2l6 INANITION AND MALNUTRITION 



An interesting case was reported by Haigh, Moulton and Trowbridge ('20), 

 in which a Jersey heifer, which had been on a calcium-deficient ration of silage 

 and corn, gave birth to an undersized and maldeveloped calf, with no eyes and 

 with hair growing from the "eye sockets." 



Deficiency of Vitamin A. Xerophthalmia. — In the human species, the sus- 

 ceptibility of the eyes to the effects of malnutrition has long been known. In 

 victims of the Irish famine, Donovan ('48) observed at autopsy blood-shot eyes, 

 as noted also in death from other wasting diseases causing absorption of orbital 

 fat. Redness and inflammation of the sclera are mentioned by Falck ('75) 

 among the characteristic symptoms of death from starvation. In atrophic 

 infants, Mackensie ('57) noted: "In particularly emaciated infants I have on 

 many occasions seen the cornea of one or both eyes lose its substance, become 

 prominent and perforate with almost no inflammation." The earliest symptom 

 of xerophthalmia, xerosis conjunctivae, was described by Bitot ('63) in mal- 

 nourished children. Von Graefe ('66) apparently gave the first minute descrip- 

 tion of keratomalacia, which was also noted by Gama Lobo ('66),Teuscher ('67) 

 and de Gouva ('83) in malnourished negro children in Brazil. A similar condi- 

 tion as a result of long fasting during the Lent Quadragesima in Russia was 

 described by Blessig ('66), Thalberg ('83), Kubli ('87) and others. Tardieu 

 ('80) mentioned corneal ulceration as one of the characteristic lesions in death 

 from inanition in newborn infants, and keratomalacia in athreptic infants was 

 also described by Koun ('03). According to Prugavin ('06), even long after the 

 Russian famine of 1898, nearly all of the children suffered from purulent inflam- 

 mation of the eyes, and much blindness resulted. The observations by Zak 

 ('17) on "chicken-blindness" are mentioned later under "Scorbutus." Schiele 

 ('07) found cod liver oil to be curative even when administered only to the 

 mothers of the nursing infants affected by keratomalacia. The more recent 

 work on human keratomalacia will be mentioned later. 



The nature and significance of these eye lesions during human malnutrition 

 were not understood until quite recently, when the subject has been cleared up 

 by animal experiments. Falta and Noeggerath ('06) and Knapp ('08) observed 

 that young rats malnourished on diets deficient in various factors (including 

 vitamins, then unrecognized) develop a marked tendency to conjunctivitis 

 and corneal ulceration. Knapp found Staphylococcus present in the conjunc- 

 tiva. Freise, Goldschmidt and Frank ('15) demonstrated that this experimental 

 keratomalacia is not contagious, however. It does not occur in rats merely 

 underfed; hence it is not due to ordinary inanition. They found that the 

 histological changes present the typical picture of a keratomalacia, with an early 

 cornification of the corneal epithelium, swelling and decreased stainability of 

 the middle epithelial cells, and inflammatory infiltration of the lower epithelial 

 cells. The substantia propria also presents edema, vascular invasion and local 

 areas of cellular infiltration. Severe cases may develop a perforating ulcer. 

 The condition may be prevented or cured by the addition of 2 c.c. of milk daily 

 to the artificial diet. Goldschmidt ('15) concluded that the efficiency of the 

 milk depends upon its content of "noch unbekannten, aber fur das Leben 

 notwendiger Substanzen," and that experimental keratomalacia in animals 



