346 INANITION AND MALNUTRITION 



Bensley's evidence appears especially strong and Giannelli's measurements indi- 

 cate that the apparent increase in islet tissue during inanition is merely relative, 

 due to a much greater shrinkage in the secretory acini. 



Upon refeeding after inanition, the pancreas recuperates rapidly and is 

 soon restored to normal size and structure. The mitoses, which in young rabbits 

 are suppressed or greatly reduced in number during inanition, become very 

 numerous in the pancreas during the reconstruction period. 



During the various forms of partial inanition, the changes in the pancreas 

 have been much less extensively and thoroughly studied. In protein defi- 

 ciencies, and in rickets and scurvy, no characteristic changes have been observed. 

 In beriberi (deficiency of vitamin B), gross atrophy and microscopic degenera- 

 tion have been noted. In thirst (aqueous inanition), the gross and microscopic 

 changes (in animals) apparently resemble those found during total inanition, 

 or on water alone, although no special study of the changes in the islets has been 

 made. 



(.4) Effects of Total Inanition on the Pancreas 



The effects upon the pancreas of man (adult and infant) will be reviewed 

 first; followed by the effects in the lower animals. 



Human Adult. — -Lucas (1826) cited a case of starvation from Gerlach, and 

 another from Ballin, in which the pancreas appeared normal. Willien ('36) 

 stated that the pancreas becomes small and firm during inanition. 



Bright ('77) in the case of starvation of Harriet Staunton, found the pancreas, 

 like the other viscera, small and shrunken, but otherwise apparently normal. 



Porter ('89) in the victims of the Madras famine, found the average pancreas 

 weight in 9 plump men 3.85 ounces; in 181 emaciated men 2.2 ounces; in 4 

 extremely emaciated men 1.5 ounces. In 8 plump women, the pancreas 

 averaged 2.3 ounces; in 121 emaciated women 1.8 ounces; in 4 extremely emaci- 

 ated women 1% ounces. The greater weight in the well nourished was ascribed 

 partly to interlobular fat. Microscopically no abnormality was noted. Gross 

 atrophy of the pancreas in starvation was likewise observed by Formad and 

 Birney ('91). 



In starved adult man, Stschastny ('98) observed some necrotic areas in the 

 pancreas, with distension of the ducts by secretion, and a few mast cells between 

 the lobules. 



Laguesse ('09a) confirmed in a man with gastric cancer Jarotzky's observa- 

 tion (on the mouse) that in starvation the pancreatic acini adjacent to the 

 islets have an unusually high zymogen granule content. These "peri-insular 

 zones" were observed by Gelle in the adult human pancreas under conditions 

 of inanition. 



Sternberg ('13, '21) concluded that "Atropine des Pankreas, wie sie als 

 Teilerscheinung eines allgemeinen Marasmus (im hoheren Alter, bei kakechti- 

 schen Zustanden u.s.w.) sich entwickeln kann, aussert sich in einer oft sehr 

 betrachtlichen Verkleinerung der Druse, die dann meist eine walzenformige 

 Gestalt, ziemlich derbe Konsistenz und oft eine dunklere, braunliche Farbe 

 aufweist. Mikroskopisch findet sich eine Verkleinerung der Acini und ebenso 



