1790 



SPRVE AND OTHER DlARRHCEAS 



The lesson we have drawn from the above is to get a sample analyzed from 

 time to time. This analysis costs but little, and the possibility of its being 

 carried out at any time puts a certain amount of restraint upon would-be 

 adulterators. 



There is a considerable difference between the average composition of the 

 milk supplied by Bos taurus, the straight-backed cow, and B. indicus, the 

 hump-backed cow, which, in general terms, may be summarized by saying 

 that the milk of the latter is much richer than that of the former. We have 

 investigated this point, and are of the opinion that if 3 per cent, of fat is con- 

 sidered to be an average for B. taurus, then 5 per cent, should be reckoned 

 f or B. indicus. 



In placing a patient upon a milk diet, tjie composition of the milk 

 should be carefully considered, especially as regards the fat, for, 

 as Harley and Goodbody have shown, no less than 47 per cent, 

 of the milk-fat is passed out in the f;^'ces. 



Milk with high percentages of fat should, therefore, be diluted 

 with whey, when the amount of nitrogen, will be kept up, while 

 the percentage of fat is diminished. Whey is easily made in the 

 tropics by means of the juice of limes. 



Preferably the milk should not be boiled or sterilized, but boiling, 

 apparently, does not interfere with its beneficial properties, and, 

 therefore, if desired or thought necessary — i.e., owing to the risk 

 of typhoid — there is no harm in so doing. In cold weather it 

 should be warmed before being taken. It can be aerated in a 

 seltzogene if desired, and can be mixed with Vichy water. Finally, 

 it must be remembered that milk is riot a perfect food for an adult, 

 however suitable it may be for a child. 



It is as well to begin with a small quantity, and gradually to 

 increase the amount. Every medical man sooner or later adopts 

 his own method of carrying this out, and we will, therefore, only 

 give general directions. If the case is very severe, with vomiting 

 and much diarrhoea, it is as well to begin with whey only, which the 

 patient should sip slowly, and practically ad libitum- — i.e., about 

 7 to 8 pints per diem. As soon as the urgent symptoms are relieved, 

 milk must be added to the diet, as whey alone is starvation. 



If the case is of moderate severity, milk can be begun at once, 

 3 pints per diem being given in the more severe, and 4 pints in the 

 less severe cases — i.e., 60 to 80 ounces — which should be divided 

 into not less than ten meals at regular intervals during the day. 

 The milk must be slowly sipped or taken through a glass tube, which, 

 of course, should be carefully boiled after each meal. On no 

 account must the patient be allowed to drink the milk in gulps. 

 It is, perhaps, as well to define a litnit of time — say about twenty 

 minutes — as the minimum time for a meal. 



If the symptoms improve, it is necessary to increase the milk 

 gradually every few days until 6 to 7 pints- — i.e., 120 to 140 ounces- — 

 are given; but in doing this, it is better to increase the number of 

 meals rather than the quantity at a given meal. Twelve meals in 

 the twenty-four hours are not difficult to arrange. 



If the symptoms do not improve, the milk must be reduced gradu- 

 ally, or whey must be tried; but as soon as the urgent symptoms of 



