122 INANITION AND MALNUTRITION 



Chudnovski ('90) in skin wounds on starved rabbits. He found that the regen- 

 eration of the epidermis cells occurs as in well-nourished animals, but more 

 slowly. The number of mitotic figures is diminished and their form may be 

 abnormal. The epithelial cell nuclei are poor in chromatin and may undergo 

 chromatolysis. Granulation tissue is absent 01 diminished in amount, and the 

 infiltration of multinucleated cells (found in wounds of well-nourished animals) 

 is feeble or absent. Rous and McMaster ('24) state that in albino rats on 

 water alone following laparotomy the abdominal wound heals slowly but by first 

 intention. 



According to Valentin ('58) in the hibernating marmot no appreciable 

 amount of regeneration occurs in skin wounds. Hansemann ('98) states that no 

 mitoses ordinarily occur in the skin of the hibernating marmot or hedgehog; 

 but in a few hibernating hedgehogs, which were killed 1-14 days after incisions 

 were made on the snout, immigration of leucocytes occurred, and cell-divisions 

 appeared in both epithelium and connective tissue. 



Tela Subcutanea. — -The most conspicuous changes during inanition are not 

 in the skin proper, but in the underlying tela subcutanea. This is because in 

 well-nourished individuals it is very largely composed of adipose tissue, which is 

 known to be rapidly depleted by inanition. The atrophy of this layer produces 

 the characteristic looseness and folds of the skin during starvation. On account 

 of the progressive character of this atrophy, the thickness of the skin folds may 

 be used as a convenient index of the stage of inanition, especially in infants, 

 according to Batkin ('15), Marfan ('21), Peiser ('21), Gerber ('21), Kading 

 ('22), Nicolaeff ('23) and Hille ('23). In a starved girl of 19 years, Schultzen 

 ('62, '63) noted that the adipose panniculus had disappeared from the trunk, 

 but was still evident in the extremities. Likewise in infantile atrophy, the 

 subcutaneous fat does not disappear at a uniform rate over the whole body. 

 Marfan ('21) describes the panniculus adiposus as becoming thin and finally 

 disappearing altogether in the various regions in the following manner: 



" Ce processus de destruction de la graisse commence par le ventre et finit 

 par la face. II atteint successivement les regions suivantes: (1) l'abdomen; (2) 

 le tronc (d'abord la poitrine, puis le dos, puis les lombes); (3) les membres 

 (d'abord les superieurs, puis les inferieurs, puis les fesses); (4) la face (d'abord le 

 front, puis les joues et le menton). On constate parfois quelques derogations 

 a cet ordre, mais elles sont tres rares." 



The histological changes in the adipose tissue of the tela subcutanea 

 of atrophic infants are shown in Figs. 47-49. 



In extreme stages of inanition, the ordinary adipose tissue of the tela subcu- 

 tanea (and elsewhere) is usually almost completely depleted, so as to lose 90 

 per cent or more in weight. Observations were made by Chossat ('43) in 

 pigeons; Bidder and Schmidt ('52) in the cat; Falck ('75) in dogs; Ohlmuller 

 ('82), DeTommasi ('94), Klose ('13) and others in the human body. Neverthe- 

 less, small areas of subcutaneous fat may be macroscopically visible, even after 

 death from starvation, as noted by Falck ('75) in the dog; Meyer ('17) and others 

 in man. In some cases the fat may persist in considerable amount (Fowler 

 '70; Jewett'75; Voelkel '86; Ffartman '00), indicating thatdeath from starvation 



