206 INANITION AND MALNUTRITION 



(B) Effects of Partial Inanition 



The effects of partial inanition upon the peripheral nervous system have 

 been studied chiefly in connection with protein deficiency (pellagra), vitamin 

 deficiency (beriberi and scurvy) and water deficiency (thirst). 



Pellagra. — Fraenkel ('69-' 70) mentioned pigment formation in the sympa- 

 thetic ganglion cells as frequent in pellagra; but Tuczek ('93) found the 

 peripheral sympathetic nerves in general unchanged; likewise the spinal 

 nerve roots. 



Rossi ('99) by Nissl's method found in the spinal ganglia of pellagrins pro- 

 gressive chromatolysis, nuclear displacement and degeneration, with prolifera- 

 tion of the neuroglia. These findings were confirmed by Amabilino ('03, cited 

 by Harris '19). Babes and Sion ('00), aside from occasional fibrosis, noted but 

 little change in the spinal ganglion cells. They found, however, degenerative 

 changes in the spinal nerve roots and larger peripheral nerve trunks, indicating 

 peripheral neuritis, and supported the theory of an exogenous origin of the 

 degeneration in the white substance of the cord (opposing the endogenous 

 theory of Tuczek and Marie, also advocated by Marinesco '09). Marie ('08, 

 '10) mentioned the occurrence of degeneration in the anterior root fibers and of 

 pigmentation in the peripheral spinal and sympathetic ganglia. Kozowski 

 ('12) noted degenerative changes in the peripheral nerves and nerve endings, 

 also pigmentation of the sympathetic ganglion cells. Raubitschek ('15) made 

 an extensive review of the changes during pellagra in the peripheral nervous 

 system, including sclerosis in the spinal ganglia and posterior roots, degeneration 

 in the peripheral nerve fibers, and fibrosis with simple or pigmentary atrophy in 

 the sympathetic ganglion cells. 



Beriberi. — In human beriberi, Baelz ('82) described degenerative changes in 

 most of the spinal nerves, and especially in the various sympathetic plexuses 

 (cardiac, pulmonary, splanchnic, celiac and renal). Rumpf and Luce ('00) 

 summarized the changes in the peripheral nerves as: "eine Neuritis chronica 

 interstitialis mit ziemlich betrachtlichem Markfaserausfall und parenchymatoser 

 Markfaserdegeneration." They cite earlier observations (by Baelz, Scheube, 

 Pekelharing and Winkler) showing a chronic interstitial neuritis with atrophy 

 and degenerative changes in the peripheral nerves (vagus, recurrent, phrenic and 

 especially the spinal nerves). 



In 125 necropsies in cases of beriberi, Ellis ('98) similarly found marked 

 degenerative changes constantly in the phrenic, and vagus nerves and cardiac 

 plexuses (probably causing death) ; also in the splanchnic nerves, and the pul- 

 monary, celiac, and renal plexuses and their branches. He concluded that the 

 symptoms of beriberi are obviously caused by degeneration of the peripheral 

 spinal nerves in the paralytic cases, and of the phrenic and vasomotor nerves in 

 the "moist" cases. Duerck ('08) and Vedder ('13) gave excellent illustrations 

 showing the degenerative changes in the peripheral nerves. Strong and 

 Crowell ('12) found that all nerves (vagus, phrenic, femoral, popliteal, sciatic) 

 show marked degeneration of the medullary sheaths by the Marchi method. 

 There is no proliferation of neurilemma nuclei or leukocytic infiltration. 



