CLINICAL OBSERVATION ON EXPERIMENTAL STARVA- 
TION IN HUMAN BEINGS * 
= By A. G. SISON 
Of the Department of Medicine, College of Medicine and Surgery, 
University of the Philippines 
The physical changes that can be demonstrated clinically in 
experimental starvation are the effect of certain metabolic 
changes that occur in the organs of the individual or of the 
animal undergoing starvation. 
Fasting may be partial or total. In the former no food is 
ingested, but the quantity of water permitted is unlimited, or 
else a specified daily amount is given; while in the latter, neither 
food nor water is taken. From the clinical viewpoint there is 
practically no difference, as the physical changes noted in either 
form are identical, differing only in degree, not in character. 
For a better understanding of the structural changes in some 
of the organs, let me describe the features of metabolism during 
starvation. The elimination of nitrogenous katabolic products 
begins to diminish in the early days of fasting, and there will 
be a period, if the fasting is continued, in which the said elimi- 
nation will reach a constant level. This fact apparently indi- 
cates that the protein katabolism is stimulated during the early 
period of fasting. Voit, in explaining this constant increase 
of protein katabolism, established the distinction between “mor- 
photic” and “ circulating” tissue protein in the body. The mor- 
photic protein, or the more stable nitrogenous component of the 
cells, undergoes only slight disintegration in the ordinary course 
of metabolism, while circulating protein is largely used during 
the early days of fasting. The fall in nitrogen excretion in the 
later period of fasting is explained by Voit as being caused by 
a stage of metabolism in which other tissue components are 
destroyed in lieu of the residual and more stable morphotic 
protein. 
When the starvation is prolonged beyond the limit of tolerance 
or resistance of the tissues of the body, there is observed an 
ante-mortem rise of nitrogenous elimination, which is a sign 
‘ Read before the Manila Medical Society, December, 1916. 
415 
