486 THE HEMORRHAGIC DIATHESES 



shown that Pasteurized and sterilized milk if used exclusively may cause Bar- 

 low's disease, and that sterilization in the Soxhlet apparatus is sufBcient to 

 produce it. Lately it has been assumed that the duration of the heating proc- 

 ess of the milk is the most important factor, but Heubner believes that heating 

 from ten to fifteen minutes is not productive of harm. 



H. Neumann ^ states in regard to this matter : " From my own experience 

 of the conditions in Berlin for the last five years, the following may be main- 

 tained : In nutrition with artificial milk preparations Barlow's disease occurs 

 very rarely, either from the fact that the prolonged use of these foods has 

 become rarer, or that more care is taken in sterilization. In the year 1899 I 

 saw but one case which was due to Gartner's 'fat-milk.' Considering the 

 mode of preparation of this food only the sterilization, not the chemical treat- 

 ment, could play a role; in my case the milk was sent for weeks in the sum- 

 mer to the seashore, and for this purpose was previously heated to a very high 

 degree. In another case, in the year 1899, cow's milk prepared in a labora- 

 tory was powerfully heated — up to the point of browning. Up to the year 

 1900, I had seen four children who were taken ill in spite of the fact that the 

 thoroughly reliable raw milk was in two cases heated only for fifteen minutes, 

 and in two cases for only ten minutes in the Soxhlet sterilizer. In two of 

 these cases infant food was added to the milk, but I do not desire to attach 

 any importance to this. I should like to mention here, however, that in two 

 of these cases intestinal catarrh preceded the disease; in the third case dys- 

 pepsia was present which may have hastened the appearance of Barlow's dis- 

 ease. On the other hand a case occurred in the entirely normal child of a 

 colleague, and in this case the preparation of the milk must be held entirely 

 responsible for the disease (fifteen minutes in the Soxhlet apparatus). Siace 

 the year 1901 Barlow's disease, at least according to my experience (which is 

 also confirmed by Heubner) has increased in frequency in Berlin, and this 

 makes it possible minutely to investigate a very remarkable fact: For the 

 fourteen children that I had an opportunity of seeing in this time the Soxhlet 

 apparatus was always used, and in seven cases the milk was sterilized for ten 

 minutes, in two cases for fifteen minutes, and in five it was boiled for a longer 

 period than this. In spite of the fact that among our well-to-do classes 

 infant's milk may be obtained from a number of reliable dairies, the milk 

 for the fourteen children treated by me was all obtained from the same dairy, 

 and from a dairy which since that time has employed its entire product in a 

 laboratory for heating, from which no exact records can be obtained. While, 

 according to my experience, the mere boiling of this milk does no harm, the 

 combination of sterilization according to Soxhlet with previous Pasteurization 

 may produce Barlow's disease. 



" Besides the cases cited above, I later saw seven others, the infants being 

 from six to ten months of age when they came under treatment. Six of these 

 patients had been fed from birth on B's milk ; it was boiled for ten or fifteen 

 minutes in the Soxhlet apparatus, or ten to twenty minutes in Hartmann's 

 milk boiler ; in one child only did the disease develop while 'exclusively nour- 



1 " Verb, des Vereinea fur innere Medicin in Berlin," 1903, 



