Only within the last three years has the literature definitely suggested the important relation of chloride metabolism to alkalosis in the Sippy1 alkali treatment for peptic ulcer. Hardt and Rivers2 were probably the first to suggest that the symptomatology of alkalosis might be partly due to the reduction of blood chlorides; however, the chlorides were normal in the one case they examined. Work has been done on upper intestinal and pyloric obstruction3 and on salt-poor4 and salt-free5 diets, but I have found no articles which compare the observations and symptoms of these conditions with the strikingly similar pictures found in alkalosis from Sippy treatment.
A study of the material in this paper and a comparison with the observations of others will show the paramount importance of chloride metabolism in the treatment for ulcers. I hope that a clearer understanding of the complications of Sippy therapy will result from studies such
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