DEFICIENCY DISEASES 285 



eye infections wliicli arc likely to occur in poorly nourished laboratory 

 animals/^ 



Nutritional Dropsy. ("War Dropsy" or Famine Edema). "^^ 



This condition, which was observcul extensively durinj^ the war, 

 especially among Russian prisoners in Germany, has been seen wherever 

 famine occurs, and is undoubtedly caused bj^ dietary deficiency. 

 Apparently it is independent of scurvy. As it is often associated with 

 xerophthalmia it has been thought to depend on al)sence of fat-soluble 

 vitamines. It seems more probable, however, that it results from 

 low caloric supply, although protein deficiency combined with exces- 

 sive fluid and salt intake in the effort to maintain life with weak soups, 

 are probably important factors.^' Most of the adult subjects have 

 been receiving 800 to 1200 calories per day, containing })ut 30 to 50 

 gms. of protein. It is much more likely to appear in undernourished 

 persons who are compelled to work than in equally starved persons at 

 rest, since work, and also cold, increase the caloric deficiency. 



Numerous studies of metabolism and blood chemistry in persons 

 exhibiting war dropsy have given concordant results, which show the 

 extreme depletion of the body in all nutritive reserves.*^ The blood 

 shows hypoglucemia, decrease in potassium, fatty acids, phospholipins 

 and residual nitrogen, with anincrease in NaCl, and of acetone bodies 

 and ammonia from starvation acidosis. There is also a decrease in 

 the amount of protein in the blood even to one-half the normal amount, 

 with hj^dremia and a less marked decrease in both red and white cells. 

 The lack of reserve nitrogenous material both in blood and tissues is 

 shown by the fact that when patients with war edema are fasted 

 a few days the N excretion may fall to 2 to 3 gms. per day, while in 

 absolute starvation of previously normal persons the N output usually 

 is 10-12 gms. (Falta). Schittenhelm and Schlecht suggest that the 

 edema is merely the result of injury to the capillary endothelium, in 

 common with all the other tissues, whereby their permeability becomes 

 increased. 



Famine edema seems to be closely related to the edema often 

 observed in infants kept on a preponderatingly starchy diet, such as 

 • barley water, for long periods. Here most striking degrees of dropsy 

 are observed, which seem in all respects similar to famine dropsy. 

 There is probablj^ also a close relation to the edema of pernicious 

 anemia and cachexia. The relation of this form of edema to the 



" See Bulley, Biochem. Jour., 1919 (13). 103. 



"Full Review by Schittenhelm and Schlecht, Zeit. exp. Med., 1919 (9), 1; 

 Maver, .lour. Amer. Med. Assoc, 1920 (74), 934. 



^' See Guillermine and Guyot, Rev. Med. Suisse Rom., 1919 (39), 115; Falta, 

 Wien. klin. Woch., 1917 (30),' 1637; Schittenhelm and Schlecht, Zeit. exp. Med., 

 1919 (9), 82. 



"See Schittenhelm and Schlecht, loc. cit.; Feigl, Biochem. Zeit., 1918 (85), 

 365; Jan&en, Miinch. Med. W'ocK, 1918 (65), 925; Biirger, Zeit. exp. Med., 1919 

 (8), 309. 



