EFFECTS OF INANITION ON THE BODY AS A WHOLE 103 



Menschen boten einen nicht weniger schrecklichen Anblick als die Facies pestica. 

 Matthias ('19) describes two types of edema, one with ascites but without 

 adipose atrophy, ascribed to partial inanition; the other involving general 

 edema and brown atrophy of adipose tissue, ascribed to general inanition. The 

 immediate cause of the edema in most cases is probably an injury of the capil- 

 lary walls (to be considered in a later chapter), without renal or cardiac lesions. 

 Croftan ('17) has emphasized the importance of edema as a danger signal in 

 the starvation treatment of diabetes. 



Pellagra. — This malady was observed in Spain by Casal about 1730 and in 

 Italy by Frappoli (1771), who introduced the word pellagra ("skin lesion"). 

 Various theories as to its etiology have been proposed, which have recently 

 been reviewed extensively by Raubitschek ('15), Harris C19), Snyder ('23) and 

 Vaughan ('23). The characteristic condition of malnutrition associated with 

 the disease was observed early, and the theory that pellagra is caused by gen- 

 eral inanition was advocated by Soler (1791), Cerri (i8o4-'o5), Robolotti ('65) 

 and others. 



That maize diet may be a factor in pellagra was suspected even by Casal, 

 and was noted by many of the earlier writers. More specifically, the deficiency 

 of this diet in protein as a causal factor was advanced by Marzari (1810), 

 Morelli ('55),Lussana and Frua ('56) and Calmarza ('70) although other environ- 

 mental factors were recognized. This theory of protein deficiency, in more or 

 less modified form, has recently been supported by Boyd ('20), Roberts ('20), 

 and by. Goldberger and his associates in several papers, but is opposed by 

 Hindhede ('23). The theory that pellagra is caused by toxins produced by 

 changes in the maize was also supported by various early writers, and more 

 recently by Lombroso and others, even down to the present (Marie '08, '10; 

 Nichols '12, '13; Centani '14; Niles '16, '17). The theory of infection as a cause 

 of pellagra has also had many adherents (cf. MacNeal '21), and recently the 

 possibility of avitaminosis has been suggested by Rondoni ('15, '19) and by 

 Funk ('22). McCollum and Simmonds ('17) state that typical pellagra- 

 producing diets are deficient in the fat soluble A vitamin, inorganic salts, and 

 protein. 



Animal experiments to determine the cause of pellagra have been somewhat 

 inconclusive. Maize or other presumably pellagra-producing diets were fed by 

 Nicholls ('12, '13) to rats; by Rondoni ('15, '19) and Rondoni and Montagnani 

 ('15) to guinea pigs; by Chittenden and Underhill ('17) to dogs ; by Sundwall 

 ('17) to rats, monkeys and pigs; by Sullivan ('20, '20a) to pigeons, and by Chick 

 and Hume '('20) to monkeys. Varied symptoms of malnutrition were thereby 

 produced, but apparently in no case did these resemble very closely those of 

 typical human pellagra. 



On account of the immense literature on pellagra (Raubitschek '15 gives a 

 bibliography of 1,472 titles including "nur bemerkenswerte und wissenschaft- 

 liche Publikationen"), it will be possible to mention only a few of the papers, 

 more especially those dealing with various phases of its pathology. As to the 

 effects on the human body as a whole, there is noted a condition of general 

 malnutrition, with variable loss in body weight, up to extreme emaciation 



