400 INANITION AND MALNUTRITION 



Schweitzer ('17), Siegel ('17), Stickel ('17), Spaeth ('17), Ebeler ('17), Vaerting 

 ('18), R. Koehler ('18), H. Koehler ('19), Holmberg ('19), Bauereisen ('19), 

 Kraus ('19), Rubner ('19, '20), Beninde ('19), Hoffmann ('20), v. Lingen ('21) 

 and others (see pp. 390-392). 



The uterus has been observed to undergo a variable degree of atrophy during 

 various conditions of inanition. Hewitt C79) stated that in chronic starvation 

 (quantitative or qualitative) the uterus undergoes "a peculiar softening and 

 relaxation of the tissues," which may favor uterine flexures and amenorrhea 

 (more rarely menorrhagia). Although little or no uterine atrophy was found by 

 Hannes ('17), Dietrich ('17) and v. Lingen ('21), this was frequently observed 

 by v. Jaworski ('16), Spaeth ('17) and Schweitzer ('17). Ebeler ('17) noted 

 marked hypoplasia of the uterus in 14 out of no cases of war amenorrhea, 

 Stickel ('17) in 27 out of 126 cases, and Czerwenka in 23 out of 59 cases. Graefe 

 ('17) reported uterine atrophy in 45 per cent of the war amenorrhea cases; 

 Giesecke ('17) found 38 per cent in 1916 and 47 percent in 1917. By palpation, 

 the uterus generally appeared firm in consistency, but flatter and smaller, with 

 subnormal length when measured by a sound. According to v. Jaworski 

 ('16a, '17) even uterine myomas were affected by the inanition-atrophy. 



Microscopic examination of the uterine mucosa in cases of war amenorrhea 

 by Pok ('17) and Hoffmann ('20) revealed anabnormal scarcity of uterine glands. 

 Further data are given by Hofstatter ('18). Various stages of degeneration in 

 the uterine glands were demonstrated by Graff and Novak ('21) in 30 cases. 



As a result of the war famine, v. Jaworski ('17) found the relative frequency 

 of uterine prolapse in the out-patient clinic at Warsaw nearly doubled on account 

 of relaxation in the pelvic supporting tissues. Among 3,080 women, 27 per cent 

 showed a variable degree of vaginal and uterine descent with more or less com- 

 plete prolapse in n per cent. The urethra was often displaced, and atrophic 

 relaxation of the urethral sphincter often caused incontinence of urine. The 

 general disappearance of fat, together with the atrophic relaxation of the 

 abdominal walls, frequently resulted in a general ptosis of the abdominal viscera, 

 resembling the syndrome of Glenard's disease. 



In famine-stricken children of various ages, Nicolaeff ('23) found extreme 

 atrophy of the uterus, especially in the musculature, although the ovaries 

 appeared normal in weight. Stefko ('23a) likewise noted uterine atrophy. 



Among animals on total inanition (or on water only) Chossat ('43) noted a 

 weight of only 0.13 g. in the oviduct of a pigeon with loss of 40 per cent in 

 body weight, the average in 3 normal controls being 0.36 g. 



Manassein ('69) recorded, without comment, in numerous starved rabbits 

 the weights of the uterus, showing apparently a variable degree of atrophy. 



Morpurgo ('88, '89, '89a, '90) in fasting rabbits of various ages found that in 

 the uterus the mitoses usually do not appear materially reduced in number. 

 They occurred chiefly in the epithelium of the glands, rarely in the muscle. 

 The mitoses likewise appeared unchanged in the uterus upon refeeding after a 

 period of inanition. 



The reduction in the diameter of the oviduct in fasting Triton by Heidkamp 

 ('09) was mentioned in connection with the ovary. 



