IOO INANITION AND MALNUTRITION 



probably due chiefly to protein insufficiency. Phosphorus and calcium are 

 especially important in the formation of bone, and their deficiency (with lack 

 of a special vitamin) may result in rickets or similar disorders with skeletal 

 lesions. Deficiencies in vitamins A and B give rise to characteristic syndromes 

 (the former to xerophthalmia; the latter to beriberi and polyneuritis), and defi- 

 ciency in vitamin C causes scurvy. Water is also essential, but fats and carbo- 

 hydrates may be replaced by an excess of protein in the diet. In most cases of 

 partial inanition, more than one essential factor is simultaneously depleted, the 

 resulting malnutrition therefore being due to a mixed deficiency. 



In a strict sense, a total inanition is non-existent. Even in the complete 

 absence of food-intake, the living cells of the body are not entirely deprived of 

 nutriment, being still nourished by the blood-stream and lymph, which are more 

 or less imperfectly replenished by absorption of such stored or reserve materials 

 as may be available in the organism. When this nutriment becomes inadequate 

 with respect to any essential factor, the cells of the tissues most concerned with 

 that factor will undergo disordered metabolism, although in young animals an 

 abnormal, dystrophic growth may continue for some time. Ultimately, and 

 especially when the cell-nutriment becomes inadequate to supply the energy 

 required for the vital functions, cell atrophy and degeneration occur (as will 

 be shown later), the body weight falls and death follows. 



On account of this fundamental similarity between total and partial types of 

 inanition, it is not surprising to find that they resemble each other in many of 

 the more general effects. Thus in both cases there is usually a marked and pro- 

 gressive loss of body weight with resultant emaciation in the adult, the limits 

 being about the same in both types of inanition. In the young there is in both 

 cases a retardation or inhibition of growth, frequently accompanied by dystro- 

 phic growth phenomena which vary according to circumstances. Finally there 

 is, after partial as well as total inanition, the possibility of recuperation upon 

 adequate refeeding, depending upon the character and extent of the injury 

 produced by the inanition. In both cases, there is an upper (somewhat 

 variable) limit beyond which death is inevitable. There is also a lower limit, 

 below which perfect recovery is possible. Between these upper and lower limits 

 of inanition, there is probably in all cases a degree of injury possible which 

 permits of only partial recovery, resulting in a variable degree of dwarfing 

 and deformity of the body. The available evidence indicates that in some cases 

 the long-continued suppression of growth during partial (inadequate protein) 

 inanition injures the capacity of subsequent growth much less than does total 

 (incomplete) inanition. The more specific effects of the various types of inani- 

 tion will be considered in the subsequent chapters upon the individual organs. 



Effects of Various Types of Partial Inanition on the Body as a Whole 



Protein Deficiency. — It has long been known that protein forms an essential 

 factor in human and animal nutrition. The earlier experiments (cf. Munk 

 '91; Rosenheim '91) upon protein deficiency, however, were unsatisfactory in 

 two important respects. In the first place, they neglected other factors, such 



