124 INANITION AND MALNUTRITION 



however) the tela subcutanea may fail to show the usual decrease in weight, on 

 account of the replacement of the fat by water. 



Adipose Tissue in General. — In considering the behavior of fat in the body 

 during inanition, we must distinguish the ordinary fat of adipose tissue from the 

 lipoidal fat which occurs especially in epithelial cells of glands, and elsewhere. 

 As pointed out by Nikolaides ('99), Carini ('01), Traina ('04), and Dietrich 

 ('io), the ordinary fat is easily mobilized during inanition, hence called "wander- 

 ing" or "usable" fat; while the lipoidal fat is usually "sessile" or "permanent" 

 in character. The ordinary neutral fats appear to be readily resorbed, while 

 the lipoidal fats contain lecithin and other phospholipins, which are more 

 resistant to inanition. Aschoff ('09) described the relations of the various types 

 of fat in various forms of fatty metamorphosis ("degeneration"). 



Bichat (1801, 181 2) long ago described the metamorphosis of adipose tissue, 

 which assumes a gelatinous aspect and consistency in the epicardial region and 

 and in the adipose bone marrow during phthisis and similar chronic diseases 

 involving emaciation. 



Virchow ('59) added further histological details of the process: 



"Bei allgemeiner Abmagerung ist nichts gewohnlicher als dass das Fettge- 

 webe unter dem Pericardium, im Nierenhilus sich wieder in deutliches Schleim- 

 gewebe umbildet. Das Fett schwindet aus den Zellen, diese verkleinern sich, 

 in die Zwischensubstanz tritt eine schliipfrige, gallertige Flussigkeit, welche die 

 schonsten Mucin-Reactionen gibt." 



Gurlt (cited by Schwann, 1839) discovered " dass bei abgemagerten Personen 

 die gewohnlichen Fettzellen mit Serum gefiillt sind." Similarly, Czajecwiz 

 ('66) described the process in young and adult rabbits as follows: 



"Bei Nahrungsentziehung wird der Fetttropfen in der Zelle resorbiert, 

 seine Stelle grosstenteils durch eine sehr feinkornige Flussigkeit ersetzt; bei 

 langerem Hungern schwindet dass Fett ganzlich und es bleiben die Formele- 

 mente des Bindegewebes in Form von grossen, schonen, runden, mit seroser 

 Flussigkeit gefullten und mit deutlicher Membran und mit einem oder mehreren 

 Kernen versehenen Zellen zuriick." 



On refeeding, the fat cells were found resume their normal structure. 



Toldt ('70) described the fat cells in emaciated animals as decreasing in 

 size and approaching the primitive " Protoblasten " in appearance. 



Flemming ('71, '71a, '76) studied the inanition atrophy of adipose tissue in 

 young and old animals, including the fish, frog, rabbit, guinea pig, rat, cat, dog 

 and man. He concluded that the " serumhaltige Fettzelle " of previous observers 

 is not the final form of the atrophic fat cell, but merely an (inconstant) inter- 

 mediate stage. This may explain the contradictory observations by previous 

 investigators. Flemming described 3 types of fat cell atrophy as follows: 



1. Simple or Normal Atrophy. — The fat droplet gradually decreases, with 

 formation of secondary droplets and granules, the cell finally reverting to the 

 ordinary connective tissue cell of variable form. 



2. Serous Atrophy. — In this case the fat droplet is replaced by a serous drop- 

 let or droplets, sometimes with small fatty granules also. Ultimately the serous 

 content disappears, and the cells assume the same final form as in (1). 



