Koumiss is the fermented milk of mares or asses. It is used largely by the Tartars and Khirgis tribes and other nomadic tribes of the South-eastern Steppe country of Russia. It is given as a cure for phthisis in the districts where it is made, with good results, which more probably depend on the climate than the koumiss. It is also made and used in Moscow and St. Petersburg.

The "koumiss cure" is carried out in the Steppes of Oren-berg and at Annaeff's and Postnikoff's establishments in Ssa-mara. Annaeff's place is on the banks of the Volga, three versts from Ssamara. It is situated in a park on a hill and is provided with a library and theatre. Patients should only go there in summer, for the winter climate is too severe.

Patients are made to rise early and to take a glass of koumiss every half hour, except during the two hours before dinner and supper. Meats and fats form the chief part of the diet. Sweets, fruits, salads, ices, coffee and spirits are forbidden. At first only a few glasses of koumiss are given, until the patient is accustomed to it, and lime water is added to stop diarrhoea. It is well digested, even in large quantities, relieves constipation, and acts as a diuretic or diaphoretic, according to the temperature of the external air.

Mode Of Preparation And Composition

The milk is fermented by means of kephir grains. Alcoholic and lactic acid fermentation occur. Milk of mares is the best, because it is rich in sugar. The milk sugar is converted into alcohol, carbonic acid gas and lactic acid. Fat is liable to butyric acid fermentation, and for this reason, too, mares' milk is the best, because it is poor in fat. The resulting fluid varies in composition with the duration of fermentation. A good sample contains about one to two per cent of alcohol and less lactic acid, and is a milky, frothy liquid with a slightly acid taste. The amount of alcohol is not greater than in many temperance drinks. It is more readily digested and more completely absorbed than milk, and can be taken in huge quantities, from 10-15 pints in the 24 hours. As much as three or four gallons may be taken on a hot day in the Steppes. Hence, a considerable amount of nutriment is taken. It is diuretic, mildly purgative, and limits intestinal putrefaction by virtue of the lactic acid and bacilli which it contains. The alcohol is a mild stimulant and food. The carbonic acid encourages gastric secretion. The casein is finely divided, digestible, and does not curdle in the stomach.

Kephir is the product of a similar fermentation of cows' or goats' milk, and has been used for ages among the Caucasian tribes. Kephir grains or beans consist of masses of dried ferment held together by a gelatinous substance. The active agents are the saccharomyces mycoderma and the lactic acid bacillus. In composition it is practically the same as koumiss. A modification of koumiss is made by various dairy companies from cows' milk, by the addition of sugar and yeast. The use of kephir grains was soon abandoned. It is sold under the names of kephir and koumiss. The milk is skimmed or diluted to reduce the amount of fat. The casein is partially predigested, dissolved, precipitated in a state of very fine division, and a small amount of peptone is formed. The taste for these preparations is an acquired one. The artificial product costs about 1s. a champagne quart. Begin with small doses, about one pint daily, and increase gradually.

An ordinary amount of koumiss per day would be about seven pints, or 4,000 c.c. Obviously the addition of this amount of food to a diet rich in protein and fat, combined with an open-air life in the pure air of the Steppes and freedom from anxiety, is likely to prove very advantageous in suitable cases of early phthisis or mild fibroid cases. In comparison with the whey cure, in which there is marked underfeeding, the results are likely to be excellent. Koumiss and kephir are practically identical in composition, but in each the actual percentages of the various constituents depend on the duration of fermentation.

Kephir.

Koumiss.

Dujar.

din-

Beaumetz.

After 2 days.

Hartier.

Analysis by Stange.

6 hours.

18 hours.

30 hours.

Protein ....

38

31

22

112

225

226

200

Fat.....

20

20

21

205

189

200

190

Carbo-hydrate

20

1.6

1.5

220

1.88

1.63

000

Lactic acid

09

0.8

09

115

039

056

064

Alcohol ....

0.8

21

1.7

1.65

1.85

1.95

3 00

Mental and bodily languor and excitement of the sexual organs have been noted as sequels of the treatment. The " cure " is suitable for gastric and pulmonary catarrh, when conjoined with a hot dry climate. Sometimes it is beneficial in anaemia, malnutrition and convalescence from illness. It has been recommended for delirium tremens and hepatic cirrhosis. Chiefly, the artificial product in this country is useful for severe vomiting and gastric and intestinal diseases, associated with putrefaction. Thus, it may be tried with fair hopes of success in chronic infantile ileo-colitis and in the colitis of adults. Apart from these latter disorders koumiss and kephir must be looked upon as aids to treatment rather than as definite curative agents.