662 
TVhen we consider tliat we know practically nothing of the essen- 
tial nature of scurvy we must be cautious in considering the con- 
nection between pasteurization and scurvy as cause and effect. 
Botch,® for instance, says: 
In those cases where scorbutus has apparently occurred in infants who were 
being fed on milk heated to 212°, it may have been some other quality in the 
milk which produced the scorbutus, and that either the percentages which the 
infant has been fed upon are not those which are adapted to and fitted to that 
especial infant or that it is an exceedingly dirty milk which they have been 
boiling at 212°, and which necessarily does not become a sterile milk in the 
meaning of infecting the individual. 
The unsatisfactory state of our knowledge upon this subject is 
evident from the following views recently expressed : 
Rummell * * 6 doubts the relationship between the Mueller - B a rlo w 's 
disease and sterilized milk. The cause of this disease, despite the 
great literature upon it, is entirely unknown. The fact that the 
occurrence of infantile scurvy varies so much in different regions 
leads one to suppose that perhaps it has some relation to the food of 
the cow rather than to the heating of the milk. That the disease 
seems to be brought about sometimes by high-grade sterilization of 
the milk, in an analogous way to scurvy in adults, seems probable. 
Animal experiments have been very contradictory and have not 
yet done much to clear up the situation. 
Koeppen c looks upon scurvy as an auto-intoxication brought 
about by intestinal putrefaction, which process is favored in children 
artificially raised. 
Recent evidence (see Schereschewsky's paper, article Xoi 23, in this 
bulletin, p. 687) points to the fact that scurvy may be brought about 
by lack of the vegetable inorganic salts of alkaline bases, especially 
potassium, in the infant's dietary. This, combined with the injurious 
effects of a high percentage of fat in the food, may bring about 
serious disturbances of digestion and metabolism, favoring the pro- 
duction of the scorbutic condition. If this view is correct it entirely 
eliminates the heating of the milk as an etiologic factor. 
The admirable work of Holst and Frolich* (1907) goes far to 
clear up many of the doubts concerning the etiology of scurvy. These 
investigators have produced a disease in guinea pigs practically iden- 
tical with human scurvy. This was done with a one-sided diet con- 
° Rotch, Thomas Morgan : “ The pasteurization of milk for public sale.” Am. 
Joum. Pub. Hyg., vol. 17, May. 1907, p. 181. 
6 Rummell, O. : Sterilisierte Milch ? Deut. Praxis, vol. 13, 1904, p. 201-207. 
c Koeppen : Zur Moeller-Barlow’schen Krankheit. Jahrb. f. Kinderheilk. Bel. 
44. 1897. 
d Holst, A., and Frolich, T. : “ Experimental studies relating to ship beriberi 
and scurvy," (II) “On the etiology of scurvy.” Joum. Hyg., vol. 7, Oct., 1907, 
p. 634. 
