_Modified Koumiss or Kephir._--Koumiss made from cow’s milk with the previous addition of milk or cane sugar to increase the alcoholic content cannot be regarded as a natural product but rather one to which the term “modified” may be applied. The greater part of koumiss made in the United States from cow’s milk is of this modified variety. Cow’s milk contains on an average about 4 or 5 percent of sugar and does not yield a fermented beverage of a sufficient alcoholic content without reducing the actual sugar content of the beverage below the point of palatability. Cane sugar is usually employed as the modifying agent. While modified koumiss cannot be regarded as of equal value with the natural article made from mare’s milk it is a palatable and wholesome beverage when produced and stored under proper conditions. The quantity of alcohol produced in any case is not very great and the change in composition which renders koumiss so easily assimilable in many cases cannot be due alone to the alcohol formed but to the fermentative changes produced by enzymic action which takes place in the other constituents of koumiss, especially casein during the process of fermentation. Koumiss or kephir, which is the name applied to koumiss made from cow’s milk, is also prepared with the addition of honey, in the place of sugar, and small quantities of wheat flour, not exceeding 20 parts to 1500 parts of other constituents. Koumiss is sometimes artificially fortified by the addition of small quantities of alcohol, but this practice must be regarded as extremely reprehensible. The alcohol of koumiss is incident to its fermentation and should not be increased beyond the normal amount. One of the important points in the making of koumiss is the control of the temperature which, during fermentation, ought not to rise above 50 degrees in order to get the best results. Koumiss may be made in the bottle in which it is kept, in fact, it is best made so, and its fermentation then resembles that of champagne. During the process of fermentation the bottle should be shaken at least once a day in order that the part which coagulates cannot be unevenly distributed throughout the mass. The bottle should be strong enough to resist the pressure produced by the carbon dioxid which is formed and the cork should be securely tied in. As in the case of champagne it is best to place the bottle with the cork down. Before using, the bottle containing the koumiss should be well shaken in order to thoroughly mix the contents which form a creamy, foamy mass extremely palatable, highly nutritious, and valuable not only as a beverage but in many cases of disease and disordered digestion as a food. In fact the value of koumiss for medicinal purposes, that is for medicinal food, is not thoroughly appreciated by the medical profession. This may be due to the fact that the art of making koumiss is not generally known, and while the general principles upon which its manufacture is