2i8 MILK AND ITS HYGIENIC RELATIONS 



number 10 had been entirely breast-fed, 4 had received only raw 

 milk, and 16 pasteurised milk. Recovery followed in a great many 

 cases without any change of diet or merely on the addition of beef 

 juice or fruit juice. In a fair number of cases recovery followed by 

 merely changing the diet, which was sometimes accompanied by 

 the addition of fruit juice, but this was not always found to be 

 necessary. 



The conclusions of the committee, after studying the analysis 

 made, were to the effect that the disease appeared to be due to 

 prolonged use of an unsuitable dietary, that the more remote 

 this dietary from the natural food the more likely it appeared that 

 scurvy would supervene. This was more especially the case with 

 proprietary foods. 



In 1900, dealing with the occurrence of Barlow's disease and 

 rickets, Escherich says : ' I have not once seen infantile scurvy 

 among all the many thousands of children fed artificially and 

 with sterilised milk which passed through my hands in Miinchen 

 and Graz.' 



In the year 1902-3 a great increase in the number of cases 

 of Barlow's disease appears to have been noticed in Berlin. About 

 this date one of the large dairies of Berlin which collected the 

 milk from a considerable distance and supplied it to a great 

 many of the well-to-do families, adopted a method of pasteurisa- 

 tion. The pasteurisation appears to have been carried out on a 

 very large scale, and the milk to have been sold in a large measure 

 for special infants' milk. It is noted by several observers upon 

 this subject that the milk was altered in character, having some- 

 times a brownish colour and appearing to have been heated to a 

 considerable temperature. 



In 1902 Neumann (i) of Berlin, in a paper dealing with Barlow's 

 disease, quotes twenty cases which had occurred in his own 

 practice. He stated his belief that the disease was due to a double 

 heating of the milk, which was already pasteurised before being 

 sold to the customer, and was then usually heated a second time 

 in the house before being fed to the infant. He quotes especially 

 two cases of scurvy. In one, a child aged twenty months, had always 

 been given heated milk, which had been kept boiling for ten minutes 

 in a Soxhlet apparatus. Some months previous to the outbreak of 

 the disease the milk supply had been changed, and instead of being 

 obtained raw had been obtained from this dairy in a pasteurised 

 form and subsequently heated in the house. 



In the other case the child had been breast-fed for six months, 

 and for eight months subsequently had received the pasteurised 

 milk, which was afterwards heated in the Soxhlet apparatus. 



Neumann mentions that if careful observations are made it 

 is usually noted that the children begin to refuse the food some 

 months before the disease actually occurs. Usually, however, 

 no attention is paid to this action on the part of the infant, 



