82 INANITION AND MALNUTRITION 



Utheim ('22) has recently reviewed in detail the question as to the etiology 

 of infantile atrophy, as studied in Marriott's clinic, and reaches the following 

 conclusions: 



" Based on the material in this clinic, it is believed, then, that in the etiology 

 of athrepsia, feeding is the main factor, a quantitative and especially a qualita- 

 tive starvation being responsible for the development of most cases, that the 

 constitutional factor is of less importance and that the parenteral infections 

 will often contribute in developing the picture." 



In agreement with the observations upon the young of lower animals, 

 the human infant perishes quickly from total inanition, with a relatively slight 

 loss in body weight. Chauvin ('40) reported an incredible case of a premature 

 (7 months) infant which remained quiescent and at constant body weight 

 without food or drink for 7 weeks after birth, with ultimate recovery. Cantala- 

 massa ('92) observed a case of premature (7 months) twins, one of which died 

 without nursing in 11 days with loss of 24 per cent in weight; the other nursed 

 slightly and died in 23 days with loss of 22 per cent. Bouchaud ('64) noted 34 

 Paris cases, mostly prematures with incomplete inanition, all of which lost 

 over 25 per cent, and 18 over 30 per cent in weight. The extreme case was 

 one of a premature (6 months) of 1,400 g. which lost 570 g. (40.7 per cent) 

 in 17 days. 



Thiercelin ('04) states that among athreptics, "il n'est pas rare de voir 

 des enfants de trois semaines qui ne pesent que la moitie de leur poids de nais- 

 sance," but apparently no other author has noted such an extreme loss in weight. 

 According to Richter, a child may die of starvation in 5 days with a loss of 

 less than 25 per cent in body weight. 



Of 38 Breslau infants dying with loss of over 25 per cent in body weight, 

 Quest ('05) found the maximum loss at death to be 38.0 per cent, and 34.8 

 per cent in those which recovered. His results were confirmed by Rosenstern 

 ('11), who observed only 3 nurslings surviving a loss of over 32 per cent (maxi- 

 mum 35 per cent). Four fatal cases reached 35 to 38 per cent. Czerny ('n) 

 states that nurslings during chronic inanition may survive a loss of one- third 

 in weight, but the danger point is reached before this during acute inanition. 



In 12 cases of deaths from (chiefly chronic) inanition in infants 5-255 

 days of age, final body weights 1,695-3,972 g., and body lengths from 46-64 

 cm., the losses in body weight were estimated by Jackson ('21) in different 

 ways as follows: loss in body weight, the final weight being compared with the 

 maximum observed during life, average loss 19.2 per cent (range 13-7-25.5); 

 loss in body weight, the final being compared with the normal for final body 

 length, average loss 28.5 per cent (range 7.4-52.3); retardation in body weight, 

 the final weight compared with the normal for corresponding age, average 

 deficit 56.8 per cent (range 41. 6-7 1.6) (see also Table 3). 



In cases of incomplete inanition (underfeeding) or of partial (qualitative) 

 inanition, the weight of infants may be stationary or merely retarded to a 

 variable degree, depending upon the length and severity of the malnutrition. 

 Camerer noted that artificially fed infants lag considerably behind the normally 

 breast-fed. 



