Hess and Unger (48) state that drying does not necessarily destroy entirely the anti-scorbutic value of milk. The temperature and time of drying, and the condition of the milk at the time of drying, are important factors in determining the quality of the final product in respect to its scurvy-preventing value. Hart and his co-workers (49) have presented data which would support the view that milk which has been dried on a drum retains more of its anti-scorbutic value than milks which have been dried by the spray process. The data presented above, showing the results attained by several investigators who have studied the effects of heat treatment on fruits and vegetables, show that the method of study is not sufficiently accurate to warrant confidence that the results can be used safely as a basis of accurate comparisons. Work of this nature, when repeated, is likely to give results more or less at variance with those of former experiments. The only safe attitude toward the use of dried milks in infant feeding is to insist upon the addition of some effective antiscorbutic food such as orange juice, tomato juice, swede juice, or certain other vegetable juices which agree with infants or young children. It does not seem important to attempt to differentiate between different milk powders as a source of the antiscorbutic factor.

210. The Diet Of The Nursing Mother Should Contain An Abundance Of Anti-Scorbutic Foods

Cow's milk, and doubtless human milk as well, has relatively low anti-scorbutic value even when derived from a highly satisfactory diet. It suffices to protect the young when the diet is almost wholly derived from milk. When, as is not infrequently done, top milk is employed, modified by dilution and the addition of sugar or cereal water, the infant may be placed in jeopardy with respect to the development of scurvy. In early childhood, the displacement of any appreciable amount of the milk diet by cereal foods is a step of doubtful expediency, and if this course is pursued, fresh fruit juices should never be omitted from the diet under such circumstances.

<21>211. Relation Of The System Of Feeding To The Incidence Of Scurvy In Infants

Further evidence relating to the importance of the mother's diet in the anti-scorbutic value of her milk is afforded by a report made by a committee of the American Pediatric Society in 1898. Among 356 cases of scurvy in infants 10 were infants which had been nursed. The following table gives very interesting information regarding the anti-scorbutic potency of milks treated in different ways (50).

Relation Between The Kind Of Food And The Incidence Of Scurvy

Breast milk................................	12 cases; alone in 10
Raw cow's milk............................	5 cases; alone in 4
Pasteurized milk............................	20 cases; alone in 16
Condensedmilk.............................	60 cases; alone in 32
Sterlized milk..............................	107 cases; alone in 68
Proprietary infant food.......................	214 cases

The above data point clearly to the easy destruction of the anti-scorbutic potency in milks which have been subjected to manipulation. The occurrence of a small number of cases among nursed infants shows that the meat, bread and potato type of diet which is in such widespread use in this and other countries in recent times, does not suffice for the production by a nursing mother of a milk which is complete for the nutrition of her infant. We have no way of determining how large a number of infants, as a result of taking breast milk of poor quality, have reached the stage of borderline cases of scurvy, but whose conditions had not reached the point where they were clinically recognizable. There is much reason to suspect that it is very large.

The experimental data presented in this chapter, leave no room for doubt that scurvy is a deficiency disease resulting from the lack of a specific chemical substance in the food. This substance is not essential in all mammals, but is indispensable to man, monkey and guinea pig, and apparently also to swine and many other species (51). It has been shown, however, that the rat and perhaps the prairie dog (22) possess the "power to synthesize this substance, and are accordingly immune to this "deficiency" disease.