Before commencing a course of milk die, certain preparations are necessary. These preliminaries must be arranged beforehand, because the treatment always includes complete rest, for a time, at least.
The consideration of the apartment where the patient is to remain is of first importance. It must be remembered that, no matter what the previous habits of the patient may have been in this regard, a very large supply of fresh air will be required, if not at first, within a few hours. A room may be used, and often is, but the best results, in my experience, have followed the use of outdoor bedrooms, such as pavilions, screened porches, roofs, sheds, lean-tos, or even a good bed with nothing over it. In most climates some protection is required from the rain, snow, sun and wind. On the whole, perhaps there is nothing more satisfactory than a pavilion, partially boarded or latticed up on the sides, with a good water-tight roof, and insect-proof screen over the openings all around. Some of the openings should extend to the roof, or ceiling and some of them should come down to the floor. It is the lack of these that prevents a room being equal to an outdoor place; no matter how many windows there may be, there is dead space above the tops of the windows where warm air accumulates, and there is a space between the bottoms of the windows and the floor where the heavy gases, such as carbonic acid, lie more or less stagnant until stirred up by some breeze of unusual strength or direction. Dust is also deposited in these dead air spaces. Anyone who has not tried living and sleeping in a space open from floor to roof, even on only one side, cannot realize what a constant difference there is between the air in such a place and the air in a room, no matter how well ventilated it may seem to be.
A room is always more or less drafty, with the windows open. While in these outside places the circulation of air, while thorough, is almost imperceptible, so gently and easily is the change made.
A great improvement in a room with sliding sash windows can be made by removing the sashes. Take off the thin strip called a “stop” on right side of window. Pull out bottom sash and remove ends of sash cord which are usually knots stuck in holes in sides of sash. Holding these knots, lower the sash weight inside of the casing as far as it will go. Put sash away in safe place. Now lower the upper sash to the window sill, and remove from right side the thin stick, “parting bead,” which keeps the windows apart. Then the upper sash can be removed just as the first one was. This gives the full size
of the window opening, more than twice as much as when the sashes are in. They can easily be replaced in case of a storm.
It is the retaining of the gases and other cast-off material from the body in the room that makes indoor life so much more unhealthy, compared with life in the open. The greater warmth, too, indoors, prevents the same degree of oxidation that is possible outdoors. The cooler the air, the better it is, as a rule, and the more oxygen we are able to absorb. There are probably other substances besides simple oxygen, in fresh air, that are necessary to our well-being.
When you have decided upon a suitable location to stay in while taking the milk, arrange for a comfortable bed, preferably one with a hair mattress. A hard bed, or a bumpy one, becomes irksome before the skin has developed the protecting pad of flesh that belongs over the bony points. The head of the bed should be toward the opening where the light and air enter. Do not make the common mistake of putting the feet out in the center space, in a current of air, and the head in some corner where the circulation is at a minimum. The reverse should be the rule.
Beds with solid headboards or foot-boards should not be used. Procure an iron bed, or a couch or cot without any headboard. Of all things, do not attempt to sleep in a modern folding bed where the head is put in a box-like space, eminently more suited to the destruction of one’s health than to its restoration.
The bed clothes should be woolen blankets by preference, with cotton sheets, fastened at the foot, and folding down from the head of the bed, so that the patient can easily turn down a fold or two when less covering is required.
In certain cases where there is much perspiration, or exhalation from the body, it is a wise plan to use a set of bed linen not over twenty-four hours at a time, not necessarily increasing the laundry expense, but putting one change of linen to air while the other set is in use. Remember that it is necessary to stay in bed all the time, except when bathing, or performing other necessary acts, and that the skin is an important breathing organ, and must not be surrounded by foul odours.
The sleeping garments should be changed twice a day, morning and night. I think a gown is preferable to pajamas, because it is very important that there be no constriction around the waist. Garments requiring to be buttoned, or belted, around the waist, interfere with the proper development of the organs contained in the abdomen, and also prevent, to some extent, abdominal breathing.
I am explicit about these directions, because a very rapid growth and development will take place in the organs of the digestive system, the stomach, liver, intestines, pancreas, etc., and this growth is greater in the first week than during any subsequent period. It is during this first week that the success or failure of the milk cure is usually determined, and this growth, or development, MUST not be interfered with.
If possible, the patient should be within easy reach of the toilet and bathroom. There must be no dressing to go outside the room to a toilet. Have a capacious slop-jar in the room and a urinal to use in the bed, especially in cold weather. By having the jar near the bed, the urinal can be used, and emptied into the jar, without getting up, or exposing the person.
A small table, or stand, about two feet high, is required near the head of the bed, to set the milk can and glass on, and for such other small articles as may be required.
A two-quart tin can, or measure, is the most convenient and best receptacle to keep the milk in at the bedside. It is lighter than any pitcher, and unbreakable. Have two napkins to cover the milk can and glass between drinks. Two glasses will be needed, marked in some manner to indicate 5, 6, or 7 ounces of milk. A ring can be scratched around a plain glass with a file at the proper point.
An old established custom in the milk cure is that of using one glass for twenty-four hours, without washing. If the weather is very warm it is necessary to serve a clean glass with nearly every quart of milk, or the residue remaining after drinking will sour the next glassful of milk.
A clock must be located where it can easily be seen from the bed. Clocks striking the hours and half-hours are a great aid in calling the patient’s attention to drinking time. Good clocks of this description can be purchased for $2 and up.
Outside the necessary articles mentioned, the less furniture there is the better it will be. Chairs for visitors are not particularly required, for there should be no visitors. If absolutely necessary, visits may be tolerated, but never for longer than half an hour at a time.
A daily warm water bath will be required and the arrangements of the bathing facilities, is one of the things that require careful attention. It is necessary for the patient to enter the tub while the water is somewhat cooler than the body, and then gradually warm the bath to the body temperature, or to such a temperature as will be entirely comfortable. This necessitates a reserve supply of hot water, which may be drawn on at intervals during the bath, as the water cools off.
The ordinary thirty-gallon reservoir, used in connection with a range in most households, is not often satisfactory, because drawing the necessary amount of hot water to prepare the bath leaves no surplus, and it is most annoying to open the hot water faucet and get cold water.
However, if the tank is full of hot water, and the fire in the stove is kept going, it may work all right, but there must be hot water up to the end of the bath. The instantaneous gas heaters, if properly arranged, are satisfactory. If the heater is in the bathroom, it must have a flue carrying the fumes outside of the room. The best arrangement is to have a gas heater in connection with a reservoir, preferably in another room, so that the hot water when not being drawn into the tub will be collecting in the reservoir.
There is serious objection to having the water heating apparatus in the bathroom, unless the room is large and well ventilated. The heater uses up more oxygen than the lungs of several people would. Many fatalities have occurred in Southern California from instantaneous heaters, causing the asphyxiation of the inmates of bathrooms, perhaps chiefly on account of the habit some people have of shutting the bathroom up tightly while bathing.
The tub itself is a matter of considerable importance. I have not yet seen a modern white enameled iron tub that seemed satisfactory as the old copper tubs, chiefly on account of the shape. The iron tubs are molded somewhat like a huge box, with flat bottom and vertical sides. Even the head of the tub where the bather’s head and shoulders rest, goes almost straight down, whereas the old style had a gentle slope about two-and-a-half feet long, making a comfortable support for the upper part of the trunk and head. The copper tubs had a rounding bottom, which fitted the body better, and did not require so much water to cover one. And the metal itself being thin, was rapidly warmed by the hot water, while the thick iron tubs now used require the expenditure of considerable heat simply to warm up the tub. The iron tubs stand up so high as to be difficult for a weak person to enter, and serious accidents have occurred on account of the bather slipping as he left the tub. Another objection is the location of the overflow, so near the bottom that the tub will only hold a few inches of water. This latter fault may sometimes be remedied by unscrewing the fixture and covering the outlet with a thin rubber sheet, or filling it up with putty. Sometimes the overflow may be stopped, by simply putting a piece of paper over it. The force of the water will hold the paper tight against it. The tub ought to be deep enough and long enough to hold sufficient water to cover the shoulders when the patient is extended at full length, and for this purpose a six-foot tub is usually necessary. A five-and-a-half foot, or even a five-foot tub may be used by short people, or ladies, but the six-foot is best. A canvas head rest
may be used, if necessary, or a rubber cushion, or hot water bag full of air, to rest the head on. The trouble with most ladies is that they object to wetting the hair, while men as a rule enjoy lying in the tub with water up to their mouths, and it is best that all should do this.
The patient should have a bathrobe to wear in going from the sleeping room to the bathroom, and a pair of easy slippers. Felt slippers are the best, as they do not require stockings, and are warm and comfortable. Hundreds of times I have seen patients, after taking a warm bath, leave the bathroom with only bathrobes and slippers on, go outdoors to their beds, in all kinds of weather, and I never knew any of them to “take cold.”
In regard to milk, a few necessary general rules will be given here. What is required is good, clean milk as it comes from the cow, without the removal or addition of any substance whatsoever. Boiled, sterilized or pasteurized milk, or milk artificially preserved in any way, can not be used for this treatment. The live cells in the milk must remain alive or there can be no “milk cure.”
In well-managed modern dairies the handling of milk is so systematized that there is no particular trouble in keeping the milk sweet until used. Dairies that are not cleanly, or have not proper appliances, often use some means of preserving the milk, by stopping the activity of the acid-forming bacteria. These bacteria are not dangerous to health, and the methods of restraining or destroying them are without effect on the bacteria of consumption, typhoid or other fevers that might contaminate milk in certain places. Prolonged boiling will destroy any germ, but boiled milk alone will not sustain life in either the infant or the adult. Pasteurizing milk or heating to 150 F., or less, has little effect on the pathogenic bacteria and renders the milk unsuitable for human use. Dogs fed on pasteurized milk only, are liable to have the mange and other disorders, while others of the same little thrive on raw, sweet and sour milk.
There are several chemical preservatives sold to dairymen by manufacturers who claim they are harmless. They are prohibited by the laws of most states. Some of them containing borax are not exactly poisonous in the amount on would ordinarily get in milk; but they render the milk much less digestible and in a weak baby or invalid adult might readily be the contributing cause of death. Others, like salicylic acid, or formaldehyde or formalin are distinct poisons. There is no harmless preservative of milk; whatever prevents its decomposition will render it more or less indigestible.
The manner in which milk is handled makes a great difference in its keeping qualities. Milk which is cooled and aerated immediately after being drawn, will keep for days; while, on the other hand, milk which is left to
stand with the animal heat in it, will often be stale within twelve hours, and sour in less than twenty-four hours.
Milk from Holstein cows is the best for the purpose, next that from Durhams or Shorthorns, and last that of the pure Jersey or Guernsey, or Alderney, as the two latter breeds were formerly called. Milk from Jersey cows may be used, but it should be skimmed after standing two to four hours to reduce the amount of cream.
So important is this question of the kind of milk to be used in this treatment that I quote from an article by Professor J. Allen Gilbert, printed in the New York Medical Record, Oct. 21, 1906, on “Choice of Cow’s Milk.” The italics are mine:
“Holstein milk is characterized by fat globules of small and uniform size, separating slowly by the gravity method, churning slowly and carrying very little colour. Set side by side with milk of no richer quality, but of larger fat globules, in a given time less depth of cream will rise. Holstein milk coagulates the most slowly of any, and on account of its small globules and their evenness in size, it has a decided advantage in ease of absorption.
“This breed can be traced back for 2,000 years and was always famous for dairy purposes. In temperament, these animals are quiet and docile, bulls as well as cows, the bulls exceptionally so. Instead of being help at bay with a long stick hooked in the nose-ring, they can usually be led out for exhibition at the end of a loose rope. Their robustness makes them specially resistant to disease, whereas the more delicate breeds, such as the Jersey, have sad tales to record from the ravages of such diseases as tuberculosis.”
“All in all, if one were choosing a human wet nurse he would look for just the characteristics in her that we find presented in a Holstein cow, viz., vigorous constitution, quiet easy-going temperament, uninfluenced by external disturbances, good glandular development, abundance of good milk, freedom from disease or tendency to disease, a good healthy child of her own, and good family history.
“Whether we are to grant any such thing as a vitality peculiar to a milk or not is a disputed question. However, Professor Carlyle of the Wisconsin Experiment Station is quoted as saying that the Physicians’ and Surgeons’ Association of Chicago recommends the milk of a certain Holstein dairyman receiving 12 cents a quart because of some reason not understood, it has more vitalizing power than any other milk they can get.
“Those buying milk by the quart, sold at a uniform price for all breeds, will receive more commercial value by purchasing Jersey milk, for in so doing they get milk with a higher percentage of solids.” Where good
digestion, adults eating a mixed diet, and highest commercial value per quart are the only elements to be dealt with in choice of a milk, the Jersey is undoubtedly the preferable milk WHERE INFANTS, WEAK DIGESTION, AND LARGE QUANTITY OF MILK ARE AT STAKE, THE HOLSTEIN LEADS THE LIST AND THE JERSEY BECOMES THE LEAST DESIRABLE FOR NUMEROUS REASONS.
“It is a well-known fact that certain Jersey cows give milk so rich in fat that they cannot suckle their own young. It is at least to be suspected that the trouble is not so much in the “richness” of the milk as in the size of the fat globules. The smaller the globules of fat, the more permanent the emulsion, and also the less irritation to the gastrointestinal tract. Also, the finer the emulsion, the easier the process of digestion and assimilation.
“The ingredient of our food which costs the most, which has the greatest physiological value, and which is most apt to be lacking in ordinary dietaries is protein. Skim milk has nearly all the protein of the whole milk. By removal of the fat in the cream, it loses half its fuel value, but practically none of the protein. What is left has all the value of the whole milk for building and repair of tissue, for the making of blood, muscle and bone, and half the value of the whole milk for supplying heat and muscular power. When the facts are fully understood, skim milk will doubtless be more widely utilized.”
“The average composition of buttermilk, which is practically sour skim milk, is quite similar to that of skim milk, though it contains slightly less protein and sugar and a very little more fat. The fuel value is about the same, about 165 calories per pint. An ordinary glass of buttermilk contains as much nourishment as a half pint of oysters or two ounces of bread, or a good-sized potato.”
Many people anxious to gain weight think they should take all the cream possible. This is a mistake, as the fat in the milk does not normally make flesh in the body. The flesh built up on a milk diet is derived almost entirely from the proteins and carbohydrates, namely: casein, albumin, etc., and milk sugar. If the fat of a full milk diet was deposited in the body, it would mean a gain of about half a pound of pure fat daily.
The fat in cream has little or nothing to do with the cure of disease. Many of my best cases were cured on skim milk, even separator skim milk.
Milk contains all the salts necessary for the building up of every part of the body. It has iron, potassium, phosphorous, sodium, lime, magnesium, fluorin, etc., and altogether contains about twenty elements.
Dairy milk, or milk from a herd of cows, gives a more even average of fat and other contents than the milk from one cow would. There is no
advantage in having one cow set aside for your use, unless by doing so you secure Holstein milk.
The milk should be delivered fresh, morning and evening, about two-thirds of the total quantity in the morning and one-third at night. In cities, the milk is usually ten to fourteen hours old before being delivered. Many of my patients have take the diet successfully under these conditions, but I think the average results are better with fresher milk.
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