In the American Journal of Diseases of Children, Nov. 1917, A. F. Hess of Columbia University, in "A Study of Pathogenesis of Infantile Scurvy," says: "Some have questioned whether pasteurized milk is really involved in the production of scurvy. The fact, however, that when one gives a group of infants this food for a period of about six months, instances of scurvy occur, and that a cure is brought about when raw milk is substituted, taken in conjunction with the fact that if we feed the same number of infants on raw milk, cases of scurvy will not develop--these results seem sufficient to warrant the deduction that pasteurized milk is a causative factor. The experience in Berlin, noted by Neumann (Neumann, H. Deutsch,, Klin., 7: 341, 1904) and others, is most illuminating and convincing in this connection. In 1901 a large dairy in that city established a pasteurizing plant in which all milk was raised to a temperature of about 60 degrees C. After an interval of some months infantile scurvy was reported from various sources throughout the city. Neumann writes about the situation as follows:

'"Whereas Heubner, Sassel and myself had seen only thirty-two cases of scurvy from 1896 to 1900, the number of cases suddenly rose from the year 1901--so that the same observers, not to mention a great many others, treated eighty-three cases in 1901 and 1902.'

"An investigation was made as to cause, and the pasteurization was discontinued. The result was that the number of cases decreased just as suddenly as they had increased."

The reader will note that the fact that pasteurized milk causes scurvy in infants has been known for forty six years or more. It was no new discovery that Hess proved by his tests, involving damaging experiments of helpless infants. In spite of this knowledge, in 1912 a Medical Commission declared that in feeding infants, heated milk is the full equivalent of raw milk. A Hebrew orphan asylum in New York, sometime thereafter, began the feeding of infants upon cow's milk which had previously been heated to 145 degrees Fahrenheit for thirty minutes. After a few months on this diet there occurred (1914) an "outbreak" of scurvy in these infants. Dr. Hess recommended the addition of orange juice to the diet. The scurvy cleared up rapidly following the addition of the orange juice.

Hess points out that the infants developed scurvy on a diet of pasteurized milk and adds: "This form of scurvy takes many months to develop and may be termed subacute. It must be considered not only the most common form of this disorder, but the one which passes most often unrecognized." He says also, that "one of the most striking clinical phenomenon of infantile scurvy is the marked susceptibility of infection which it entails--the infrequent attacks of 'grippe,' the widespread occurrence of nasal diphtheria, the furunculosis of the skin, the danger of pneumonia in advanced cases," constitute evidences of this susceptibility. A study of the widespread epidemics of the Middle Ages reveals that they followed in the wake of widespread scurvy, a condition that was very prevalent in those days .

Hess thinks that although pasteurized milk "is to be recommended on account of the security which it affords against infection, we should realize that it is an incomplete food." Is it not strange that a man can show that the feeding of a diet of pasteurized milk produces scurvy and greatly increases liability to infection and then, at the same time, state that pasteurized milk affords security against infection? He recommends the feeding of "an antiscorbutic, such as orange juice . . . or potato water" to the pasteurized milk diet and says, "In order to guard against it (scurvy), infants fed exclusively on a diet of pasteurized milk should be given antiscorbutics far earlier than is at present the custom, even as early as the end of the first month of life."

Why wait a full month before beginning to protect the child against the deficiencies and inadequacies of pasteurized milk? Infants can take orange juice and other juices from the third day after birth. It is my practice to start juices this early if there is reason to think the mother's milk is inadequate or if the child is placed on cow's milk, even raw cow's milk.

Berg says of the scorbutogenic diet, "the addition of milk to the diet will prevent the onset of scurvy; but this prophylactic power is more or less completely lost if the milk be boiled, condensed or dried." The antiscorbutic property of milk is ascribed to its vitamin C, which is destroyed even by pasteurization. Discussing the influence of heat on this complettin, Berg says: "this makes it obvious why the pasteurization of milk greatly reduces the C content of the nutriment and why infants and children fed on pasteurized milk are so apt to suffer from scurvy. Of course in the process of condensation, the antiscorbutic qualities of milk are gravely impaired. In young monkeys, and also in guinea-pigs it induces typical scurvy."

The addition of sodium citrate, lime and other alkalies to milk further impairs the milk, besides interfering with its digestion. Berg says: "Since the complettin C is sensitive to alkalies, we can readily understand that it is completely destroyed when milk is sterilized after addition of sodium citrate, which has an alkaline reaction.

Generally speaking, the sterilization of nutrients impairs their antiscorbutic power, being more injurious in proportion to the height of the temperature. Tinned meat and tinned milk are therefore invariably scorbutogenic." Barnes and Hume showed that the drying of milk reduces its antiscorbutic efficacy to approximately two-fifths the original. Hess and Unger showed that this does not occur if the milk is dried in a few seconds.

Berg refers to a four-year-old child which developed scurvy while fed exclusively upon a diet of soups, coffee and boiled milk. He says "such cases are, in truth, far less exceptional than might be supposed." Many mild cases developed in Germany during the war, while, reports of "epidemics" of scurvy in orphanages exist.

R. M. Overstreet, in Northwest Medicine, June, 1938, as abstracted by Clinical Medicine and Surgery, "The Increase of Scurvy," says: "Within the past few years an increasing number of patients affected with scurvy have been brought to the Oregon Children's Hospital. As the prophylactic amount of vitamin C (15 mg daily) is contained in 300 cc. of breast milk, scurvy is rarely found in breast-fed babies.

"The vitamin C of cow's milk is largely destroyed by pasteurization or evaporation."

In the Journal of Nutrition for Dec. 1939, in an article dealing with "The Destruction of Ascorbic Acid in Commercial Milks," Warren W. Woessner, C. A. Elvehjem and Henry A. Schuette say: "Samples of raw, certified, certified Guernsey and certified vitamin D milks were collected at the different dairies throughout the city of Madison. These milks on the average are only a little below the fresh milks as recorded in table 1, indicating that commercial raw and certified milks as delivered to the consumer lose only a small amount of their antiscorbutic potency. Likewise samples of commercial pasteurized milks were collected and analyzed. On an average they contained only about one-half as much ascorbic acid as fresh raw milks and significantly less ascorbic acid than the commercial un-pasteurized milks.

"It was found that commercial raw milk contained an anti-scorbutic potency which was only slightly less than fresh raw milks and that pasteurized milks on the average contained only one-half the latter potency. Mineral modification and homogenization apparently have a destructive effect on ascorbic acid."