CHAPTER XXII 



EFFECTS ON THE RESPIRATORY TRACT. LUNGS, TRACHEA AND 



LARYNX 



Terminal bronchopneumonia appears to be unusually frequent in conditions 

 of inanition and malnutrition, including most of the deficiency diseases. 

 Following a brief summary, the effects of inanition upon the lungs will be 

 considered under (.4) total inanition and (B) partial inanition. A few data 

 for the larynx, trachea, etc. are also included. 



Summary or the Effects on the Respiratory Tract 



The lungs appear exceedingly variable in weight during inanition, partly on 

 account of the variable degree of congestion present, and especially through the 

 frequency of secondary infections, notably terminal bronchopneumonia, which 

 may increase the weight of the lungs in the late stages. In uncomplicated cases 

 of total inanition, or on water only, the lungs are usually normal in appearance. 

 The loss in weight of the lungs in such cases is usually relatively less than that in 

 the body as a whole, though sometimes equal to, or even relatively greater than, 

 that of the entire body. In the young, the lungs usually appear more resistant 

 to loss in weight. There is also a moderate loss in the weight of the larynx 

 and trachea, relatively about half that in the body as a whole. 



The structural changes may include a general atrophy of the alveolar walls. 

 There is frequently localized atelectasis in some regions and emphysema in 

 others. The lining epithelium may undergo fatty degeneration, and the 

 frequent terminal infections are associated with the usual leukocytic infiltration 

 and hemorrhagic exudation into the alveolar lumina, etc. The mucosa of the 

 trachea and bronchi likewise shows atrophy with frequent degenerative and 

 inflammatory changes in the later stages of inanition. The pleura usually 

 appears normal, excepting cases of secondary infections. 



On refeeding after a period of inanition the lungs, as a rule, promptly 

 regain their normal weight and structure. 



In the various forms of partial inanition, the lungs show even greater vari- 

 ability in weight and structure. In malnutritional edema and pellagra they seem 

 to undergo in general the same atrophic changes as during total inanition. In 

 rickets and scurvy, the thoracic deformity may impede respiration and result 

 in pulmonary disorders with increased liability to infection. Congestion and 

 edema of the lungs are very frequent in human beriberi, though not in experi- 

 mental beriberi of animals. In thirst (aqueous inanition) the lungs usually 

 show pronounced atrophy, with degenerative changes, including pigmentation, 

 round cell infiltration and some fibrosis. 



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