342 INANITION AND MALNUTRITION 



a protein deficiency, although it is admittedly a partial inanition of mixed and 

 variable .type. Atrophy of the liver in association with this disorder was noted 

 by Budzynski and Chelchowski ('16), Hiilse ('17), Schittenhelm and Schlecht 

 ('18), Enright ('20), Maase and Zondek ('20) and Prince ('21). Paltauf ('17) 

 reported the weight of the liver as low as 980 g. (usually 1,000-1,200 g.), 

 while Oberndorfer ('18) found it as low as 950 g. On the other hand, Richet 

 and Mignard ('19) found hypertrophy of the liver common in ex-prisoners 

 suffering from chronic inanition, but without edema. 



As to the histological changes in the liver during human malnutritional 

 edema, Paltauf ('17) and Oberndorfer ('18) mentioned capillary congestion and 

 cell atrophy, with absence of glycogen and fat droplets. Paltauf also observed 

 pericapillary edema. Nuclear vacuoles (noted by Oberndorfer) were thought 

 to be related to the inclusion of erythrocytic fragments, as first observed by 

 Branz. Maase and Zondek ('20) likewise found little hepatic glycogen. 

 Schittenhelm and Schlecht ('19) observed hepatic hyperemia, but only slight 

 fatty metamorphosis; while Enright ('20) noted almost constantly fatty 

 degenerative changes in the liver-cells. Mann, Helm and Brown ('20) found 

 the liver usually slightly cirrhotic in 200 necropsies. Fracassi ('22) reported 

 hepatic capillary hemorrhages and slight increase of connective tissue. 



In human pellagra, Morelli ('55) found the liver affected more frequently 

 than any other organ (in 31 out of 37 autopsies), usually enlarged, soft and 

 friable, yellowish in color and anemic. Fraenkel ('69-' 70), however, reported 

 the liver diminished in size in 28 out of 30 cases. Lombroso ('92) found hepatic 

 lesions frequently, with decreased size of the liver in 18 out of 39 cases, and 

 "brown atrophy" in 8. Tuczek ('93) and Carraroli ('02) observed hepatic 

 atrophy and fatty degeneration, and De Giovanni ('96) found the liver "small 

 and undeveloped," according to Harris ('19). 



Nicholls ('12) reported an average liver weight of 37H ounces in African 

 pellagrins, the normal being 52 ounces. Kozowsky ('12) found hepatic con- 

 gestion and fibrosis; parenchyma atrophic, with degeneration, brown pigment 

 and fatty infiltration of the gland-cells. Similar observations were made by 

 Nicholls ('12, '13). Raubitschek ('15) reviewed the changes in the liver, which 

 is sometimes enlarged, but usually decreased in size, with frequent brown 

 atrophy and fatty degeneration. Similar changes were described by Marie 

 ('08, '10), Lynch ('17), and Harris ('19). 



Degenerative changes were found by Rondoni and Montagnani ('15) in 

 the liver of guinea pigs on maize diet, and by Sundwall ('17) in various 

 animals on protein-poor diet. Rondoni ('19) found the liver slightly above 

 normal weight in guinea pigs on maize diet. 



Mineral Deficiencies. — Von Hosslin ('82) observed fatty infiltration of the 

 liver in young dogs on iron-poor diet. 



In human rickets, Whistler (1645), Seibold ('27), Comby ('01) and Pfaundler 

 ('22) noted that the liver and spleen are often distinctly enlarged, although 

 Stoeltzner ('03) and others failed to find any significant change in size. Accord- 

 ing to Vincent ('04) and Cheadle and Poynton ('07), the liver is sometimes 

 enlarged, but usually normal in size. 



