EFFECTS ON THE SPLEEN 251 



Effects of Protein Deficiency. — The reasons for including pellagra and 

 malnutritional edema under protein deficiency were given in Chapter V. 



Pellagra. — According to Fraenkel ('69-' 70) the spleen appeared subnormal 

 in weight in 23 out of 30 cases. Lombroso ('92) found it atrophic in 41 and 

 hypertrophied in 12. Babes and Sion ('00) likewise found the spleen usually 

 atrophic, except in malarial cases. Nicholls ('12, '13) in 8 negro pellagrins 

 noted an average weight of only 3 ounces for the spleen. Raubitschek ('15) 

 and Harris ('19), from a comprehensive review of the literature on the pathology 

 of pellagra, concluded that the spleen is usually decreased in size, though some- 

 times enlarged. 



As to the structural changes in the spleen during pellagra, Fraenkel ('69-'7o) 

 noted hyperemia, more rarely pigmentation. Tuczek ('93) found atrophic 

 changes and abnormal pigmentation, which are also included in the review by 

 Marie ('08, '10). Kozowsky ('12) described thickening of the trabeculae, 

 venous congestion and hyalinization of the small arteries. An increase in the 

 fibrous tissue (sclerosis), especially of the blood vessels, and marked hematoge- 

 nous pigmentation of the spleen are mentioned by Nicholls ('12/13), Raubit- 

 schek ('15) and Harris ('19). 



The weight of the spleen in human famine edema appears somewhat vari- 

 able. Paltauf ('17) observed a range of 70-235 g. Atrophy of the spleen 

 was reported by Hiilse ('17) and Oberndorfer ('18), the latter finding weights 

 as low as 50 g. Enright ('20) found the spleen enlarged only in cases com- 

 plicated by malaria; otherwise small, sometimes weighing only 3 ounces. Mann, 

 Helm and Brown ('20) reported the spleen normal or shrunken in 200 necropsies. 

 Prince ('21) found the spleen usually slightly increased in volume. 



As to the structure of the spleen in famine edema, Oberndorfer ('18) de- 

 scribed it as sclerotic; the pulp anemic and atrophic; color dark reddish brown; 

 follicles small but distinct. Enright found the consistency of the spleen normal 

 except in the malaria cases, when it appeared hard and pigmented. Fracassi 

 ('22) noted splenic fibrosis. 



In guinea pigs on maize diet (mixed deficiency of protein, vitamins and salts), 

 Rondoni and Montagnani ('15) obtained a sclerosis and sometimes hyperemia 

 of the spleen. ■ Rondoni ('19) found that the spleen formed 0.14 per cent of 

 the body in maize-fed guinea pigs (normal 0.12 per cent), indicating a slight 

 increase in relative weight. 



In monkeys, pigs and albino rats on corn-oil cake, maize and similar diets 

 (mixed deficiencies of protein, etc.) producing emaciation, Sundwall ('17) found 

 the spleen intensely congested, showing hemosiderosis, and sometimes amyloido- 

 sis and hyalin changes; proliferation of endothelial cells of the pulp, containing 

 red blood cells and pigment; and reduction in size of the Malpighian bodies. 



In pigeons and monkeys on diets with mixed deficiency of protein, vitamins, 

 etc., McCarrison ('19b, '21) found marked atrophy of the spleen, especially in 

 the pigeons. 



Lefholz ('23) found that in kittens the spleen shows no consistent response 

 to variations in the protein, fat or sugar content of the diet (thus, like the thymus 



