230 INANITION AND MALNUTRITION 



the heart in athreptic newborn. Thiercelin ('04) likewise held that the athrep- 

 tic heart may undergo fatty degeneration, as in all chronic cachexias. Helm- 

 holz ('09), however, reported negative cardiac findings, except in one case of 

 ischemic necrosis. Monckeberg ('12) mentioned cardiac atrophy as character- 

 istic in cases of pedatrophy, while Nobecourt ('16) stated that slight hyper- 

 trophy occurs in some cases. Lesage and Cleret ('14) found the myocardium 

 apparently normal in cases of congenital spasmodic atrophy. 



Variot and Cailliau ('12) made a careful study of the cardiac histological 

 structure in atrophic infants, describing three stages corresponding to the degree 

 of malnutrition: (1) In nurslings not very atrophic; heart large. The lesions 

 are discrete, with no atrophic muscle fibers and some even hypertrophic (up to 

 40-50/x). The muscle nuclei are slightly increased in size and number; peri- 

 nuclear sarcoplasm abundant; vacuoles rare. (2) In more advanced cases, 

 the heart still appears hypertrophied (although the body weight and stature are 

 subnormal), but the cardiac muscle fibers are distinctly atrophic; none hyper- 

 trophic. Some fibers appear moniliform. The nuclei are proliferated and 

 deformed. The perinuclear sarcoplasm is increased in volume, and frequently 

 contains numerous non-fatty vacuoles. (3) In extreme marasmic atrophy the 

 myocardial lesions are very marked, with atrophy as well as generalized vacuola- 

 tion, involving the entire contractile substance. The interstitial connective 

 tissue of the myocardium shows multiplication of nuclei and sometimes 

 increase of fibrous tissue or enlarged interstitial spaces. 



In famine-stricken children of various ages, Nicolaeff ('23) noted subepicardial 

 edema with absence of fat. The cardiac muscle fibers appear atrophied, with 

 loss of transverse striations in places. The sarcoplasm is sometimes vacuolated, 

 especially near the nuclei, which appear more numerous. Nicolaeff made 61 

 necropsies, with histological study in 19 cases. 



In animals, the changes in cardiac structure during inanition have been fre- 

 quently and carefully studied. Manassein ('69) in fresh preparations from 

 starved rabbits found marked histological changes in the heart muscle. The 

 cross-striation disappears to a variable extent. Granules appear which are 

 soluble in ether but not in acetic acid; and in marked cases large and confluent 

 fat droplets may appear. Brown pigment granules were sometimes noted; 

 also mentioned by Lepine ('74). In fresh cardiac muscle fibers of a starved dog, 

 Falck ('7 5) noted distinct cross-striation, with diffusely scattered granules, 

 resistant to acetic acid and caustic potash. 



Zander ('79) found that in pigeons which died from inanition following sec- 

 tion of the vagi there is a fatty degeneration of the heart muscle fibers. Eich- 

 horst ('79) doubted the fatty character of the granules thus produced, since 

 they failed to blacken in osmic acid. Knoll ('80) concluded that in starved 

 pigeons the amount of ordinary fat in cardiac muscle is decreased; but there is an 

 increase in other granules of lipoidal nature, with intermediate stages between 

 these and true fat droplets. Popov ('85) and Ochotin ('85, '86) noted cloudy 

 swelling, granular and fatty (?) degeneration of the cardiac muscle fibers in 

 starving rabbits; and similar changes, with disappearance of cross-striation, 

 were found by Isaew ('87) in starved dogs. 



