An investigation conducted by the American Pediatric Society in 1898 showed that infants developing scurvy had in nearly all cases been fed with heated milk or with proprietary foods.

Infantile scurvy is usually quickly cured by feeding either raw milk, or milk which has been pasteurized at a low temperature supplemented by some fresh fruit juice (usually orange juice).

Investigations to determine whether children are subject to scurvy when fed exclusively upon pasteurized milk have given conflicting results, probably for two reasons: (1) pasteurization of the milk at different temperatures or for different lengths of time in different cases, (2) differences in susceptibility to scurvy among infants.* Aging of the milk may also be a factor (Hess).

Hess and Fish report that they have had a considerable number of cases of infantile scurvy among hospital children fed on milk pasteurized at 1450 F. for 30 minutes or 165° F. for 20 minutes. Orange juice was efficient as a preventive or cure and did not lose its antiscorbutic property when boiled for 10 minutes. It was found that the juice of the orange peel could be substituted for that of the orange as an antiscorbutic. Potato was found to be an excellent antiscorbutic for children, and the authors propose that potato water (made by mixing a tablespoonful of boiled potato in a pint of water) be used as a diluent instead of the barley water now commonly used in modifying cow's milk for infants. They held that if this is done, no other antiscorbutic will be necessary.

In his later papers (1915, 1916), Hess reports that when milk which has been heated for 30 minutes at 1450 F. is fed with sugar and cereal, but without orange juice or other antiscorbutic food, for from two to eight months there is usually a development of mild scorbutic symptoms, or a subacute scurvy such as might pass unrecognized. Such cases are apt to show some but not all of the classical symptoms of infantile scurvy and usually involve retardation of growth. Under these conditions the addition of an antiscorbutic food such as orange juice to the diet induces an increased rate of growth as well as relief of such other scorbutic symptoms as may have developed. Even if, as some critics have suggested, the symptoms reported by Hess are somewhat different from those shown by well-developed and clearly marked cases of infantile scurvy, the influence which the presence or absence of antiscorbutic food in the diet was shown to exert upon the nutrition and rate of growth of the infant is a matter of considerable interest from the standpoint of food chemistry.

* Differences in susceptibility to scurvy are to be expected in view of the well-known fact that when groups of men, as sailors and prisoners, are subjected to the same conditions and partake of the same rations, some become scorbutic while others do not. Physicians have also found that some infants show signs of scurvy when receiving an amount of antiscorbutic food which is amply sufficient for most infants and recover when a diet still richer in antiscorbutics is given.

More recently still (1917), Hess finds that infantile scurvy is possibly not a single disease, and probably not a simple dietary disease. Use of pasteurized milk is a contributing cause, but the aging of such milk is quite as much a factor as the heating. The diet is held to be at fault in allowing the intestinal bacteria to elaborate toxins, while antiscorbutic foods improve intestinal conditions and are also beneficial as diuretics.