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Page 29
During the first week or two, exclusive milk diet gives rise to a marked
sense of sleepiness. It causes nearly always, and even for weeks of its
use, a white and thick fur on the tongue, and often for a time an
unpleasant sweetish taste in the early morning, neither of which need be
regarded. Intense constipation and yellowish stools of a peculiar odor
are usual. Of the former I shall speak in connection with the use of
milk in special cases. The influence of milk on the urinary secretion is
more remarkable, and has not been as yet fully studied.
There is, of course, a large flow of urine; and in dropsical cases due
to renal maladies this may exceed the ingested fluid and carry away very
rapidly the dropsical accumulations. It is sometimes annoying to nervous
persons because of the frequent micturition it makes necessary. I have
discovered that while skimmed milk alone is being taken, uric acid
usually disappears almost entirely from the urine, so that it is
difficult to discover even a trace of this substance; nor does it seem
to return so long as nothing but creamless milk is used. Almost any
large addition of other food, but especially of meat, enables us to find
it again. Creatine and creatinine also seem to lessen in amount, but of
the extent of this change I am not as yet fully informed.
A yet more singular alteration occurs as to the pigments. If after a
fortnight or less of exclusive milk diet we fill with the urine a long
test-tube, and, placing it beside a similar tube of the ordinary urine
of an adult, look down into the two tubes, we shall observe that the
milk urine has a singular greenish tint, which once seen cannot again be
mistaken. If we put some of this urine in a test-tube carefully upon hot
nitric acid, there is noticed none of the usual brown hue of oxidized
pigment at the plane of contact. In fact, it is often difficult to see
where the two fluids meet.
The precise nature of this greenish-yellow pigment has not, I believe,
been made out; but it seems clear that during a diet of milk the
ordinary pigments of the urine disappear or are singularly modified. A
single meal of meat will at once cause their return for a time.
These results have been carefully re-examined at my request by Dr.
Marshall in the Laboratory of the University of Pennsylvania, and his
results and my own have been found to accord; while he has also
discovered that during the use of milk the substances which give rise to
the ordinary f�cal odors disappear, and are replaced by others the
nature of which is not as yet fully comprehended. The changes I have
here pointed out are remarkable indications of the vast alterations in
assimilation and in the destruction of tissues which seem to take place
under the influence of this peculiar diet. Some of them may account for
its undoubted value in lith�mic or gouty states; but, at all events,
they point to the need for a more exhaustive study both of this and of
other methods of exclusive diet.
As regards milk, enough has here been said to act as a guide in its
practical use in the class of cases with which we are now concerned; but
I may add that it is sometimes useful, as the case progresses, to employ
in place of milk, or with it, some one of the various "children's
foods," such as Nestle's food, or malted milk.
Before dealing with the treatment of the an�mic and feeble and more or
less wasted invalids who require treatment by rest and its concomitant
aids, I desire to say a few words as to the use of rest, milk dietetics,
and massage in people who are merely cumbrously loaded with adipose
tissues, and also in the very small class of an�mic women who are
excessively fat and may or may not be hysterical, but are apt to be
feeble and otherwise wretched.
Karell has pointed out that on creamless milk diet fat people lose
flesh; and this is true; so that sometimes this mode of lessening weight
succeeds very well. But it does not always answer, because, as in
Banting, loss of weight is apt to be accompanied with loss of strength,
so that in some cases the results are disastrous, or at least alarming.
I do not know that this is ever the case if the directions of Mr.
Harvey[26] are followed with care and the weight very deliberately
lessened. But for this few people have the patience; and, even if they
can be induced to follow out a strict diet, it is often useful to be
able to cut off very rapidly a large amount of weight, and so shorten
the period of strict regimen, or at least put over-fat persons in a
condition to exercise with a freedom which had become difficult, and
thus to provide them with a healthful means of preventing an
accumulation of adipose matter. This can be done rapidly and with safety
by the following means. The person whose weight we decide to lessen is
placed on skimmed milk alone, with the usual precautions; or at once we
give skimmed milk with the usual food, and in a week put aside all other
diet save milk and all other fluids. When we find what quantity of milk
will sustain the weight, we diminish the amount by degrees until the
patient is losing a half-pound of weight each day, or less or more, as
seems to be well borne. Meanwhile, during the first week or two rest in
bed is enjoined, and later for a varying period rest in bed or on a
lounge is insisted upon, while at the same time massage is used once or
twice a day, and later in the case Swedish movements. At the same time,
the pulse and weight are observed with care, so that if there be too
rapid loss, or any sign of feebleness, the diet may be increased. In
many such cases I allow daily a moderate amount of beef- or chicken- or
oyster-soup,--more as a relief to the unpleasantness of a milk diet than
for any other reason.
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