Analogous to the koumiss or kephir cures, dependent as they are on the presence of lactic acid and lactic acid bacilli, is the treatment of intestinal and other affections by buttermilk or by lactobacilline. Buttermilk should be made from sour cream or milk, and be less than 24 hours old. According to Salge, when made from sour cream it contains protein 2.5-2.7, fat 0.5-1.0, sugar 30-3.5 per cent; the decrease in the sugar being due to the lactic acid fermentation. It is best made from sour milk previously skimmed. Churn one pint at a temperature of 60° F. to 70° F. for 15 minutes in a glass churn of two pints' capacity. Stand it on ice and use it during the next 24 hours. The casein is finely divided by centrifugalization and separated from its calcium base, and the calcium is transformed into soluble salts, chiefly lactate, about 1.85 grammes per litre.

The acidity is about 05 per cent., and the caloric value 300-450 per litre. On heating, the finely divided casein clots in large masses like ordinary sour milk. This can be prevented by constant stirring or by adding carbonate of soda up to slight alkalinity. The clots are composed of casein lactate. Buttermilk is not often taken raw. Usually it is sweetened and sterilized, or is mixed with 10-25 grammes of flour and 35-90 grammes of sugar per litre and brought to a boil three times. The following is another method of preparation. Add one teaspoonful of wheaten flour and four of granulated sugar to a quart of buttermilk, with constant stirring. Then heat to boiling point in a double saucepan, stirring often, and taking care not to curdle the mixture by too much heat. Cool rapidly and keep it in bottles. A condensed buttermilk is sold under the name of "Nutricia" Condensed Buttermilk.

Obviously, fresh buttermilk differs from the cooked preparations in the presence of numerous active lactic acid bacilli which are so easily destroyed by heat. The effects, therefore, will differ according to the mode of preparation.

Another mode of treatment has been devised whereby these bacilli can be given in compressed tablet form, or can be added in the form of powder to milk, with the view to turning it sour by inoculating it with huge numbers of the bacilli. In Paris the "Milk curdled a la Lactobacilline" and "Lactobacilline Broth" can be obtained ready for use, or a lactobacilline liquid for the preparation of such milk. In London it can be obtained from Wilcox, Jozeau and Co. in the form of powders, together with the necessary apparatus for the preparation of the milk, or as tablets which can be given separately. Similar tablets of active lactic acid bacilli are sold by Allen and Hanbury under the name of "Sauerin." The indications for the use of these foods, that is, for the administration of lactic acid or of bacilli, which will produce lactic acid in the intestines, are the same as those of the koumiss cure. They limit intestinal putrefaction and are useful in most forms of enteritis, the green diarrhoea of infants, typhoid fever, colitis, and diseases which can be ascribed sometimes to intestinal putrefaction or the absorption of toxins from the alimentary tract. They may possibly be useful in rheumatism, gout and allied affections, and in arteriosclerosis.