A Substitute for Buttermilk in the Treatment of Digestive Disorders During Infancy.

In the treatment of digestive disturbances in infancy, especially in acute gastro-enteritis, aci(I milk mixtures have been used with success for some considerable time. Buttermilk was first used empirically in Holland, with very good effect, and was then adopted elsewhere abroad. At the present time the use of buttermilk, Finkelstein's Eiweissmilch, or concentrated protein milk, can be regarded as the usual routine treatment in acute gastro-enteritis, both on the continent and in America. Protein milk mixtures arc, of course, acid milks, consisting of cow's milk curds mixed with buttermilk, or with equal parts of buttermilk and water. Faber (1) and Levine ( 2) have both recently written excellent reviews concerning acid milk mixtures and their use in infant feeding. It is, however, still impossible to give an exact reason why such mixtuires prove beneficial. Marriott and Davidson (3) believe that the reduction of 'the buffer value of the milk itself, which is brought about in acid milks, is chiefly responsible for their good effect, as it allows gastric digestion to be accomplished more easilv. Since the secretion of hydrochloric acid in the stomach is decreased in infants suffering from gastro-intestinal disturbances, this is obviously a point of importance. Schiff and Mosse (4), however, doubt this explanation of the efficacy of these mixtures, and after an exhaustive and critical review of all the data, together with the results of their own experiments, frankly confess that they are unable to assign any one particular reason for their good effect. Gyorgi suggested that perhaps the lactate ion itself might be the responsible factor in the case of milks soured by lactic acid, but Brahdy (5) has been unable to find evidence of this. It is possible that in the percentage composition of the mixtures themselves lies the explanation of their value. It has, however been generally considered that sweet milk mixtures of similar percentage composition do not achieve such good results. If it be conceded that an acid milk mixture of the type above referred to is the food of choice in gastro-enteritis or in digestive disturbances, then it is a matter of importance, especially in hospital out-patient practice, to be able to employ a mixture of this sort which is easy of preparation or readily obtained, and which is cheap. Discussion of a Buttermilk Substitute.-Fresh buttermilk itself is not easily obtained in this country. Its preparation by skimming or centrifuging cow's milk and subsequently inoculating this with Bacillus Bulgaricus, is not uisually feasible in out-patient practice, any more than is the preparation of