803 



protein and fat without at the same time supplying an excessive amount 

 of carbohydrate. 



In the severe form of the disturbance, as seen in infants, there is, 

 at the outset, usually a rapid increase in weight which may be mistaken 

 for a satisfactory normal gain. Soon, however, it is noticed that the 

 infant is definitely edematous. The edema may be of the most extreme 

 degree so that the skin appears like a thin membrane filled with water. 

 The edema is not dependent upon either cardiac or renal involvement. 

 There are no signs referable to the heart. The urine, aside from being 

 scanty in amount, during the period of increasing edema is normal in 

 composition. 



The edema may vary from day to day and it is not infrequent to 

 observe the loss of a large portion of the body weight within a single 

 day's time. 



Infants with this condition have very little resistance to infection. 

 They suffer frequently from attacks of otitis media, bronchitis, furun- 

 culosis and pyelitis. They are more likely to succumb to any of the acute 

 infectious diseases than is the normal infant. In the more advanced 

 cases a marked hypertonicity of all the muscles of the body is a prominent 

 feature. The outlines of the separate muscles may be seen through the 

 skin and there may be a general rigidity of the body with opisthotonos. 

 A chronic inflammatory process in the conjunctiva may make its appear- 

 ance (xerosis conjunctive), the sclera may become softened so that the 

 contents of the eyeballs exude (keratomalacia). So far reference has 

 been made especially to the effects of a one-sided dietary on infants be- 

 cause the condition is of more frequent occurrence at this time of life. 

 Older children, except under conditions of war or extreme poverty, are 

 rarely fed diets consisting of such great excess of carbohydrate and so 

 little fat and protein. The condition does occur in older children, how- 

 ever, and has been observed repeatedly during the World War. It has 

 also been seen in child caring institutions (Bloch). The symptoms do 

 not differ essentially from those observed in infants. 



Metabolism differs from the normal chiefly in so far as water and salts 

 are concerned. Lederer found a high water content of the blood and 

 WeigertO) a high water content of the tissues as well. Salge found a di- 

 minished amount of chlorids in the urine and a lowered salt content of 

 the blood plasma. Blauberg determined that there was a loss of mineral 

 matter from the body. 



There have been, in general, two theories as to the pathogenesis of 

 the condition. (1) That it is due to an excess of carbohydrate. (2) 

 That it is due to a deficiency of fat or protein. The more recent work 

 on the subject would indicate very definitely that the condition is a defi- 

 ciency disease. For example, Bloch observed a large number of cases 

 in infants fed on a diet of skimmed milk. These all suffered from the 



