The milk drip.

certainly possible to improve the results of medical treatment in our present state of knowledge. First the diagnosis of ulcer should be established as early as possible after symptoms begin and thorough treatment with bed rest should be given at the onset; how rarely does one see a patient in a hospital bed with an ulcer history of less than a year? It is in this respect that our professional colleagues so often have the advantage over the hospital patient. Secondly, the diet prescribed should be palatable ; in spite of dietitians how many hospitals can be said to provide this? Moreover, some attempt should be made to instruct not only the patients themselves but also their wives in the methods of preparation of such a diet. Finally, the social circumstances of the patient must be considered and every help given to enable him to adjust himself to the difficulties and responsibilities of his daily life. Since Winkelstein (I932) first introduced the continuous alkalinized milk drip for the treatment of peptic ulcer, this method of therapy, with certain modifications, has enjoyed increasing popularity. Not only has it been widely adopted in the management of the dyspepsias, but also as a means of feeding in certain cases of injury or disease of the mouth or pharynx. In a number of conditions of nervous origin as well as in ceitain forms of renal disease it has proved a life-saving measure. The basis for Winkelstein's introduction of the milk drip in the treatment of peptic ulcer rested upon his observation that night sampling of the resting gastric contents in cases of gastric and duodenal ulcer showed abnormally high curves for both free and total acid. In duodenal ulcer, especially, a high continuous curve was obtained. He subsequently showed the absence of free hydrochloric acid in such cases during milk drip treatment and concluded that the method is a logical and practical means of producing constant achlorhydria. Subsequent experience has proved the value of Winkelstein's method of treatment, but in recent years more concentrated modified milk mixtures fulfilling calorie, vitamin and electrolyte requirements have been devised. Details of five such diets will be found elsewhere in this issue. The main advantage of these fortified milk mixtures is that a completely balanced diet can be administered in a volume of 3 or 4 pints and that patients may be fed by continuous intragastric drip for …