EFFECTS ON THE ALIMENTARY CANAL 3OI 



Structurally, the stomach during inanition presents a variable degree of 

 atrophy, with degenerative changes in extreme cases. The mucosa may appear 

 normal, aside from simple atrophy; but in advanced stages of inanition there is 

 frequently congestion and often localized degenerative changes — erosion of 

 the superficial epithelium, ulceration, hemorrhages, regressive changes in the 

 gastric glands; and edema, leukocytic infiltration or fibrosis in the stroma of 

 the mucosa and submucosa. The smooth muscle tissue likewise shows a vari- 

 able degree of atrophy. 



The localized degenerative gastric lesions in the advanced stages are prob- 

 ably due largely to gastritis, which appears to be more frequent during human 

 starvation than in experimental inanition among animals. Infantile atrophy 

 is usually secondary to gastroenteritis (or other disorders, such as syphilis or 

 tuberculosis), which interferes with nutrition and establishes a "vicious 

 circle." The resultant inanition causes atrophy of the alimentary canal and 

 associated glands, which in turn intensifies the general state of malnutrition. 



Changes similar to those described for inanition occur in the alimentary 

 canal of the fasting salmon; and also (to a variable extent) in various animals 

 during hibernation, during which a characteristic leukocytic infiltration of the 

 stroma has been observed. 



Very similar atrophic and degenerative gastric changes occur to a variable 

 degree also in the different types of partial inanition, including protein and 

 vitamin deficiencies, thirst (aqueous inanition), etc. 



In the intestines, the changes during inanition in general resemble those 

 in the stomach. There is a variable loss in weight with shortening and attenua- 

 tion of the intestinal wall. In both man and animals there is a general and 

 progressive atrophy in the earlier stages of inanition, following certain minor 

 changes in the mucosa associated with the normal process of digestion and 

 absorption. The epithelium (surface and glandular) contains mitochondria 

 and lipoidal granules which are somewhat resistant to inanition. The atrophy 

 affects all the tissues, but especially the intestinal glands and lymphoid struc- 

 tures. In the later stages, as in the stomach, more profound and degenerative 

 lesions may occur, with enteritis, ulceration, hemorrhages, and disintegration 

 of surface epithelium, glands, and even entire villi. 



In the young, similar intestinal changes may occur; but the process is in 

 some cases modified by the persistent growth impulse. 



In various types of partial inanition, a variable degree of intestinal atrophy 

 and, in more extreme cases, degenerative and inflammatory lesions occur, 

 which are essentially similar to those found during total inanition. General 

 atrophy and weakness of the intestinal walls, and especially of the tunica muscu- 

 laris and associated sympathetic ganglia, may result in distension and meteor- 

 ism. The lymphoid structures appear variable, perhaps because the primary 

 atrophic effect of the inanition is sometimes opposed by the toxic or inflamma- 

 tory conditions. The tendency to hemorrhages is especially marked in scurvy 

 and thirst (aqueous inanition). 



Upon refeeding after a period of inanition, mitosis (which is depressed during 

 inanition) is greatly accelerated in the cells of the various atrophic intestinal 



