A NORMAL DIET 415 



Coincidentally, reports from Germany showed that similar effects, but 

 greatly intensified, were appearing there. The early favorable results of a 

 reduced dietary were found to be illusory and a very real failure to accom- 

 plish the usual amount of work was evident on all sides. 



War Edema. Outbreaks of what came to be known as "war edema" or 

 "hunger edema" appeared in 1917 and became more and more frequent as 

 time went on. The mortality figures soon showed an increase, particularly 

 in the number of deaths from tuberculosis. A very good review of the sup- 

 posed effects of the war diet on the incidence of disease was published by 

 Determann. 



Many factors have been held responsible for the appearance of "war 

 edema." It is easy to point out some of these, such as the lack of protein 

 and of fat (page 410), but there seem to be natural and experimental diet- 

 aries that share these deficiencies and that have been employed for long 

 periods without producing -edema. The large amount of water in the 

 food has also been blamed. But Hawk and his collaborators found no 

 such ill effect to follow the regular use of large volumes of water. 



Rubner(aa) (1920) calculated the inorganic content of the rationed 

 food of the German people in 1917-8 to be 3.375 grams K 2 O, 0.226 gram 

 CaO, 0.290 gram MgO, 0.089 gram Fe,O 3 and 1.922 grams P 2 O 5 , per head 

 per day. A similar calculation for the food used before war gave the fol- 

 lowing values: 4.403 grams K 2 O, 1.221 grams CaO, 0.576 grams MgO, 

 0.154 gram Fe 2 O 3 and 4.472 grams P 2 O 5 . The difference is marked. The 

 calcium content of the war-time diet is far below Sherman's indicated re- 

 quirement and is even less than that of Japanese diets, as calculated by 

 Rubner. 



When we consider how large a part the inorganic constituents of the 

 body fluids play in determining their osmotic properties, it seems quite 

 likely that a change in the inorganic content of the food, in which change 

 the lack of calcium may or may not have been the significant factor, should 

 have had some influence in the causation of .the edema. 



However that may be, lack of food simple starvation must be regard- 

 ed as largely responsible, not only for war edema but also for the other 

 disastrous effects observed. It is possible that a proper mixture of salts, 

 vitamins and amino-acids added to the reduced diet would have prevented 

 some of these, but for the present it seems safe to say that the only practic- 

 able way to secure these needed substances is to eat enough food of sufficient 

 variety. 



Probably the most complete and most accurate study of nutrition in 

 Germany during the war, though limited to one individual, was made by 

 Neumann upon himself. For seven months, from November, 1916, to May, 

 1917, he confined himself to the rationed articles with only such additions 

 as were available to the poorer classes in his city (Bonn). This diet 

 furnished him 45 grams protein, 18.9 grams fat, 287 grams carbohydrate 



