Cow's milk is not a natural food for grown-ups, either human or bovine. Milk is deficient in iron, and contains an excess of protein, and lime. Cow's milk disagrees with many persons, children as well as adults. It is certainly by no means an ideal food. Yet many persons are benefited by its temporary use when proper precautions are taken. The first essential is that the milk shall be taken in large amount, so large as greatly to exceed the needs of the body, and thus fill the alimentary canal with material which will promote the growth of friendly bacteria, or sour milk germs, for which milk supplies the very best medium.
A second essential is that the milk shall be taken often. A half pint every half hour or every forty minutes is the usual plan. This is necessary to make it possible to take into the stomach the five or six quarts of fluid required for one day's milk ration. It is also important to maintain a constant stream of fresh material passing along the alimentary canal, so that a considerable portion may reach the colon undigested and unabsorbed. It is especially important that a sufficient amount of milk sugar should reach the colon unabsorbed to maintain in the colon a state of acid fermentation thereby preventing putrefaction and changing the intestinal flora. This is, indeed, in many cases, the chief benefit derived from the milk diet. To encourage this change it is well to give at each alternate feeding yogurt buttermilk in place of sweet milk; or equal parts of sweet milk and milk soured by the Bulgarian ferment may be taken at each feeding.
Feeding begins at 7:00 a. m. and ends at 7:00 p. m. - twenty-five feedings in all. At 10:00 a. m. and 4:00 p. m. the milk is omitted and a meal of fruit is taken instead. The purpose of this is to encourage bowel activity, since very free and frequent bowel movement is essential to success. The disappointing results often encountered in the use of the milk diet are chiefly due to the constipation which is likely to be produced in many persons, the natural result of which is intestinal toxemia and an aggravation of the very symptoms relief from which is sought.
An ounce of wheat bran or agar-agar should be taken daily in half ounce doses, preferably at 8:00, 10:00, 12:00, and 4:00 o'clock feedings. In cases in which the colon is badly crippled, the use of the Russian paraffin oil in doses of one tablespoon-ful three or four times a day is necessary to secure the active bowels required for a rapid and efficient change of the flora.
When the period of exclusive milk feeding is ended, the milk should be at once discarded and a strict fntitoxic diet adopted; milk, meat, fish, fowl, eggs and all kinds of animal protein must be discarded. Milk is unwholesome for most invalids and often even in very small amounts. This is especially true of persons suffering from colitis. It is most likely to produce unpleasant effects when taken in small amounts with other foods. It is generally tolerated when taken as an exclusive diet and in large amount because of the special conditions established whereby a change of the intestinal flora is accomplished.
It should be remembered that the chief advantage of the milk diet as a means of changing the intestinal flora lie - (1) in the large amount of milk sugar which by this means is carried into the colon and there, fermenting, produces lactic acid and so prevents the growth of the putrefactive bacteria; (2) in the frequent bowel actions induced by the large surplus of food ingested. The soft curds, undigested and unabsorbed by their bulk as well as by their acidity stimulate peristalsis to such a degree as to cause several bowel movements daily. In certain cases, however, in which mechanical obstacles to bowel action exist, such as either spasm or incompetency of the ileocecal valve, or adhesions of the pelvic colon, constipation may continue in spite of the largest quantities of milk that can be taken. In such cases the sugar of milk is wholly absorbed, leaving the curds to putrefy in the lower colon, and the most intense toxemia may result. The writer has met a number of cases of this sort. This is the cause of the disastrous failure of the "milk cure" in certain cases.
To meet the needs of certain patients who have an idiosyncrasy against milk, especially cases of colitis, the writer has conducted a large number of experiments for the purpose of discovering a diet for changing the intestinal flora suitable for general use and especially in cases in which milk is not tolerated. The result of many experiments was the selection of a diet consisting chiefly of wheat bran and fruit; lettuce, cucumbers, tomatoes and any other uncooked product of the garden may be added, but the chief part of the diet must be bran and fruit. Such a dietary practically eliminates protein and fats. Food may be taken either three or four times a day. Two or three tablespoonfuls of sterilized wheat bran should be taken at each meal. A convenient way to take the bran is in the form of a soup or porridge made with stewed tomatoes or some fruit. A spoonful of oatmeal or corn-meal may be added if desired.
All sorts of fruit may be eaten freely. Dates are especially valuable because of the sugar which they contain.
The result will be three or four free bowel movements daily, and at the end of three or four days the stools will become odorless or nearly so. A slight acidity is a good indication, showing that the flora is completely changed, the putrefactive and poison-forming germs having been displaced by the beneficent acid-formers.
After the flora has been thus changed by a bran and fruit diet closely adhered to for a few days, a careful antitoxic diet should be closely followed as a permanent regimen. It is a great error to suppose that the intestinal flora can be definitely and permanently changed by a brief course of treatment or by any plan which does not include the complete and permanent exclusion of "toxic" foods. Meats of all sorts must be wholly discarded. Eggs must be used sparingly if at all. In not a few cases milk must be carefully avoided even as an ingredient of soups and other dishes. Some persons may recoil at the idea of so great a limitation of the dietary; but a person who has suffered from such distressing effects of chronic intestinal toxemia as a severe eczema, frequent "sick headaches," Bright's disease or arteriosclerosis will be quite willing to undergo almost any sort or degree of gustatory discipline if assured that the sacrifice will secure the desired result. Fortunately, this assurance may usually be given with the greatest confidence that the results will not be disappointing.
The free use of bran and paraffin must be continued indefinitely, and care must be taken not to omit their use at a single meal. If thorough evacuation of the bowels does not occur three or four times daily the amount of paraffin or quantity of bran, or both, should be increased. Agar-agar in some form may be used in place of bran, or in connection with it. There need be no fear of injuring the intestine by producing irritation. The writer does not hesitate to make this statement after having carefully watched the effects of the measures above recommended in hundreds of cases. If the measures suggested are employed with sufficient thoroughness, and continued for a sufficient length of time, the effort will not fail of success. It is necessary in many cases, to supplement the regimen recommended by means of treatment which will thoroughly cleanse the colon, introduce a normal flora, and reform the wild bacteria with which the colon is infected. For a detailed description of these measures the reader is referred to the directions given elsewhere in this work for the treatment of colitis. (See page 330). If an ammoniacal or putrescent odor appears in the feces at any time the fruit regimen must be resumed for a few days until the odor disappears. The diet should be carefully studied and modified as necessary until the stools become regular, frequent, and practically free from odor, or at least free from putrescence.