270 INANITION AND MALNUTRITION 



In the somewhat exceptional cases of splenic enlargement, there is often conges- 

 tion and general hyperplasia. In the more characteristic decrease in the size 

 and weight of the spleen, the atrophy takes place in the parenchyma, but not in 

 the stroma. The capsule and trabeculae thus become relatively more promi- 

 nent, giving a variable degree of fibrosis and sclerosis. 



The atrophy affects especially the lymphoid tissue, so that the Malpighian 

 nodules and pulp-cords become variably reduced in size and indistinct. The 

 lvmphoid cells decrease in number and size. The nuclei tend to be slightly 

 decreased in size and the number of mitoses is greatly diminished. In the 

 sinuses and red pulp, the erythrocytes are variable in amount, giving in some 

 cases an appearance of congestion; in others, of anemia. Correlated with the 

 increased destruction of erythrocytes, there is a variable degree of hemosiderosis. 

 Granular masses of pigment occur both extracellular and intracellular (in the 

 endothelium and macrophages of the pulp-cords). Nucleated erythroblasts 

 may also appear. 



During the various types of partial inanition, the structural changes in the 

 spleen in general resemble those noted for total inanition. Where splenic enlarge- 

 ment occurs, there is usually congestion and a variable degree of general hyper- 

 plasia. In the more frequent diminution in size of the spleen, there is a relative 

 fibrosis, with marked atrophy of the pulp (especially of the lymphoid structures) 

 and a variable increase in pigmentation and hemosiderosis. Sometimes the 

 changes appear inflammatory in character, and hemorrhages rarely occur 

 (infantile beriberi, scurvy, thirst). It may furthermore be noted that these 

 changes are not peculiar to inanition, but occur also in many other conditions 

 affecting the spleen. 



Upon adequate refeeding after inanition of any type, the spleen in general 

 makes a prompt recovery in normal structure as well as in size. Abundant 

 mitoses accompany the proliferation in the lymphoid tissue during recuperation 

 from its atrophic condition. 



(^4) Effects of Total Inanition, or on Water Only 



The changes in the weight of the spleen in man and animals will be reviewed 

 first, followed by the changes in structure. 



Changes in Weight. — The normal weight of the spleen is so exceedingly 

 variable that conclusions as to changes are often difficult. From a review of the 

 literature, Willien ('36) concluded that the spleen is small and firm after inani- 

 tion. At the autopsy of a 19 year old girl who had died from starvation, Schult- 

 zen ('62, '63) noted a very small spleen — "Lien perparvus, ^Yi" longus, 2^" 

 latus, i/-£" crassus." Curran ('74) found the weight of the spleen only 1 ounce 

 in a greatly emaciated, starved old woman. Bright (et al.) ('77) stated that the 

 spleen in a case of starvation was considerably below normal weight; but at 4^ 

 ounces (about 130 g.) it was not much subnormal for an initial body weight 

 of 121 pounds (final weight 74 pounds). 



Casper-Liman ('82) found a very small spleen at death from starvation, but 

 opposed Tardieu's view that this is a characteristic sign of medicolegal impor- 



