326 INANITION AND MALNUTRITION 



per cent) and 50 children (78 per cent). There was a "nutmeg" appearance 

 in 39 men, 44 women and 4 children; cirrhosis, with "hobnail" appearance in 

 5 men and 6 women; pigmentation in 17 men, 6 women and 1 child. The gall- 

 bladder varied from distension to emptiness; and the bile also varied much in 

 color and consistency. 



In the cases with the most extreme general atrophy of the body (4 men, 

 averaging 77 pounds; 4 women, 66% pounds; and 4 children) the liver was 

 always small, averaging about 24 ounces in the adults. It also appeared nearly 

 always anemic and fatty, yellowish in color. A similar appearance was noted 

 by Formad and Birney ('91) in the liver of a woman 60 years old, who died of 

 starvation. 



Stschastny ('98) in the liver of a starved man found stasis of blood, atrophy 

 of the cell-columns, pigmentation, deeply staining nuclei (sometimes vacuolated) 

 and hyalin degeneration of the connective tissue. Dunschmann ('00) mentioned 

 atrophy of the liver as characteristic at death from starvation. Helly ('11) 

 described various types of hepatic steatosis, which he considered an expression of 

 the fatty metabolism of the cell and dependent upon its vitality and the cir- 

 culatory relations, affected by inanition and other factors. Sternberg ('13, '21) 

 described in cachexias, inanition and senile marasmus a general atrophy of the 

 hepatic parenchyma. The gland cells become reduced in size, some entirely 

 destroyed; often (especially in senility) containing pigment (lipochrome)masses. 

 Vacuolation, steatosis and other degenerative changes may occur. There is a 

 relative increase in the connective tissue stroma. 



Meyer ('17) in a man who died from starvation found the liver pale and soft, 

 weighing 914 g. (body weight decreased from about 135 to 80 pounds). 

 Microscopically the liver appeared very atrophic, with disintegration of the 

 cell-cords, especially near the central vein of the lobule. " Many of the hepatic 

 cells are reduced to one-fourth or even to one-fifth their normal size. Others are 

 represented by a small amount of protoplasm surrounding a nucleus, while still 

 others are mere shadows of cells. A good deal of golden pigment is found 

 intracellularly and in considerable masses also extracellularly." 



Bean and Baker ('19), in a large series of adult autopsy weights, found the 

 average weight of the liver greatly affected by the general nutrition of the body. 

 In 771 white males, the average increased from 1,342 g. in the "extremely 

 emaciated" group to 1,909 g. for the "obese;" and in 523 white females from 

 1,150 g. in the extremely emaciated to 1,790 g. in the obese. Similar increases 

 were noted for the negroes. 



Rubner ('19) mentioned atrophy of the liver as one of the results of under- 

 feeding in Germany during the war. This was also noted by Roessle ('19), 

 excepting cases where the atrophy is masked by fatty or amyloid degeneration. 



In a few cases of voluntary starvation (complete or incomplete) Sison ('20) 

 found on living patients a distinct decrease in the hepatic area of dulness on 

 percussion. He ascribed this partly to an actual atrophy of the liver, and 

 partly to increased tympany of the overlapping lung margin. 



Krieger ('20) found the apparent loss in liver weight greater in general 

 cachexias than in infections, probably because the atrophy in the latter is 



