EFFECTS ON THE ALIMENTARY CANAL 313 



with the stomach. These include observations by Andrews, Barry, Beguin, 

 Bessesen, Bidder and Schmidt, Bizzozero and Vassale, Boyd, Brown, Coen, 

 Collard de Martigny, Comby, Falck and Scheffer, Fede, Gulland, Hedinger, 

 Heitz, Jackson, Jackson and Carleton, Jackson and Stewart, Kudo, Kusmin, 

 Lazareff, McCarrison, Miller, Morgulis, Howe and Hawk, Ott, Quattrochi, 

 Reese, Schittenhelm and Schlecht, Sedlmaier, Stewart, Strong and Crowell, 

 Sundwall, and Weiske. Further details concerning the changes in the intestines 

 will now be considered under (A) effects of total inanition (or on water only), 

 and (B) effects of partial inanition. 



(A) Effects of Total Inanition, or on Water Only 



The effects upon the human intestine (adult and infant) will be presented 

 first, followed by the data for the infrahuman species. 



Human Adult. — Donovan ('48) in famine victims did not find the intestinal 

 inflammation and ulceration described by Duncan, Collard de Martigny and 

 others. He observed: "total disappearance of the omentum, and a peculiarly 

 thin condition of the small intestines which (in such cases) were so transparent 

 that if the deceased had taken any food immediately before death, the contents 

 could be seen through the coats of the bowel . . . This condition I look 

 upon as the strongest proof of starvation." Fowler ('70), however, maintained 

 that in acute starvation there may be no attenuation of the intestinal walls. 

 Curran (74) found the intestines thin and transparent, somewhat distended 

 with' gas; while Bright ('77) found them empty and collapsed, with greatly 

 atrophic walls. In both cases, the omentum was atrophic and fatless. Schult- 

 zen ('62, '63) described the large intestine as contracted and nearly empty; the 

 mucosa reddish in places. 



Falck ('81) noted that in starvation the intestines are usually found con- 

 tracted and nearly empty, containing a slight amount of bile. The mucosa in 

 both large and small intestines is usually normal. Casper-Liman ('82) found the 

 "Darmtract stellenweise verengert, ganz leer oder hochstens einzelne verhartete 

 Kothreste enthaltend, die Haute des Darmkanals bis zur Durchsichtigkeit 

 verdiinnt." 



Porter ('89) in numerous autopsies upon victims of the Indian famine noted 

 that the peritoneum usually appeared healthy, excepting a variable amount of 

 serous effusion in nearly % of the adults and L ^ of the children. The mesentery 

 showed more or less fat in nearly half of the adults, but in only \'i of the children. 

 A few cases presented edema, thickening and congestion. The duodenum and 

 jejunum showed in general an anemic, catarrhal appearance, in some places 

 showing loss of the surface epithelium, with congestion, atrophy and pigmenta- 

 tion of the stroma. In the ileum, the changes were more extensive; the mucosa 

 atrophic, with indistinct villi; the epithelial layer usually absent, and the stroma 

 markedly altered, with fatty and granular pigmentary degeneration, probably 

 due to extravasated blood. The lymphoid tissue, including solitary glands and 

 Peyer's patches, appeared very atrophic and absent over large areas, in children 

 as well as in adults. The mucosa of the large intestine likewise usually appeared 



