(B) The Milk May Be Given Raw

The Milk May Be Given Raw, boiled, diluted with plain water, barley water, lime water, Vichy, Seltzer, or Apollinaris, or pan-creatinised according to taste and need. Gelatin, as well as gum arabic, is sometimes added to milk to dilute it and prevent tough curds from forming. The milk should never be skimmed. Its taste may be disguised by the addition of a little strong coffee or some of the extract of coffee, or a little caramel makes it agreeable to the taste where patients have refused it before, or it may occasionally be preferred with a cup of cocoa in which the milk predominates. If diarrhoea is present, a milk diet is especially useful, and the milk should be boiled.

When vomiting occurs, it is better to use peptonised or pancre-atinised milk than soda or lime water, for the latter tend to neutralise the activity of an already enfeebled gastric juice. These fluids may be given either hot or cold, according to taste. If cold, the nausea is sometimes controlled, but digestion may be somewhat retarded. If the vomiting is very obstinate, koumiss, kefir, or zoo-lak may be given for a time with very good result in place of milk. Whey or buttermilk is also used sometimes for a change for a few days. A. L. Loomis recommended from four to six quarts of the latter per diem.

(C) Substitutes For Milk Diet

When milk is obviously disagreeing and producing flatulence, I have often seen improvement follow an entire change of diet for a day or two to animal broths. Similar results are familiar in the treatment of infantile diarrhoea.

In cases like those above described in which, after fair trial, it is found impossible to urge upon the patient the taking of milk, there is no objection to giving strained broths of mutton, chicken, or beef, a little clam broth for a relish, and light farinaceous articles, such as the prepared starchy foods, like Mellin's or Nestle's, barley water, farina, arrowroot, and other gruels, custards, egg-nog, or a piece of zwieback softened by soaking in milk, weak tea, or bouillon. I have used gruel made from banana meal, which is palatable, highly nutritious, and easily digested (see p. 182). Junket and cream are very nutritious and agreeable to the palate. Egg albumin can be made very palatable by beating it with a little milk and sherry. In this manner considerable variety is secured for the patient; the appetite, and in many cases the digestion, are improved, and by alternating one or more of these articles with the milk, a much larger quantity of nourishment will in the end be taken and absorbed. Layton estimates that typhoid patients may sometimes lose half a pound in weight per diem, and in that class of cases in which rapid emaciation is a most alarming feature of the disease these various adjuncts to the milk diet are especially useful.

Moreover, patients fed in this manner are not likely to become ravenous during convalescence.

It is well expressed by Henry that "it is not so much solid as indigestible food that should be eschewed, and it should never be forgotten that all foods except such as are predigested are solid in the first stage of digestion." A pint of milk contains as much solid material as a mutton chop.

The continued use of beef tea, beef juice, or meat extracts and peptonoids undoubtedly produces loosening of the bowels, and such substances must be avoided when diarrhoea is present; but in cases where there is a tendency to constipation this may be a decided advantage. Veal and chicken broth are less apt to have a laxative effect than beef and mutton broth, and calf's-foot jelly is allowed by some clinicians. When patients tire of the taste of beef tea or broth it may be flavoured with a little celery salt or, if there is no diarrhoea, with a very little tomato juice or other simple vegetable extract.

Henry advocates the use of gelatin as an "albumin sparer," although it should not be given if diarrhoea is present. As much as a claret-glass full may be given on alternate days, and it can be in the form of simple blancmange or peptonised milk jelly, which is made by adding, while hot, gelatin dissolved in a little water to peptonised or pancreatinised milk, and flavouring with lemon or orange and sherry or rum. It is eaten cold. In the stomach it is quite as fluid as predigested milk.