Fish or meat course, Pudding, Savoury; or Soup, Entree, Savoury.

(The soup should preferably be clear, and not made from rich vegetable stock. A limited amount of potatoes and green vegetables may be given. Rich, oily salads should be avoided. The meat should be freshly cooked or cold - no rich sauces or gravies. Suet puddings and pastry should only occasionally be taken, the best puddings being stewed fruit (without added sugar), custard, curds, jellies, blancmange. Extras in the form of fruits, nuts, and sweets should be avoided.) 10 P.M. - Tumblerful of hot water.