41 8 INANITION AND MALNUTRITION 



The changes in structure appear equally variable during inanition (including 

 hibernation), with frequently conflicting data. In the cortex, there is a variable 

 degree of cell atrophy in some regions, especially in the zona fasciculata and 

 zona reticularis. The characteristic fat content is frequently described as per- 

 sistent or sometimes even increasing during inanition, though in other cases a 

 variable decrease is claimed. In some regions (zona glomerulosa and outer 

 fasciculata) there is often a tenacious persistence of the lipoids, even to death 

 from starvation. The losses also appear variable in the different elements of the 

 suprarenal fat (neutral fats, cholesterin, phosphatids, etc.) which may explain 

 some of the apparent discrepancies in results. The pigment is variable, fre- 

 quently increased. The cortical changes appear somewhat similar in the 

 various types of both partial and total inanition. 



In the suprarenal medulla, the atrophic and degenerative cell changes during 

 inanition appear less marked and frequent than in the cortex. Interest has 

 centered mainly in the chromaffin substance, with conflicting results. Most 

 investigators have described a decrease in the chromaffin reaction during 

 inanition, especially in the later stages, although in some cases the reaction 

 persists apparently undiminished even up to death from starvation. Post- 

 mortem changes may account for the marked decrease in chromaffin reaction 

 described by some authors. Associated with the enlargement of the suprarenal 

 gland, there is usually a marked increase in the total epinephrin content during 

 beriberi, but apparently a decrease during scurvy. Fibrosis and inflammatory 

 changes have been described in the medulla during pellagra. 



(.4) Effects of Total Inanition, or on Water Only 



The data for man (adult and infant) will be presented first, followed by 

 those for the lower animals. 



Human Adults. — In man, no observations upon the effects of inanition on 

 the suprarenal glands have been found in the earlier literature. Orth ('93) 

 stated that a decrease in the fat (lipoids) of the human suprarenal occurs during 

 inanition. Beneke ('94) likewise concluded that "Allgemeine Ernahrungs- 

 storungen veranlassen entsprechende Veranderung der Nebennieren; fettreich 

 erwachsene Personen haben auch sehr fettreiche Nebennieren, wahrend bei 

 Kachexie das Fett verschwindet." Stilling ('98) and Hermann ('05) also 

 found a decrease in the suprarenal cortical fat (lipoids) in man during inanition 

 from wasting diseases, such as tuberculosis. This view was also supported by 

 Babes and Jonesco ('08), who found a diminution of suprarenal fat in various 

 abnormal conditions in man and rabbits (to be mentioned later). 



The opposite conclusion was reached by Napp ('05), who found the amount of 

 suprarenal fat in human adults generally independent of the nutritive condition. 

 The suprarenal fat sometimes appeared scanty in well nourished individuals, 

 and frequently it was found abundant in the emaciated. Especially in toxic 

 conditions (including tuberculosis), no correlation was found between suprarenal 

 fat and general nutrition. Kawamura ('n) similarly concluded: "Bei der 

 Inanition habe ich — mit Ausnahme des Falles von chronischer Peritonitis — 



