It is also of considerable importance to the patient that he does not gulp the milk as this would cause it to curd into a large cohesive mass of casein, which would be slowly dissolved or acted upon by the gastric juice, and might give rise to distress from indigestion. If, on the other hand, the patient sips the milk slowly, or eats it with a spoon, the curds will be small and flaky particles which even a weak stomach may digest. There are quite a number of persons who like milk, yet whose stomachs do not take to it, and for these a milk cure might be just the thing. It requires often a great deal of ingenuity to devise a plan whereby the obstacle may be overcome. The first step should be to shorten the interval between each meal and lessen the quantity correspondingly; thus to give the patient the milk every hour would imply that he was to take only one-fourth as much at a time as if he took it every four hours. Perhaps the milk would digest more easily if it were first beaten and slightly seasoned with a pinch of salt, or if a little strained gruel were added to mechanically divide the curd. A soda cracker, toasted bread, or the rind of thoroughly baked wheaten bread is an excellent substitute for dividing the cheesy substance of the milk when it gets into the stomach. They should not be soaked or dipped into the milk and eaten together, but eaten dry and thoroughly masticated until the saliva has reduced the bread to a soft pulp, after which a spoonful of milk should be taken and the bread stuff washed down. The saliva serves another useful purpose besides moistening the bread as it changes the starchy substance into sugar.

In other cases the milk sours on the stomach, and then some antacid or alkali, like lime water or bicarbonate of soda should be added for several days or until the disposition to lactic fermentation has subsided. If notwithstanding every precaution, waterbrash, heartburn, or a heavy oppressed pain in the stomach occurs, or if sourish, slimy secretions are vomited, the milk cure must be abandoned for something else.

Diarrhœal diseases of infants who are fed on cow’s milk are caused, in many instances, by germs or spores that get into the milk from lack of proper cleanliness and from the unavoidable exposure of the fluid to the atmosphere of stables and dairy rooms where the milk is handled before transportation to consumers. To obviate the danger of feeding nurslings with infected milk, and to destroy the vitality of germs which find access to the milk, methods have been devised for sterilizing the milk. This process was first proposed in 1886 by Professor Soxhlet, and has ever since gained favor with the profession; it consists of exposing the milk to a temperature of live steam or boiling water for about forty-five minutes. In New York City there are two reliable firms which sterilize milk at the dairy in the country and ship it to the city.

In all the methods of sterilization the milk is placed in six or eight-ounce bottles and set on a tray or shelf, which stands above the water at the bottom of a vessel, the cover then applied and the water made to boil forty-five minutes; a perforated stopper is inserted into each flask, admitting of the escape of air and gases at the beginning of the heating process. The stopper may consist of cork with a glass tube in the center, or cotton, or of rubber with a channel a part of the distance on one side. If necessary the family can improvise their own apparatus; an inverted tin pan will serve the purpose of a tray to support the nursing bottles, and this placed in the bottom of an ordinary tin vessel with a cover completes the contrivance. The milk is to be prepared as it is to be administered, that is, the proper quantity of water, a little sugar, and the point of a penknifeful of bicarbonate of soda added, and distributed among as many eight-ounce flasks or nursing bottles as the child is fed during the twenty-four hours; thus if fed every four hours the milk should be distributed among six flasks, and if fed every three hours, it would require eight flasks. When the milk has been sterilized, it keeps sweet for an indefinite period at ordinary temperature; the bottle is to be well shaken to mix the cream before the cork is removed and the nipple applied.

When an apparatus or a sufficient number of flasks cannot be readily obtained I have the milk boiled in a fruit jar after the manner of making beef tea, as follows: A quart preserve jar is filled with milk, obtained not later than four to six hours after milking, the cover is lightly put on, to allow the escape of air and gases, and then the jar is put into a vessel, on the bottom of which an inverted pan has been placed so that the preserve jar does not rest on the bottom of the vessel where the heat would crack it; the vessel is then to be filled a third with water, and this boiled for an hour, after which the jar is carefully closed, as in preserving fruit, until wanted for use. The milk should be kept in a cool and clean place, and only as much measured out each time as is required for one mess, after which immediately close the jar. The water that is to be used for diluting the milk must have been thoroughly boiled; it is always better to prepare and dilute the milk before sterilizing it for very young infants, but when they are a year or more old, the boiling water may be added at each meal.

The casein, which is the curd or coagulable part of milk, differs greatly in its physical property in the milk of the cow from that in human milk. Mother’s milk curds in soft flaky coagula which are readily dissolved in the infant’s stomach, while cow’s milk curds in a semi-solid conglomerate coagulum which the cavity of the child’s stomach is often unable to tolerate nor the gastric juice to penetrate and dissolve. It is this heavy curd which forms the main objectionable feature of cow’s milk as a substitute for that of the mother. This can be greatly modified by first thoroughly beating or churning the cow’s milk with an egg beater, and afterwards scalding it as above described; the milk treated in this manner curds light and flaky. But it must not be presumed that the physical characteristic of casein is the only peculiarity of cow’s milk in comparison with mother’s milk, for this is not so; it also differs in quantity, that is, mother’s milk has less of casein, a fact which may be better understood by the following chemical analysis of both:

Human milk.Cow’s milk.
Water87.0987.00
Casein and albumen2.483.72
Fat3.903.66
Sugar of milk6.044.92
Phosphatic salts0.490.70
——–——–
100.00100.00

There are some children who are unable to digest cow’s milk in any form, either from a peculiarity of constitution, or from a derangement of the digestive apparatus; the milk, no matter how prepared, passes through them curdled, in lumps and undigested; to continue feeding infants on milk, notwithstanding this symptom would in all probability sacrifice the life of the child. If curds persist in the stools milk is to be withheld for a time, and crushed wheat, barley gruel or other diluents should be given alone or in combination with the thoroughly beaten white of egg. This treatment must be continued for several days and in some cases for several weeks.

Whey prepared from sweet and pure milk has often been borne by delicate and suffering infants, when nothing else could be retained. An examination into the chemical composition of whey reveals astonishing nutritive virtue, which it holds in solution; the following table shows the proportional constituents in one hundred parts: