670 
tion caused by the diminution in the body of those alkaline bases 
which are necessar}^ for the maintenance of a normal condition of 
health. These are ordinarily supplied in our food in the form of 
salts of the alkaline bases, especially potassium. Now, I would go a 
step farther and say that in order to undergo absorption during diges- 
tion, these salts must be supplied in combination with an acid radical 
which can be set free by the action of the digestive juices, such as 
phosphoric, citric, malic, and similar acid radicals. The negative 
proof of this contention is the rapidity with which scurvy is cured 
when the system is freely supplied with such salts. 
I think two causes often going hand in hand are mainly responsible 
for the production of scurvy in infants. The first is an absolute in- 
sufficiency of the salts alluded to and the second is a relative insuffi- 
ciency of these salts when compared with the fat present in the diet. 
In regard to the latter condition we have seen how a diet excessive 
in fat may draw upon the alkaline bases of the body for the purposes 
of saponification. When they are being inadequately supplied in the 
food as well it is easy to see that the time would not be long in coming 
when the available supply would be depleted, radical changes wrought 
in the composition of the bodily tissues and the constitutional symp- 
toms would follow. 
In many of the cases of infantile scurvy caused by sterilized milk 
the formulae used seems to have been the causative factor, i. e., low 
proteids or low proteids and high fat. Now all such modifications 
are derived from the dilution of top milks and creams with water. 
This implies that the quantity of the mineral salts present in the milk 
is greatly diminished, as, in order to produce this relative proportion 
of fat and proteid, small amounts of these top milks and creams are 
diluted with large volumes of water. 
Thus a modified milk mixture of the following formula: Fat, 3; 
sugar, 6, and proteid, 1, is obtained by diluting 6 ounces of 10 per cent 
crekm with 12 ounces of water and adding 1 ounce of milk sugar. 
This has at once the effect of reducing the mineral salts in this mix- 
ture to one-third the amount present in a similar amount of whole 
milk. When higher fat modifications derived from cow’s milk are 
used without increasing the proteid, or when the proteid percentage 
is to be reduced, a richer cream must be taken in smaller amount and 
diluted with a greater volume of water. On the other hand, I would 
attribute the occurrence of cases of scurvy which have been observed 
to result from the use of whole sterilized cow’s milk to the presence 
of an excessive amount of fat in the milk, which, by reason of the 
greater digestibility of sterilized milk, when compared to raw milk, 
was ingested without causing acute gastro-intestinal disturbance. 
