220 MILK AND ITS HYGIENIC RELATIONS 



reviewed the work at his consultation and stated that in the 3000 

 cases included in this report, there had been no case of Barlow's 

 disease. 



Bresset, dealing with the results of similar work in another 

 district in Paris, states that in over 2000 cases fed on sterilised 

 milk no case suspicious of Barlow's disease was seen. 



Budin says : ' As for the so-called infantile scurvy which is 

 alleged to follow the use of sterilised milk, I have heard a very 

 great deal about it during the last few years, but I am still looking 

 for my first case.' 



In the year 1908 the Medical Society of Geneva held an inquiry 

 into the frequency of Barlow's disease in Switzerland. Papers 

 of inquiry were sent to the medical men of the district, and seventy- 

 one answers were received from different physicians. Of the 

 seventy-one physicians only five had seen cases of the disease, 

 and only ten cases in all were reported, of which six had occurred 

 in Geneva itself. Of these ten cases nine had been fed either 

 upon special forms of milk or upon milk sterilised at high 

 temperatures. The tenth child had been fed upon milk prepared 

 in a Soxhlet apparatus. 



An interesting case is quoted by Carel of a child who was taken 

 away from home with a supply of sterilised milk sufficient to last 

 for several weeks. The child appears to have shown peculiar 

 symptoms, which disappeared on the arrival of a fresh supply 

 of sterilised milk. As this fresh supply became stale, the same 

 symptoms, previously noticed, reappeared, and the child was brought 

 up for medical advice. The case was diagnosed as one of infantile 

 scurvy. This case suggests that it is not advisable to employ 

 sterilised milk which has been kept, as a food for infants. 



Plantenga published an account of an outbreak of Barlow's 

 disease which occurred among the children of his infant consulta- 

 tion in 1910. The milk, which was given out at his consultation, 

 was at one period pasteurised overnight by heating at 70 C. for 

 half an hour, and in the morning was further heated by 

 being boiled for five minutes in a Soxhlet apparatus. Twenty- 

 three cases of Barlow's disease developed among the infants of the 

 consultation, which numbered 200 in all. As a result of this 

 outbreak the routine of the milk preparation was altered, and 

 the morning's milk was obtained and subjected only to pasteurisa- 

 tion before being given out. No case of Barlow's disease occurred 

 with the adoption of this alteration. Plantenga attributed the 

 occurrence of the trouble to the length of time the milk had been 

 kept before being used, and he pointed out that the value of raw 

 milk in certain cases may arise from the fact that it is given sooner 

 after milking. 



There is evidence that changes occur in milk, when it is allowed 

 to stand, and in this connection reference may be made to 

 Appendix C, dealing with the preservation of human milk, and to the 



