There are recorded many instances of the occurrence of epidemics of dropsy during times of food shortage owing to famine conditions brought on by drought, flood devastation or war. In 1876-77 there occurred a famine in India, and in eight famine districts nine-tenths of all deaths were due to famine dropsy, dysentery, diarrhea and debility (25). The Government attempted to operate a system of rationing the sufferers by determining their calorific needs calculated on the basis of body weight. This system proved a failure because those who appealed for relief were found to be either emaciated or apparently very fat. These latter appeared to be in no immediate danger of starvation, and yet they were in many cases in immediate danger of death, because they were not really fat but dropsical. This contrast between one group of the population which was nothing but skin and bones, and another which was bloated as a result of dropsy, occurred in persons of all ages.

In 1899 Patterson (26) described cases of edema among Chinese starving during a period of famine. Weed seeds and greens obtained from wild plants were the only food, and Patterson, who apparently was not familiar with any literature on the subject, called it "greens dropsy." In 1917 the City of Mexico was under military rule for several months and many cases of dropsy developed in persons of all ages. These people had been reduced to beets and spinach as almost their sole food supply.

An epidemic of edema among infants has been reported from Germany by Wagner. It was caused by feeding modified milk alone or modified milk with cereal (27). Potter (28) described an epidemic of dropsy among infants restricted for a time to barley water, which was very low in protein, inorganic and fat content. Czerny and Keller have called attention to a condition which they speak of as "Mehlnahrschaden" literally, a state of malnutrition resulting from too much cereal in the diet (29). This they regarded as the equivalent of saying that they had a diet too rich in carbohydrate, too low in protein and too low in fat. There are, we now know, serious mineral deficiencies, lack of fat-soluble A, water-soluble B and water-soluble C in all cereal preparations, especially when these represent essentially the endosperm of the seed.

Nutritional edema has been many times reported in medical literature. It occurred especially during time of war and scarcity of food. During the great war the condition became known as war edema. In earlier literature it was called by various names such as prison dropsy, hunger swelling, epidemic dropsy, deficiency edema, etc.

Hoist (30) states that many cases of dropsy occurred during the Crimean war when there was an epidemic of scurvy. He states that dropsy occurs every year on French fishing vessels off the coast of Newfoundland. Edema was very common among prisoners in England and America during the first half of the nineteenth century. This happened before prisoners received the humane treatment and moderately satisfactory diet now generally accorded them. It was recognized, as some of the names indicate, that it had its origin in faulty nutrition.

Budzynski and Chelchowski (31) described one hundred and ten cases of "hunger swelling" during the war in Poland. These cases resulted from lack of food. It was pointed out that the most marked characteristic of the condition was an edema which resembled wet beri-beri.

Edema has been, as the cases mentioned illustrate, frequently associated with other deficiency diseases, especially beri-beri and scurvy. The histories of the cases recorded, point to a low protein dietary as the condition favoring the development of the disease. Indeed, there is convincing experimental data that seems to prove that protein starvation is the essential specific cause of the condition, but it appears that a water-rich diet poor in protein, especially promotes the development of edema. Maver refers to the occurrence of edema in horses and oxen which work about sugar factories, and subsist for a time upon cane. Cattle fed distiller's wash, or too liberally on beet pulp become dropsical (32).