The numerous and important applications of milk-diet in the treatment of certain forms of disease render it necessary to devote considerable space to the consideration of this subject. Milk is a food already prepared, and therefore needs no intervention of unskillful cooks; it can be obtained everywhere; few patients are disinclined to take it.

Physiological Effects of Milk-Diet

In the use of a diet for a long time exclusively of milk, great difficulty is often experienced in overcoming the repugnance of the patient. Although as a rule it is taken with readiness at first, after a time it begins to pall upon the appetite, and the greatest resolution is necessary on the part of the patient in order to continue it. A distressing sense of emptiness is experienced at the epigastrium. The mouth becomes pasty, and the tongue is coated with a thick, whitish fur. Constipation, sometimes exceedingly obstinate, occurs, and the stools are hard and of an ochre-yellow color. Occasionally diarrhoea is produced, but this is due to the fact that the milk disagrees and is not digested. The urinary secretion is increased in amount, but this is due simply to an increased flow of water. Although milk contains all the constituents necessary for the nutrition of the body, when it is used as an exclusive article of diet in the case of those accustomed to a full mixed diet, a decided diminution in the weight of the body takes place. After a time, however, the waste ceases, and the weight continues at a uniform level. The interference of a milk-diet with nutrition is more decided when skimmed milk is used—a form in which it is more usually administered in intestinal disorders. The pulse is quickened and the arterial tension lowered; but a fall in the pulse-rate takes place when the body ceases to lose weight. A marked degree of debility is experienced by some persons, so that they are unable to take exercise. In two cases in which I used this method with signal success—chronic eczema, and chronic ulcer of the stomach—the patients, both females, experienced vertigo and faint-ness, and Mitchell mentions a case in which from the same cause he was compelled to discontinue the milk. Ordinarily, however, nothing more than weakness is experienced.

Therapy

Pecholier, Carel, Mitchell, and all who have treated of the milk-cure, insist upon the suspension of all other food and drink,, The quantity to be taken will vary with the constitutional peculiarities, habits of life, and probably the mental condition of the patient. As milk requires about three hours for its complete digestion, this furnishes a rule for its administration. One gill, or four ounces, every three hours, beginning on rising in the morning, is the rule which I have followed with success. As soon as the patient can take a sufficient quantity, one or two tumblerfuls four times a day may be ordered. From a quart to two quarts is the daily amount which will be taken usually by the patient. It is better administered slightly warm.

In many cases of stomach and intestinal disorders, it is better to give skimmed milk. The milk should stand for twenty-four hours in a cool place, and then all the cream which has risen should be carefully removed. Sometimes, says Pecholier, when crude milk disagrees with or is disgusting to the patient, it may be boiled. The digestion of the milk, says the same authority, when it is poorly borne, may be aided by the addition of lime-water, bicarbonate of soda, and other alkalies. Mitchell has added lime-water for the first few days under the same circumstances, and, in order to overcome the patient's repugnance to the taste, has faintly flavored the milk with a little coffee or caramel; but he prefers to give it alone as soon as possible. My own observation has been, that milk is better borne when given for the first few days with lime-water, in proportion of one fourth of the latter.

For the nourishment of infants deprived of their natural food, no substitute is better than cow's-milk diluted with about one third of water and sweetened with sugar, in order more closely to assimilate it in composition to the human milk. This should be given at a temperature of 100° Fahr., and at intervals of three hours. No other food than milk is proper for infants up to the eighth month of life, for their digestive organs are not adapted to the digestion of the farina-ceous foods so commonly supplied them. If the milk be rejected, the addition of lime-water may enable the infant to retain and digest it.

In the treatment of disease in the adult with skimmed milk, the time for suspension of the diet depends on several conditions. Carel begins to make additions after two or three weeks; Pecholier when the effects sought for in the treatment are obtained. Mitchell formulates his method as follows: " My own rule, founded on considerable experience, is this: Dating from the time when the patient begins to take milk alone, I wish three weeks to elapse before anything be used save milk. After the first week of the period, I direct that the milk be taken in just as large amount as the person desires, but not allowing it to fall below a limit which, for me, is determined in each case by his ceasing to lose weight. Twenty-one days of absolute milk-diet having passed, with such exception as I shall presently mention, I now give a thin slice of stale white bread thrice a day. After another week I allow rice once a day—about two tablespoonfuls—or a little arrow-root, or both, as circumstances may dictate. At the fifth week I give a chop once a day; and, in a day or two, another at breakfast; and after the sixth week I expect to return gradually to a diet which should still consist largely of milk for some months." My own rule has consisted in the gradual addition of other diet after the cessation of symptoms for which the milk-treatment was instituted.

Dr. Stanley S. Cornell, of Ontario, Canada, has favored me with an account of a case of fecal impaction, in which a great quantity of curds accumulated behind the faeces. Such an accident illustrates the necessity of keeping the bowels in good condition during a course of milk diet. One of the Saratoga waters, a little Epsom or Rochelle salts in the early morning, or a little aloes and belladonna at night, will usually suffice. A little black coffee added to the milk may answer.

The milk-cure is especially adapted to the treatment of obstinate stomach affections. It has succeeded admirably in the treatment of dyspepsia, gastric catarrh, gastralgia, gastric ulcer, and has procured marked amelioration in cases of scirrhus of the stomach. In chronic intestinal indigestion, obstinate and persistent enteralgia, chronic diar-rhcea, and dysentery, it has proved very efficacious.

The treatment of ascites by a milk-diet appears to have been of ancient origin, for Hippocrates distinctly refers to it, but the revival of the practice in modern times is due to Chrestian, of Montpellier, who demon-strated the utility of this practice in a number of cases (Fonssagrives). Pecholier and Chairon also report cases of success treated by this method. In cases of ascites the result appears to be due to the profuse alvine and urinary discharges which are caused by the milk-diet in this disease. Pecholier also reports cases of general anasarca due to cardiac disease, much benefited by this treatment. In England, Donkin has issued a monograph on the skim-milk treatment of albuminuria, with successful cases. This method has also been extended to diabetes, and reports of cures are not wanting.

Eczema, connected with acid indigestion, has been successfully treated by an exclusive skim-milk diet in my hands, and Mitchell reports an analogous case. Gout and gouty affections have also been much improved, and the diathesis apparently removed, by a persistent use of the milk-cure. Lastly, aneurism and cardiac disease (irregular and tumultuous action due to valvular lesions) have been benefited by a milk-regimen.

"Whey-Cure.—This mode of treatment is conducted in the mountain health-resorts of Switzerland and Germany, and is usually connected with the grape-cure. As whey contains so little of the nutritious elements of the milk, we may conclude with Lebert that the hygiene and climate of these mountain-resorts do everything for the patients, and if they improve they do so in spite of the whey.