304 INANITION AND MALNUTRITION 



In 459 autopsies upon victims of the Madras famine (including 226 men, 

 155 women and 78 children), Porter ('89) classified the stomach as "large" 

 in about ^3 of the men, x /b of the women and only 3 children; and as "small" 

 in }/2 of the men, % of the women, and % of the children. It was found empty 

 in % of the adults and ^3 of the children. The gastric mucosa appeared con- 

 gested in 36 men, 14 women and 7 children, with variable pigmentation in 12 

 men, 1 woman and 1 child. It was usually soft, with an anemic, catarrhal 

 appearance. 



In a starved man, Stschastny C98) noted marked gastric hyperemia. The 

 lining epithelium was lacking, but the peptic glands were preserved and a few 

 scattered "hyaline Kugeln" (parietal cells ?) were observed. 



Meyer ('17) recorded a weight of 112 g. in the stomach of a man who 

 died from starvation. The mucosa was pale and yellow, but presented no 

 gross lesions. The parietal cells of the gastric mucosa were better preserved 

 than the chief cells, which were disintegrated. The post mortem changes (18 

 hours) could not be excluded. 



According to Ivanovsky ('23), Oppel noted that during the Russian famine 

 perforating gastric ulcers became frequent on account of the use of indigestible 

 food. 



The gastric changes have frequently been described in atrophic infants, 

 which represent a variable group with mixed nutritional deficiencies, frequently 

 complicated by infections, etc. 



Parrot ('77) described two types of gastric lesions (ulcerous and "diph- 

 theroid") as characteristic and of primary importance, in infantile athrepsia. 



Baginsky ('84, '84a) claimed that there is in athreptic infants a primary 

 atrophy of the gastrointestinal mucosa, which will be considered later, under 

 the intestine. 



Marfan ('94) found the surface gastric epithelium usually lacking in dys- 

 peptic infants, possibly due to post mortem changes. The gastric mucosa is 

 replaced by a fibrous layer, infiltrated with leukocytes and containing multi- 

 nucleated cells, desquamated epithelium, remnants of the gastric glands, etc. 



Fede ('97, '98, '01a) found chiefly atrophic changes, similar to those in 

 other organs, in the gastric mucosa of athreptic infants. Instead of the more 

 extensive lesions described by previous authors, he finds merely a marked 

 thinning of the gastrointestinal wall, with occasional ecchymoses, but no 

 ulcerations or destructions of glands or villi in uncomplicated cases, aside from 

 post mortem changes. 



Thiercelin ('04) described in athrepsia the various gastric lesions, gross and 

 microscopic, similar to those found by Parrot and Marfan. The changes in 

 the mucosa are variable. There are often punctiform hemorrhages, with intense 

 capillary congestion and hemorrhagic exudate between the gastric glands. 

 Rarely ulcerations occur, with localized lesions of interstitial and parenchyma- 

 tous gastritis, and frequently sclerosis. The other tunics may also be involved, 

 and the interstices infiltrated with leukocytes. 



Schelble ('10) made careful histological study of the stomach and intestines 

 in 37 atrophic infants, but could find no evidence to support the theory of 



