EFFECTS ON THE HEART AND BLOOD VESSELS 229 



the "pale, soft and flabby" appearance. The first detailed microscopic study 

 of the human heart was apparently by Hayem ('77), who observed that during 

 inanition the heart is affected much like other (skeletal) muscles, sometimes with 

 even more intense lesions. He found that in acute inanition, the heart muscle 

 undergoes atrophy, with either simple granular or granulo-fatty degeneration 

 (as found in rabbits by Manassein '69). Vitreous (waxy) degeneration is rare, 

 but brown or pigmentary atrophy which does not occur in other muscles, may 

 appear in the heart in all forms of cachexia. He stated that: 



"Cette lesion est generalisee. L'organe devient petit; ses parois sont amin- 

 cies et les cavites sont en general retrecies, plus rarement un peu elargies (parti- 

 culierement quand il existe des lesions d'orifice); souvent elles conservent leurs 

 dimensions normales. Le tissu musculaire en s'atrophiant prend une teinte 

 brune speciale, qu'on a comparee a celle d'une feuille morte; mais, quand les 

 lesions sont tres-accentuees, les parois cardiaques ont la teinte de la terre de 

 Sienne brulee. Le coloration feuille-morte indique une alteration mixte, 

 d'ailleurs frequente, a la fois graisseuse ou pigmentaire. Au microscopique les 

 fibres plus ou moins nettement atrophiees sont remplis d'amas de pigment accu- 

 mules autour des noyaux. De plus, dans quelques points, particulierement 

 dans ceux qui repondent a la teinte feuille-morte, on trouve des granulations 

 graisseuses eparses, ne masquant pas habituellement la striation." 



Voelkel ('86) noted a small heart with fatty degeneration in a starved man. 

 In victims of the Indian famine, Porter ('89) found edema frequently replacing 

 the epicardial fat. In about one-sixth of the adults, there were surface patches 

 of a white, detachable lymphy deposit, known as " soldier's spot." In a man who 

 died from starvation, Stschastny C98) noted cardiac changes, with brown 

 atrophy, disappearance of cross-striation, and vacuolation of muscle fibers and 

 nuclei. In a similar case, Meyer ('17) found marked atrophy of the cardiac 

 muscle fibers, which appeared separated by extensive spaces (Fig. 59). 



Krieger ('20), in various human cachexias, found brown atrophy character- 

 istic in all except the infectious group, and most marked in tumor-cachexias. 

 The pericardial fat usually underwent gelatinous degeneration or disappeared, 

 but was found notably persistent in a few cases. 



According to Rubner ('20), various German observers have noted a displace- 

 ment of the heart resulting from the resorption of pericardial and abdominal fat. 

 Bradycardia occurs in chronic underfeeding, as well as during certain forms of par- 

 tial inanition, to be mentioned later. Reiss ('21) found sclerotic changes. 



The question as to the cause and character of fatty degeneration of cardiac 

 muscle during inanition has been much discussed, in connection with the prob- 

 lem of fatty degeneration in general. Krehl ('93) concluded that "Mangel- 

 hafte Versorgung der Gewebe mit O gait als haufigste Ursache der fettigen 

 Degeneration." For human adults, Borchers ('14) and Eyselein ('14) found no 

 constant relation between the degree of malnutrition and the amount of fat 

 present in the cardiac muscle fibers. This question is discussed later, in connec- 

 tion with the effects on lower animals. 



In human infants, Parrot ('68), in accordance with his doctrine of visceral 

 steatosis during inanition, claimed the occurrence of a slight fatty degeneration in 



