374 THE VITAMINES 



tributed to heart weakness, according to Schittenhelm and Schlecht 

 (I.e. 1443), but to the same causes that bring about the edema. In 

 these cases, adrenaline dose not raise the blood pressure, and the usual 

 heart stimulants, such as digitalis and caffeine, have little effect, 

 while atropine has no effect on the bradycardia. The pulse is 

 extraordinarily small, slow (32 to 36) and soft; reflexes and normal; 

 constipation was noted more frequently than diarrhea, though the 

 latter progressed as the edema disappeared. The disease appeared 

 mostly in hard-working men; the over-exertion seemed to hasten 

 the onset of the disease. Frequently, rest in bed sufficed to dissi- 

 pate the edema and to bring about an improvement. The disease 

 is often found associated with various infections, such as lobar 

 pneumonia, bronchitis and furunculosis. 



Various investigators offer different explanations of the mode of 

 development of the disease, though there is no doubt that the poor 

 diet must be the primary cause; the predisposing conditions may be 

 severe manual labor and exposure. Knack and Neumann (1450) 

 stated that the cause was inadequate nutrition with turnips and a 

 large water intake. Falta (1451) thought that the faulty diet was 

 bread, cabbage, dried vegetables and turnips. The total diet con- 

 tained 30 to 59 grams protein and 1200 to 1400 calories; the vege- 

 tables were cooked in large quantities for 4 to 7 hours. The cases 

 reported by Falta occurred among war prisoners. Burger (1452) 

 gave the exact composition of the faulty diet; it consisted of 55.9 

 grams of protein, 8.5 grams fat and 284.6 grams carbohydrate (1478 

 calories). Kraus (1453) observed cases developed after hard labor, 

 on a diet containing 15 per cent indigestible carbohydrates, little 

 fat and a maximum of 50 grams protein, and 800 to 1300 calories. 



PATHOLOGY 



On autopsy, a complete disappearance of subcutaneous fat tissue 

 was found, although well-nourished bodies also came to necropsy. 

 Atrophy of all parenchymatous organs was observed; the liver and 

 muscles were glycogen-free. Hiilse (1454) found atrophy of the 

 heart; in a few cases the adrenals were enlarged; however, according 

 to Lippmann (1455), no pathological changes in the nerves were 

 observed. According to Paltauf (1456) the anemia is very insignifi- 

 cant. In the pre-edematous stage, according to Jacobsthal (1457) 



