

EFFECTS ON THE SKELETON 139 



cation of the fontanelles and sutures, similar to the craniotabes of syphilis or 

 rickets. In "congenital spasmodic atrophy," on the contrary, Lesage and 

 Cleret ('14) described the head as small and the cranium hard, an intense 

 osseous hyperplasia sometimes filling the fontanelles and sutures with a dense 

 bony tissue. Zuntz ('19) noted that the hardness of the skull is not modified 

 in the fetus of rats during maternal starvation. Nicolaeff ('23) found osteo- 

 porosis, especially of the vertebrae and cranial vault, in famine-stricken children. 

 Recovery upon Refeeding. — As previously noted, a recovery of normal 

 body weight is possible, if the inanition has not exceeded certain limits in 

 length or severity. If the normal size as well as the weight of the body is to 

 be recovered in the young, the subsequent growth of the skeleton is necessary. 

 Aron ('11, '13) found that puppies and young rats underfed for long periods 

 do not regain normal size upon full refeeding. This was confirmed by Jackson 

 and Stewart ('18, '20) in underfed young rats. If the underfeeding period 

 is not too severe or prolonged, however, and if not begun at too early an age, 

 perfect recovery was found possible (Stewart '16). The weight of the 

 skeleton (ligamentous, cartilaginous and dry) at various stages of recovery 

 was studied by Jackson and Stewart ('19). 



In children refed after prolonged inanition, Goldstein ('22) observed that 

 the increase in weight begins quickly while increase in length (skeletal growth) 

 does not appear until after a stationary period. 



As to histological structure, Solts ('94) refed 2 dogs and 3 puppies after 

 inanition, finding that the bone marrow regains normal structure. The mucoid 

 substance gradually disappears and the necrotic cells are absorbed. Many 

 mitoses occur in the marrow cells, and nucleated red cells become abundant. 

 Jackson ('04) similarly found that the bone marrow in a pigeon, richly fed for 

 3 weeks after a severe underfeeding period of 16 days, showed disappearance 

 of the gelatinous bone marrow with complete recovery of normal structure. 

 Bourgeois ('70) found that during inanition in animals the formation of a 

 callus and the consolidation of fractures is difficult or impossible. The effect 

 of inanition upon regeneration of bone was studied also by Trifiliev ('01) in 

 fractures of the radius in starved and normal rabbits. The callus was found 

 less voluminous and the process of repair delayed several days in the test 

 rabbits in comparison with the controls. Hammer ('20) noted a similar effect 

 as a result of human malnourishment during the war famine. "Wir haben 

 namlich seit langerer Zeit beobachten konnen, dass einzelne Frakturen eine 

 auffallend geringe Neigung zur Heilung zeigen die in einer verzogerten Kallus- 

 bildung ihre unmittelbare Ursache hat, eine Beobachtung die auch anderwarts 

 gemacht worden ist, worauf neben anderen (Eisler, Rupp, Tietzke) vor alien 

 Melchior mehrfach hingewiesen hat." Hammer concludes that this inhibition 

 of the regenerative capacity of the bone, which may exist in the absence of 

 clinical symptoms, is not due to dietary deficiency of calcium or phosphorus, 

 and is probably an indirect result of the effects of inanition upon the endocrine 

 glands. A delay up to 8 or 10 months in the healing of fractures during the 

 Russian famine was recorded by Abel ('23). 



