

EFFECTS ON THE SPLEEN 277 



Changes in Structure.- — The effects of total inanition (or on water only) upon 

 the structure of the spleen will be reviewed first in man, adult and infant; later 

 in the lower animals. 



In the victims of the Madras famine, Porter ('89) noted in the usually 

 atrophic spleen a variable thickening of the capsule and usually a deficiency in 

 the pulp, with pigmentation in a few cases. In a man of 30 years who died from 

 voluntary starvation, Stschastny ('98) observed in the spleen a pronounced 

 atrophy, with scarcely recognizable Malpighian bodies, hyalinization of vessels 

 and trabeculae, numerous eosinophile cells, hemoblasts in mitosis, and con- 

 siderable pigmentation with hemosiderin. In a similar case, Meyer ('17) found 

 the Malpighian nodules nearly obliterated, only a few barely distinguishable. 

 The splenic sinuses were not evident, but erythrocytes (no nucleated forms) 

 were abundant in the parenchyma. Only a few giant cells and phagocytes 

 were found, although pigment was relatively abundant. The staining reactions 

 of the cells were normal, though somewhat faint. 



In extensive material from cases of starvation (age 1-63 years) Stefko 

 ('23) finds hyperemia of the spleen, with atrophy of the lymphoid follicles, but 

 increase in the reticulum and trabeculae. 



As to the changes in the spleen of malnourished infants, Moldenhauer ('99) 

 noted a relative increase in the stroma. Lucien ('08) found the spleen in 

 athreptic infants firm and sclerotic. The Malpighian nodules were apparent, 

 though small. In general, the histological changes were less marked than in 

 the 'thymus and other organs. Helmholz ('09) in atrophic infants noted 

 extensive pigmentation in the spleen, though no relation was found between 

 the intensity of the pigmentation and the severity of the disease. The (iron- 

 containing) pigment usually occurred in large intercellular masses as well 

 as in fine intracellular granules. The Malpighian nodules were usually free 

 from pigment. In general, the spleen presented relatively few erythrocytes, 

 and relatively conspicuous fibrous tissue. Schelble ('10), on the other hand, 

 found no significant histological changes in the spleen of atrophic infants. 



In cases of congenital spasmodic atrophy of infants, Lesage and Cleret 

 ('14) described perivascular sclerosis, with secondary fibrous trabeculae per- 

 vading the parenchyma. Mattei ('14) during athrepsia found the splenic 

 capsule and trabeculae somewhat thickened. The white pulp of the spleen 

 appears more abundant at first; later the red pulp gradually replaces the white, 

 which persists only in the Malpighian nodules. Siderosis was found constant, 

 with active red cell destruction in the macrophages of Billroth's cords. Nobe- 

 court ('16) reviewed the literature, emphasizing the splenic siderosis, which 

 accompanies the hepatic siderosis, as found by Triboulet, Ribadeau -Dumas 

 and Harvier ('10), Helmholz and others. "La pulpe rouge de la rate est 

 incrustee de blocs pigmentaires plus ou moins volumineux. Les sinus et les 

 cordons de Billroth sont la siege d'une macrophagie active avec nombreuses 

 figures de destruction globulaire, de sorte qu'il parait evident qui tout le fer mis 

 en liberte provient de la destruction des globules rouges." The large vessels 

 appear congested, but the venous sinuses appear nearly normal. Marfan ('21) 

 stated that the splenic and hepatic siderosis found in athreptic infants is a 



