314 INANITION AND MALNUTRITION 



anemic, sometimes showing inflammatory thickening or ulcerated areas. The 

 lymph nodes were pale and inconspicuous. The changes characteristic of true 

 dysentery rarely occur in "famine dysentery." 



Meyer ('17) found the stomach and intestines only slightly filled with gas, 

 and no ulcerations as reported by Formad and Birney ('91). The ascending 

 and transverse colons were relaxed; the descending colon firmly contracted; 

 the iliac and pelvic colon nearly empty. The appendices coli were completely 

 absent and only very small masses of omental fat remained in the intervascular 

 areas. Histologically the intestine appeared congested in places, with complete 

 disintegration of the mucosa over extensive areas in both small and large intes- 

 tines (partly due to postmortem change). Depletion of the solitary and aggre- 

 gated lymph nodules, and congestion of the submucous plexuses were also noted. 



Rubner ('19), Determann ('19), Ivanovsky ('23) and others have reported 

 an increased occurrence of hernia and intussusception as a result of the malnutri- 

 tion and famine during the war. The hernia may be due partly to the intestinal 

 atrophy and partly to general weakness of the abdominal walls. Sison ('20) 

 could sometimes see and feel the peristaltic movements of the intestines through 

 the abdominal wall during voluntary starvation. Hehir ('22) noted severe 

 intestinal disorders, resembling dysentery, during the chronic starvation in the 

 siege of Kut. 



In malnourished infants, the condition of the intestines has frequently been 

 studied. Parrot ('77) held that athrepsia is a condition of malnutrition second- 

 ary to gastroenteritis, with "diphtheroid" or ulcerated conditions in the intes- 

 tines, similar to those mentioned for the stomach. As a sign of death from 

 inanition in the newborn, Tardieu ('80) noted: " Verdauungstractus atrophisch, 

 durchscheinend, leer." Ohlmuller ('82) recorded an intestinal weight of 140 g. 

 in an atrophic infant of 56 days, with body weight of 2,381 g. (previous weight 

 not stated). In a well nourished control of the same age, the intestinal 

 weight was 183 g., body weight 4,150 g. 



Blaschko ('83) found no degeneration of the sympathetic plexuses of the 

 intestinal wall in atrophic children. Baginsky ('84, '84a) described a marked 

 distension and atrophy of the intestinal wall in athreptic infants, including 

 partial atrophy of the muscle fibers, degeneration of the plexuses of Auerbach 

 and Meissner, atrophy of the lymphoid follicles, and almost complete disappear- 

 ance of glands and villi. Baginsky considered these atrophic changes as the 

 primary cause of pedatrophy, a conclusion which was opposed by many subse- 

 quent investigators. 



Cantalamassa ('92) claimed that in starved infants the colon shows the 

 greatest decrease in diameter and in thickness of the walls, in comparison with 

 other parts of the intestine. 



Gerlach ('96) demonstrated that the characteristic atrophic appearance of 

 the intestinal wall described by previous authors can be produced by simple 

 mechanical distension with gases, etc. 



Fede ('97, '98, '00, '01) likewise opposed Baginsky's doctrine of intestinal 

 atrophy as the cause of athrepsia. He found a certain degree of thinning in the 

 intestinal wall, with other atrophic changes in the glands, etc., but no destruc- 



