136 INANITION AND MALNUTRITION 



forms of "Hungerosteopathie" (osteoporosis and osteomalacia) frequently 

 observed during periods of famine (by Chelmonski '21; Dalyell and Chick '21; 

 Koepchen '19; Schlesinger '19; Richet and Mignard '19; Sauer '20; Simon '21; 

 Szenes '21; Seeliger '23; Nicolaeff '23) and to similar skeletal disorders in 

 malnourished animals (by Theiler et al., '12, '20; Gans '15; Hedinger '20). It 

 is also possible, as will appear later, that some of the effects of inanition upon the 

 skeleton may be indirect, through injury to some of the endocrine glands (para- 

 thyroid, etc.) which are concerned in calcium metabolism. (Cf. Stefko '23a.) 



Gusmitta ('93) found apparent dilation of the Haversian canals and enlarge- 

 ment of the lacunae in the bones of a starved dog; aside from this no data appear 

 as to the effect of total inanition upon osseous tissue. 



Changes in Adult Marrow. — The changes in the adipose bone marrow during 

 inanition were described in the preceding chapter, p. 125. It undergoes mucoid 

 atrophy, with the absorption of the fat and metamorphosis of the fat cells, 

 which return to their primitive stellate form and become embedded in an 

 abundant gelatinous or mucoid intercellular substance. Hyperemia usually 

 occurs. The reticulum fibers, which are observed in the adipose marrow, appear 

 still quite distinctly in the atrophic mucoid marrow (Jackson '04) (Figs. 

 50, 51). Kolliker ('89) described a transformation of yellow (adipose) marrow 

 into red (lymphoid) marrow through inanition. The formation of gelatinous 

 marrow in the long bones of various mammals was reviewed by Ricklin ('79) 

 and Ackerknecht ('12). 



The red or lymphoid marrow may also undergo mucoid atrophy, depending 

 upon the relative abundance of adipose cells present (Denys '87; Roger and 

 Josue '00; Traina '04; Jackson '04; Dickson '08; Dantschakoff '09; Meyer '17; 

 Jolly '20; Stefko '23). The various stages in the marrow changes during 

 inanition were described by Solts ('94), in fasting dogs with loss of 13-52 per 

 cent in body weight. There is hyperemia in the early stages, followed by mucoid 

 degeneration in the middle stages. Some of the fat cells become stellate; some 

 are destroyed. Other marrow cells, including the giant cells, undergo vacuolar 

 degeneration and final necrobiosis. Capillary thromboses and hemorrhages 

 may occur. Traina ('04) likewise found the bone marrow nearly normal in 

 fasting rabbits up to about 10 per cent loss in body weight. At 10-20 per cent 

 loss, the fat disappears from the adipose marrow cells (in the long bones, first 

 at the ends). The fat may be replaced by serous fluid, with undiminished 

 cell volume; or the fat cells may form a branched reticulum, enclosing marrow 

 cells of normal or diminished size. Interstitial gelatinous substance appears, 

 and the cells, including the megakaryocytes, undergo degenerative changes. 

 At death from starvation, small fat droplets may still be found in the fat cells, 

 also in the leukocytes and even free in the blood vessels. Altmann's granules 

 become more numerous and distinct in the marrow cells. The observations of 

 Opie ('04) on the eosinophiles in the bone marrow of fasting guinea pigs are 

 stated in Chapter XV. The changes in the marrow cells during inanition have 

 been reviewed by Helly ('06). 



Although the lymphoid tissue is generally found to undergo atrophy with 

 disappearance of the lymphocytes in the bone marrow as elsewhere during 



