A simple milk diet is one in which milk alone is given fresh, uncooked, boiled or peptonized, whole or diluted with a simple diluent. This is the method of feeding in many febrile and digestive disorders, and is so well known that it needs no further comment. As a definite "cure" milk may be added to the ordinary diet or given as the only article of food. For infants it forms a complete food, but for adults it is wofully deficient in carbo-hydrates. As a simple addition to the ordinary diet, a tumblerful of milk may be given at 11 a.m. and at bedtime. It is the most suitable plan for the treatment of malnutrition.

As an exclusive diet milk may be recommended for all kinds of dropsy, functional and organic disorders of the alimentary tract, hepatic and renal diseases, chronic bronchitis and emphysema, alcoholism, neurasthenia, rheumatic and gouty affections, and for arterial disease. Possibly in the latter it may be disadvantageous, because of the amount of lime salts present, unless it is given in the form of buttermilk. In my experience the treatment is chiefly valuable for chronic affections of the colon and small intestine, associated with toxaemic states. It is useful, too, in the cure of anaemic obesity, when the patient is kept in bed, provided it is only used as a preliminary method of treatment, with a view to reducing the general watery engorgement of the tissues and relieving the strain on the circulation and the heart.

Technique Of Treatment

The milk should be obtained fresh twice a day and be thoroughly skimmed. Occasionally it is advisable that the fat be entirely removed by centrifugaliza-tion, but this complete separation of fat is not often beneficial. It should be given at a temperature of about 60° F. to 70° F., the room temperature in summer, and warmed in winter. It must not be boiled, unless there is diarrhoea. It must be drunk slowly, sipped. Begin with small doses. They are less likely to cause nausea and disgust, and the semi-starvation at once begins to afford rest and relief to the organs. Karrell recommends a dose of 3-6 oz. four times a day, at intervals of four hours, and no other food. Weir Mitchell recommends 4 oz. every two hours, and that as the dose is increased the interval should be increased to three hours. One dose, with a little lime water, is allowed during the night. As soon as small solid stools indicate that the milk is well digested, the amount may be increased, until finally the patient is taking from 10-20 oz. for each meal. The amount should never exceed six pints daily; and the duration of the treatment must not be prolonged more than six weeks. Slight modifications may be permitted. Thus, the milk can be flavoured with tea, coffee, pure cocoa, salt or burnt sugar. To counteract acidity, lime water or Vichy water may be added. Or the milk may be scalded by the addition of one-fourth its bulk of boiling water, and salt and carbonate of soda added; or it may be mixed with barley, rice or oatmeal water.

It is essential that the patient be kept in bed at first, for the diet is small, insufficient, and leads to loss of weight and strength. Sleeplessness may be troublesome in the first week. Later on drowsiness is not uncommon. The tongue becomes coated with a thick creamy fur; the mouth has a nasty taste in it; and there is constipation, showing that the milk is absorbed. Flatulence and diarrhoea may arise from too great a quantity, lack of freshness, or insufficient skimming. Thirst can be relieved by plain or aerated water. The mouth should be washed out after each meal. Constipation should be treated by simple enema, castor oil, rhubarb powder, liquorice powder, or the addition of baked apples or stewed prunes to the diet, according to the nature of the case. If in two or three weeks there is keen desire for solid food, a little stale bread and salt, or a salted herring, is given, and once a day some soup made with milk and thickened with groats. In another fortnight it is generally necessary to make some further modification, such as the addition of Benger's food or some other starchy proprietary food.

While on the pure milk diet the stools should vary in colour from yellowish to orange, have a peculiar odour, and be devoid of the typical faecal smell. The bowels should act every two or three days. The secretion of urine is increased by the lactose in the milk, for it acts as a mild diuretic. The urine assumes "a singular greenish tint," and contains little uric acid.

Milk is a purin-free digestible nutritious fluid, which turns sour readily, but does not undergo putrefaction easily. It is, therefore, a most suitable diet in many intestinal affections.