It should be borne in mind that lactic acid therapy is only indicated when the putrefactive anaerobic micro-organisms are in excess in the colon, and there is no guarantee that without such a guide this form of medication may not aggravate rather than alleviate the intestinal condition. It is not at all unusual for severe colic, and occasionally diarrhoea, to arise during a course of curdled milk treatment, and although such untoward symptoms may be anticipated just at the beginning, in many cases they do not always subside. It would be futile for me to deny the benefit frequently accruing during the treatment, but at any rate in muco-membranous colitis I have seen just as valuable results from fresh cow's milk, when it agreed with the patient, as from the curdled milk. We are very apt to forget that there are other factors in the curdled milk treatment besides the lactic acid bacillus. Milk per se is a most valuable nutrient, and the new system is an excellent artifice for enabling recalcitrant patients, who object to ordinary milk, to obtain the unquestionable advantages of the continued use of milk. Nor is it to be forgotten that it often replaces the objectionable tea and coffee, which in most cases of intestinal ailments are decided irritants, and always nerve poisons in the neuro-arthritic type of patient. At the same time it diminishes the desire for flesh foods, because it possesses quite a respectable proportion of protein.

The longevity of the Bulgarian peasantry is not necessarily due to the use of soured milk. There are many other powerful factors in operation. The most important of these is an open-air life, with considerable muscular exercise, extreme moderation and simplicity of diet, absence of the nerve-exhausting occupations of civilised life, and the influence of heredity, an element whose potency must not be overlooked.

But is it quite certain that .curdled milk is used with such frequency, or in such proportions, in Bulgaria as is being so constantly reported? My friend Mr. Frank Marsh, F.R.C.S., of Birmingham, who resided for eight months in a Bulgarian peasant's cottage, never once saw or heard of curdled milk whilst there, although he recollects that much fresh cow's milk was used, and naively adds that he saw more tuberculosis amongst the people than he has ever seen since that time. It has been asserted that intestinal putrefaction paves the way for intestinal infections, because putrefactive bacteria prepare the soil for the growth of pathogenic bacteria, and this has been utilised as an argument in favour of a pure vegetarian diet, eggs, cheese, and cow's milk being rejected because capable of encouraging the growth of dangerous microbes. Vegetable albumin is said to be. less putrefiable than flesh proteins, and possesses the further advantage that it is always accompanied by at least three times its weight of carbohydrates. A remarkable commentary on this statement, which is bolstered up by concrete facts, exists in the practice of vegetarians taking large quantities of curdled milk. This, at any rate, is the custom at Battle Creek, and one cannot help feeling surprised that with a low-protein diet, where there is stated to be practically no surplus of non-putrefiable vegetable albumin, there can be any necessity for the use of any means to neutralise the toxins of putrefactive organisms which have no obvious cause for existence. I cannot help looking upon such a system as a convenient excuse for the introduction of lacto-vegetarianism, because the lactic acid bacillus is only supposed to be of any value in protein decomposition, and is absolutely useless in carbohydrate fermentation - the probable evil in a fleshless system of diet.

An interesting commentary on these remarks, which were written and published more than a year ago, is to be found in a more recent pronouncement of Metchnikoff, who has discovered that lesions identical with those sclerotic changes produced by the phenols and indols of the faeces in man are also present in the horse and rabbit, which are unquestionably vegetarian. If this be so, then there does exist some justification for the use of curdled milk by vegetarians, on the assumption that the lactic acid bacillus inhibits the activity of the proteolytic bacteria, but the doctrine of intestinal auto-intoxication can no longer be utilised as an argument in favour of a fleshless diet, but of a well-balanced mixed diet.

Perhaps it is fortunate that, as has been demonstrated by Professor Walker Hall and Dr. W. A. Smith, a great many of the tablets used in preparing curdled milk are of no real value, the bacilli being quite unable to pass through the stomach safely, or even when they have done so, not being sufficiently active to overcome the faecal bacteria. After a most careful and exhaustive examination of many of the lactic acid ferments on the market, they came to the conclusion that few of these were reliable, and that it was most difficult to determine this without a bacteriological examination, because the best acidi-fiers were by no means the best multipliers, and the amount of curd was by no means an index of the capacity of the organisms to pass through the alimentary canal.

Therefore, in many cases, much of the benefit ascribed to the curdled milk must have been owing entirely to the use of the milk as such, and incidentally the reduction or exclusion of more harmful liquids. There is, therefore, a great deal of doubt as to the beneficial therapeutical influence of lactic acid bacilli, and it has been well summed up by Mendel in these words: "The usefulness of lactic acid, sour milk, and lactic acid ferments as curative agents is nothing less than problematical at the present moment."

But whatever difference of opinion may be expressed on this point, it is absolutely certain that there is no indication for the indiscriminate and widespread use of curdled milk as a therapeutic agency. If the practice of moderation in eating and drinking be the keynote of the whole life; if a daily alvine evacuation be the rule - and this is by no means the prerogative of vegetarians - then we can afford to despise the much-advertised ravages of the putrefactive organisms in the colon.