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 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