232 INANITION AND MALNUTRITION 



Protein Deficiency. — Evidence was cited in Chapter V indicating that in both 

 malnutritional edema and pellagra the chief factor is probably protein deficiency, 

 although there may be other factors of importance. 



Malnutritional Edema. — The effects upon the heart in this or allied condi- 

 tions among animals have not been extensively studied (cf. review by M aver '20). 

 In "cachexia aquosa" of sheep, Frohner and Zwick ('15) stated that the heart 

 is soft and atrophic. Hedinger ('15) mentioned not infrequent cardiac dilation 

 in lamziekte of cattle. 



In "famine edema," the condition of the heart among human victims has 

 frequently been noted. Practically all investigators of this condition agree 

 that bradycardia (slow heart beat) is a cardinal symptom. This suggests a 

 cardiac lesion, although it might, of course, be of nervous or other origin. 

 Although it is generally agreed that this edema is not to be classed with those 

 arising from cardiac insufficiency, an atrophy or decrease in cardiac weight has 

 been noted at autopsy by Hiilse ('17, '18), Schittenhelm and Schlecht ('19), 

 Prince ('21) and others. Paltauf ('17) reported the heart weight as nearly 

 always below 300 g., occasionally as low as 200 g. Oberndorfer gives the weight 

 at 180 g., and Enright C 2 °) states that: "The heart usually weighed only 3 to 5 

 oz., but in other respects was apparently normal." Mann, Helm and Brown 

 ('20) reported the heart normal in size in 200 necropsies. 



In structure, v. Jaksch ('18) and Schittenhelm and Schlecht ('19) found brown 

 atrophy of the cardiac muscle in human famine edema. Jansen ('19a.) noted 

 pigment masses at the poles of the cardiac cell nuclei; otherwise no regressive 

 changes. Oberndorfer ('18) reported complete absence of glycogen and fat 

 droplets in the heart muscle. Mann, Helm and Brown ('20) noted edema or 

 gelatinous appearance of the cardiac surface. The edema of the "auriculo- 

 ventricular" junction, found almost constantly by Park ('18) and Menzies 

 ('20), probably represents merely the local gelatinous metamorphosis of the 

 epicardial fat, which has frequently been observed also in other conditions of 

 chronic inanition. 



Pellagra. — In general, the heart is usually found more or less atrophic in 

 pellagra, though sometimes hypertrophied, according to the review of the litera- 

 ture by Marie ('08, '10), Raubitschek ('15) and Harris ('19). Thus Fraenkel 

 ('69-'7o) reported the heart hypertrophied in only 12 out of 113 cases; while it 

 appeared atrophic or emaciated in 49. Lombroso ('92) stated that the hyper- 

 trophic appearance of the heart is often deceptive, on account of its flaccidity. 

 Actual weights of 26 hearts of pellagrins showed 2 slightly above normal; 

 5 slightly below; and 19 markedly below normal. Nicholls ('12) observed in 

 8 cases an average cardiac weight of 7^ oz., the normal being 9 oz. 



As to histological changes in the cardiac muscle, pigmentary atrophy was 

 noted by Fraenkel ('69-'7o) as characteristic. Lombroso ('92) found brown 

 atrophy in 28 out of 35 cases examined, and fatty degeneration in 3. The 

 cardiac fibers often appear abnormally separated. Brown atrophy and fatty 

 degeneration were also found by Tuczek ('93) and Marie ('08, '10), Kozowsky 

 ('12), and Raubitschek ('15). Kozowsky also mentions cardiac fibrosis, espe- 

 cially along the vessels, and pigmentary degeneration of the cardiac ganglia. 



