EFFECTS ON THE LIVER 325 



through intestinal absorption or from fat in other cells of the body) is deposited 

 in the liver-cells partly as fat of the ordinary "wandering " type, which is quickly 

 mobilized during inanition ; and partly as fat of the lipoidal " sessile " type which, 

 as in other cells, is very resistant to inanition. The general question of fatty 

 degeneration versus fatty infiltration has been the subject of much controversy, 

 especially in the liver-cells. 



During the more advanced stages of inanition, a progressively increasing 

 number of liver-cells undergo degeneration in various forms, including cloudy 

 swelling, vacuolar, granular or fatty degeneration, pigmentation (of hemato- 

 genous origin), and finally in some cases karyolysis, pycnosis or karyorrhexis, 

 with complete disintegration and removal of the cell. These degenerative 

 changes occur likewise variably in the different forms of partial inanition. They 

 are obviously not characteristic of inanition only, however, since they occur 

 in many other abnormal conditions of the liver. 



Upon adequate refeeding after a period of inanition, the liver as a rule 

 promptly regains its normal weight, partly by hypertrophy of the atrophic 

 gland-cells, and partly by hyperplasia. In young animals, the mitoses, which 

 are greatly decreased in number during inanition, become very numerous upon 

 refeeding. 



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



The effects upon man (adult and infant) will be discussed first; later those 

 among the animals. 



Human Adult. — Tiedemann ('36) noted that after death from starvation 

 the gall-bladder appears distended with bile, an observation which was con- 

 firmed by Donovan ('48) and others. Willien ('36) also noted that the liver 

 becomes dense and anemic. Schultzen ('62, '63) observed gross atrophy with 

 fatty and granular degeneration in the liver of a 19 year old girl who died from 

 starvation on account of an esophageal stricture. Macroscopic changes in 

 the liver during inanition were noted by Frerichs ('66). 



Curran ('74) in an old native woman who died from starvation found the 

 liver very small (15 ounces or 428 g.), anemic and brownish in color. Bright 

 ('77) in a female 35 years old, with weight reduced by starvation from 

 121 to 74 pounds, found the liver weight 34M ounces. Casper-Liman ('82) 

 stated that in starvation the liver appears pale, anemic, and hardened; the 

 gall-bladder distended with dark-colored bile. Popow ('85) observed hemor- 

 rhages in the liver in a case of death from esophageal stricture. Voelkel ('86) 

 noted a fatty liver in a man who died from voluntary starvation. 



In victims of the Madras famine, Porter ('89) found the average weight of 

 the liver 32 ounces in the men and 28 ounces in the women. The ratio to body 

 weight averaged 1:36, which is not far from the normal, indicating that the 

 liver had lost in weight relatively to the same degree as the entire body. The 

 liver appeared congested in 58 men (about }~i of all cases), in 16 women (3iD, 

 and in 16 children Q4)> an d anemic in 16 men, 31 women and 12 children. In 

 some cases the liver presented nearly normal gross and microscopic appearances. 

 "Fatty degeneration" appeared in 113 men (65 per cent), 103 women (83 



