EFFECTS ON THE HEART AND BLOOD VESSELS 223 



nating animals. This fat is progressively consumed during inanition, although 

 certain lipoidal granules (probably containing phospholipins) here as elsewhere in 

 the body appear very resistant to starvation. Through fatty degeneration, 

 on the other hand, there is apparently in some cases an increase in the amount of 

 fat within the cardiac muscle fibers, although the question of fatty degeneration 

 has been much disputed. 



The various types of partial inanition also occasion cardiac changes more or 

 less resembling those during general inanition, but with some characteristic 

 differences. In human malnutritional edema (protein deficiency) the heart 

 appears atrophic and brown atrophy has been observed. In pellagra, the heart 

 is variable in size, usually atrophic, and presents a pigmentary degeneration 

 similar to that found in starvation. In rickets, the heart (especially the right side) 

 appears variably hypertrophied, perhaps due to obstruction of the circulation 

 from thoracic deformity. A similar cardiac hypertrophy occurs in human 

 beriberi (due to deficiency in vitamin B); but in birds there is usually a marked 

 cardiac atrophy. In both cases, there may be a variable degree of myocardial 

 degeneration. In infantile scurvy there is a marked cardiac hypertrophy, which 

 is slight or absent in guinea pigs. Slight degenerative changes may occur, 

 occasionally hemorrhagic infiltration. During aqueous inanition (thirst) the 

 heart weight undergoes changes nearly proportionate to the body weight 

 (rat), and structural changes somewhat inflammatory in character have been 

 observed (dog), especially in the endocardium. 



The blood vessels during inanition likewise undergo changes which are 

 somewhat variable in extent and character. During total inanition (or on 

 water only) there is an apparent atrophy of the larger arteries and veins, with 

 variably degenerative changes in all the tunics. Atrophy of the capillaries 

 has also been observed in various regions. A primary lesion of the capillary 

 endothelium is probably responsible for the characteristic edema arising from 

 protein deficiency, and for the hemorrhagic tendency in scurvy. Abnormal 

 permeability of the vascular endothelium may be due also to calcium deficiency. 

 In pellagra, the dermal vessels show degenerative and sclerotic changes of 

 primary importance. During aqueous inanition (thirst), congestion and degen- 

 eration likewise appear in both the capillaries and the larger blood vessels (dog 

 and chick). 



(^4) Effects of Total Inanition, or on Water Alone 



The effects upon the weight of the heart will be considered first, in man and 

 lower forms, followed by the effects upon cardiac structure. 



In human adults, Schultzen ('63) found the heart very small and devoid of fat 

 in a starved girl of 19 years. Curran ('74) likewise found the heart very small 

 (5 oz.) in an old woman who died from starvation; while Bright ('77) noted a 

 weight of 7% oz. in the famous case of Harriet Staunton, with final body weight 

 of 74 pounds. Miiller ('83) stated that during emaciation the pericardial fat, 

 like the body fat in general, is nearly or entirely consumed; and that the heart 

 weight is decreased, though proportionately less than the body weight. In an 



