besity alone or in extreme
fatness with anaemia, I spoke in a former edition with a confidence
which has been increased by the added experience of physicians on both
sides of the Atlantic. Finally, there are exceptional cases of
intestinal pain of obscure parentage or seemingly neuralgic, of
dyspepsia incorrigible by other treatments, which, having resulted in
grave general defects of nutrition, are best treated by several weeks of
milk diet, combined with rest, massage, and electricity. Milk,
therefore, must be so much used in these cases in connection with the
general treatment I am describing that it is perhaps as well to say more
clearly how it is to be employed when given alone or with other food. I
am the more willing to do this because I have learned certain facts as
to the effects of milk diet which have, I believe, hitherto escaped
observation. In fact, the study of the therapeutic influence and full
results of exclusive diets is yet to be made; nor can I but believe that
accurate dietetics will come to be a far more useful part of our means
of managing certain cases than as yet seems possible.

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 anaemia with obesity, and in
the latter state uncomplicated by defective haemic 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 deg., 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 immersi