68 INANITION AND MALNUTRITION 



relatively less than the remainder of the body, and hence becomes relatively 

 larger. These rules in general apply likewise to conditions of human 

 malnutrition. 



The embryonic vertebrate is usually protected from inanition through 

 storage of nutriment in the egg of oviparous forms and through sacrifice of 

 the maternal organism in mammals. Starvation of the pregnant mother must 

 be very severe in order to reduce the birth weight of the offspring. Attempts 

 to reduce the size of the human fetus by restriction of the diet during pregnancy 

 therefore appear generally impracticable. 



Even under relatively normal conditions, there is a large amount of malnutri- 

 tion among children, and this is greatly increased by the conditions of war and 

 famine. The best simple physical index of nutrition (with the possible exception 

 of Bornhardt's index) is probably the weight: height 3 ratio, but this is normally 

 variable, even in individuals of the same age and race. Such indices may serve 

 a useful purpose in directing attention to suspicious cases, but require confirma- 

 tion by clinical evidence. 



During "physiological inanition," certain growth changes may proceed 

 in the body of young vertebrates, as illustrated by the salmon during migration, 

 by amphibia during metamorphosis and by the human infant during the post- 

 natal loss in weight. In various mammals (including man), despite under- 

 feeding or malnutrition sufficient to prevent increase in weight, there is a 

 persistent tendency to growth in certain parts (especially skeletal) at the expense 

 of others, resulting in dystrophic growth with characteristic abnormal propor- 

 tions, the body being elongated and the head enlarged. These dystrophic 

 growth changes are contrary to Liebig's "law of the minimum," if strictly 

 interpreted. 



Recovery from inanition is generally possible, unless extreme stages have 

 been reached. Recuperation under proper nutritional conditions is especially 

 rapid in the young, but permanent stunting or dwarfing with failure to attain 

 normal adult size may occur when the inanition has been severe or prolonged, 

 and especially when occurring at a very early age. The conditions limiting 

 the possibility of recovery from inanition and malnutrition are of practical 

 importance in human medicine. 



Effects of Total Inanition, or on Water Alone 



The topics considered under this heading include the duration of inanition, 

 the effects on body weight in adult and young, nutritional indices, dystrophic 

 growth, changes in adult proportion (head, trunk and limbs), and recovery 

 upon refeeding. The effects of partial inanition will be discussed in the next 

 chapter. 



Duration of Inanition. — That different animals exhibit marked variations in 

 their resistance to inanition has long been known and the earliest experiments 

 were concerned chiefly with this feature. Many of the earlier observations 

 (by Redi, Spallanzani, Haller, Blumenbach, and others) were compiled by 

 Lucas (1826), whose data for invertebrates have been noted in the previous 



