76 
D. D. CUNNINGHAM. 
of famine- diarrhoea and dysentery indicate in regard to the 
es'sential nature and origin of the disease processes proximately 
causing death. The prominent symptoms observed during life 
are those of diarrhoea and dysentery ; we must attempt to ascer- 
tain whether and how far the diseases merit the titles of famine- 
diarrhoea^^ and famine-dysentery.^^ Any forms of disease 
occurring during periods of famine may, in a sense, be termed 
famine-diseases ; conditions of scarcity and distress must, no 
doubt, more or less favour the prevalence of all diseases. 
Cholera and smallpox, for example, probably find in the famine- 
stricken a most favorable field, but there is no evidence to prove 
that famine alone can produce either the one or the other. In 
other words, these and other diseases are not directly due to 
famine, but they may and probably do become much more pre- 
valent in consequence of famine than they otherwise would have 
been. But is there evidence to show that the so-called ^^famine- 
diarrhoea and ‘‘famine-dysentery” possess characters, either 
in their symptoms or in their pathological appearances, sufficient 
to distinguish them as the results of insufficient nutrition ? 
Does the evidence regarding them justify us in believing that 
special forms of intestinal disease prevail during periods of 
scarcity, essentially dependent on the effects of insufficient 
nutritive supply ? It appears to me that it does. Subjects of 
famine are of course exposed to the ordinary exciting causes of 
diarrhoea and dysentery, and may probably be specially suscep- 
tible to their influence ; but the pathological phenomena charac- 
terising many cases of such disease in them appear to indicate 
very distinctly that the predisposing cause is starvation, and that 
the symptoms are fundamentally due to destructive changes in 
the mucous membrane of the digestive canal induced by imper- 
fect nutrition. 
On comparing the results of the autopsies in cases of these 
diseases with those obtained by experiment, it appears clear that 
the changes effected by defective nutritive supply in the human 
subject are closely analogous to those occurring in the amphibian 
larvae. In both cases a fatty change and subsequent disappear- 
ance of tissue elements occur ; and in both this change is 
specially pronounced in the tissues of the intestinal apparatus. 
The phenomena observed in the human subject show as distinctly 
as those in the amphibian larvae that the effects of famine on the 
tissues are to produce an actual destruction of tissue, and not 
a mere atrophic diminution of bulk, as affirmed by Bauer. The 
great diminution in the mass of the blood, which forms such a 
conspicuous phenomenon in starvation, would of itself seem to 
indicate that destruction of tissue elements occurs, unless it be 
demonstrated that the anaemia is merely relative and solely due 
