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Page 28
We are indebted chiefly to Dr. Karell, of St. Petersburg, for our
knowledge of the value of milk as an exclusive diet, and to Dr. Donkin
for the extension of Karell's treatment to diabetes. I shall formulate
as curtly as possible the rules to be followed in using milk as an
exclusive diet in dyspeptic states, and in an�mia with obesity, and in
the latter state uncomplicated by defective h�mic conditions.
For fuller statements as to the reasons for the various rules to be
observed in using milk, I must refer the reader to Karell's paper and to
Donkin's book.
Have the utmost care used as to preservation of the milk employed, and
as to the perfect cleansing of all vessels in which it is kept. Use
well-skimmed milk, as fresh as can be had, and, if possible, let it be
obtained from the cow twice a day. Or if this is not possible, or where
any doubt exists as to the condition of the milk, or any difficulty is
experienced in keeping it fresh, it may be pasteurized as soon as
received by heating it to 160�, keeping it some minutes at this point,
and at once chilling on ice. For this purpose it is best to have the
milk in bottles, and to heat by immersing the bottles in a water-bath.
For longer preservation, as, for example, when travelling, sterilizing
may be more thoroughly done by greater heat and lengthened immersion.
Still, these should be expedients for use only when milk cannot be
secured fresh and in good order, as it is more than doubtful if the milk
is so well borne when it has been altered by these processes.
For ordinary daily use it might be better to let all the milk for the
day be peptonized in the morning with pancreatic extract, to the extent
which is found to be agreeable to the patient's taste, and then preserve
it by placing it upon ice. In this way milk may be kept for several
days. Then, too, it has been found that where even skimmed milk upsets
the stomach of patients, milk prepared in this manner can be taken
without trouble. In peptonizing, the directions which accompany the
powders to be used for that purpose should be followed carefully. It is
to be remembered that if the patient desires to take the milk warm, the
process of conversion into peptones, which has been stopped by the cold,
will be promptly started again when the fluid is warmed, and then a very
few minutes will suffice to make it disagreeably bitter. At first the
skimming should be thorough, and for the treatment of dyspepsia or
albuminuria the milk must be as creamless as possible. The milk of the
common cow is, for our purposes, preferable to that of the Alderney. It
may be used warm or cold, but, except in rare cases of diarrhoea, should
not be boiled.
It ought to be given at least every two hours at first, in quantities
not to exceed four ounces, and as the amount taken is enlarged, the
periods between may be lengthened, but not beyond three hours during the
waking day, the last dose to be used at bedtime or near it. If the
patient be wakeful, a glass should be left within reach at night, and
always its use should be resumed as early as possible in the morning. A
little lime-water may be added to the night milk, to preserve it sweet,
and it should be kept covered.
The milk given during the day should be taken at set times, and very
slowly sipped in mouthfuls; and this is an important rule in many cases.
Where it is so disagreeable as to cause great disgust or nausea, the
addition of enough of tea or coffee or caramel or salt to merely flavor
it may enable us to make its use bearable, and we may by degrees abandon
these aids. Another plan, rarely needed, is to use milk with the general
diet and lessen the latter until only milk is employed. If these rules
be followed, it is rare to find milk causing trouble; but if its use
give rise to acidity, the addition of alkalies or lime-water may help
us, or these may be used and the milk scalded by adding a fourth of
boiling water to the milk, which has been previously put in a warm
glass. Some patients digest it best when it has the addition of a
teaspoonful of barley-or rice-water to each ounce, the main object being
to prevent the formation of large, firm clots in the stomach,--an end
which may also be attained by the addition at the moment of drinking of
a little carbonated water from a siphon. For the sake of variety,
buttermilk may be substituted for a portion of the fresh milk, and
though less nourishing it has the advantage of being mildly laxative.
When used as an exclusive diet, skimmed milk gives rise to certain very
interesting and what I might call normal symptoms. Since at first we can
rarely give enough to sustain the functions, for several days the
patient is apt to lose weight, which is another reason why exercise is
in such cases undesirable. This loss soon ceases, and in the end there
is usually a gain, while in most rest cases an exclusive milk diet may
be dispensed with after a week. Where milk is taken alone for weeks or
months, it is common enough to observe a large increase in bodily
weight. I have seen several times active men, even laboring men, live
for long periods on milk, with no loss of weight; but large quantities
have to be used,--two and a half to three gallons daily. A gentleman, a
diabetic, was under my observation for fifteen years, during the whole
of which time he took no other food but milk and carried on a large and
prosperous business. Milk may, therefore, be safely asserted to be a
sufficient food in itself, even for an adult, if only enough of it be
taken.
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