to the milk, which has been previously put in a warm glass.  Some patients digest it best when it has the addition of a teaspoonful of barley-or rice-water to each ounce, the main object being to prevent the formation of large, firm clots in the stomach,—­an end which may also be attained by the addition at the moment of drinking of a little carbonated water from a siphon.  For the sake of variety, buttermilk may be substituted for a portion of the fresh milk, and though less nourishing it has the advantage of being mildly laxative.

When used as an exclusive diet, skimmed milk gives rise to certain very interesting and what I might call normal symptoms.  Since at first we can rarely give enough to sustain the functions, for several days the patient is apt to lose weight, which is another reason why exercise is in such cases undesirable.  This loss soon ceases, and in the end there is usually a gain, while in most rest cases an exclusive milk diet may be dispensed with after a week.  Where milk is taken alone for weeks or months, it is common enough to observe a large increase in bodily weight.  I have seen several times active men, even laboring men, live for long periods on milk, with no loss of weight; but large quantities have to be used,—­two and a half to three gallons daily.  A gentleman, a diabetic, was under my observation for fifteen years, during the whole of which time he took no other food but milk and carried on a large and prosperous business.  Milk may, therefore, be safely asserted to be a sufficient food in itself, even for an adult, if only enough of it be taken.

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.