CHAPTER XIX 



EFFECTS ON THE ALIMENTARY CANAL 



The effects of inanition upon the alimentary canal are widespread and sig- 

 nificant. A knowledge of the changes during the earlier stages of inanition is 

 necessary to understand the normal processes of digestion and absorption. 

 The effects during the later stages are associated with the marked disturbances 

 of the digestive system which are characteristic, not only in total or partial 

 inanition in the narrower sense of the term, but also in the state of malnutrition 

 which is associated with so large a proportion of diseases in general. In both 

 children and adults, there is often established a "vicious circle," the primary 

 involvement of inanition causing an atrophy of the alimentary tract, which in 

 turn serves to intensify the general state of malnutrition. The process of 

 recuperation is also conditioned by the possibility of regeneration in the atro- 

 phied and degenerated tissues of the digestive system, a consideration of great 

 practical importance to the physician. Following a somewhat brief summary 

 of the effects upon the entire canal, the changes will be reviewed in detail under 

 (i) the mouth, pharynx and esophagus, (2) the stomach, and (3) the intestines. 



Summary of the Effects on the Alimentary Canal 



The changes in the alimentary canal during inanition vary greatly in the 

 different regions. 



In the mouth, atrophic and degenerative changes have been noted in the 

 epithelium of the oral mucosa, but mitoses persist in the deeper layers. The 

 tongue is very resistant to loss in weight (frog), but during extreme thirst 

 degenerative changes occur in the lingual muscle fibers (fowl). Lesions of the 

 oral mucosa occur in pellagra, and especially in the gingival regions during 

 scurvy. 



In the pharynx, the size of the tonsils is greatly affected by the character 

 of the diet as to calories, protein, carbohydrates and especially the fat content. 

 The weight of the pharynx and esophagus is found reduced nearly in proportion 

 to the body weight during inanition (pigeons and steers). The lesions in 

 these segments are usually slight. 



The stomach presents extremely variable changes during inanition. In 

 human starvation, it usually appears contracted and small in adults, but fre- 

 quently above normal weight in malnourished infants. In animals, the loss 

 in weight is usually relatively less (rarely more) than in the body as a whole, 

 and there may even be a persistent gain in gastric weight in the young (rat and 

 human infant) during chronic underfeeding. 



300 



