336 THE VITAMINES 



Etiology^ 



Langstein (1186) believed in the analogy of this disease with 

 beriberi. In one case, he saw such a great hypertonus of the muscles 

 that he thought it might be a case of Little's disease. Some supposed 

 cases of carbohydrate dystrophy may really have been beriberi. 

 According to Hess (I.e. 918), who noted the development of the 

 disease in the presence of sufficient vitamine C, an analogy with 

 scurvy is excluded. On the other hand, according to some recent 

 work, it seems to be similar to hunger edema. L. F. Meyer (1187) 

 and Rietschel (1188) believed this to be true. Following * this, 

 Benjamin (1189) reported that in carbohydrate dystrophy, after 

 feeding "Eiweiss" milk there was high nitrogen retention, pointing 

 perhaps to a craving of the organism for protein. At first, the reten- 

 tion amounted to 50 per cent of the intake; later, 15 to 20 per cent. 

 Since the cause of hunger edema has often been regarded as lack of 

 protein, this statement is of interest. However, since a dit com- 

 posed chiefly of flour may be very poor in vitamines, under certain 

 conditions, the possibility of dealing with a vitamine deficiency can 

 not be excluded. Hess (I.e. 918) also came to this conclusion. At 

 any rate, Keller (1190) is right when he says that an almost exclusive 

 carbohydrate diet may be used only intermittently. However, there 

 seem to be cases in the literature, as that of Steinitz and Weigert 

 (1191), in which, as a result of a poor tolerance for milk, an exclusive 

 carbohydrate diet was given for a long time. Salge (1192) believed 

 that in individual children, there are great differences in the tolerance 

 for starch. He saw a child fed for 2 months on flour exclusively 

 without any untoward results. The pathological conditions arising 

 from a diet rich in starch were studied also by Abt (1193). 



ATROPHY 



In the English pediatric literature the term "Mehlnahrschaden" is 

 rarely encountered; disturbances of this kind are generally classified 

 as "atrophy" (Cautley, 1194). The latter described the symptoms 

 as follows: The disease arises as a result of an inadequate diet, 

 especially one abundant in flour. There is considerable loss of 

 weight, diarrhea and vomiting. These symptoms are frequently 

 accompanied by stomatitis aphthosa, enteritis, bronchitis and furun- 

 culosis. In severe cases, he found edema of the skin of the extrem- 



