EFFECTS ON THE URINARY TRACT 371 



degenerative changes. In general, the renal changes during inanition in many 

 respects resemble those of a parenchymatous (tubal) nephritis. 



Upon adequate refeeding after a period of inanition, the kidney usually 

 soon regains its normal size and structure; but in case of severe lesions, traces 

 may persist for a considerable time. 



In the urinary bladder, the atrophy and loss of weight during inanition 

 appear in general somewhat greater than in the kidney, although relatively less 

 than in the body as a whole. During various forms of total or partial inanition, 

 the bladder sometimes shows a marked increase (instead of a loss) in weight, 

 caused perhaps by infection in the condition of lowered resistance. No marked 

 lesions of the bladder have been described, however, excepting in scurvy (guinea 

 pig). The few observations upon the ureters and urethra during the various 

 forms of inanition have revealed no significant changes. 



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



The effects upon man (adult and infant) will be reviewed first, followed by 

 the data for the lower animals. 



Human Adult. — Lucas (1826) cited from Ballin's "Erfahrungen" a case of 

 starvation (in religious dementia) in which the kidneys and ureters appeared 

 normal; the bladder small and thick- walled. Willien ('36) concluded that dur- 

 ing inanition the kidneys are small and firm; the bladder normal, with pale 

 mucosa. In a girl of 19 years who died from starvation due to an esophageal 

 stricture, Schultzen ('62, '63) found a slight granulo-fatty degeneration of the 

 kidneys, which appeared somewhat small and hyperemic, with increased stroma. 

 Curran ('74) noted that in an old native woman, greatly emaciated from starva- 

 tion, the kidneys appeared relatively large and the surface granular. On 

 incision, the kidney substance was tough, and bloody serum exuded from the cut 

 surface. In the case of starvation of Harriet Staunton, aged 35, with loss of 

 40 per cent in body weight (final weight 74 pounds), Bright ('77) found the 

 kidneys small but normal in appearance. The right kidney weighed 3^ 

 ounces, and the left 4 ounces, which would indicate that they had lost relatively 

 little in weight. 



Popow ('85, '85a) in a case of inanition from esophageal stricture observed 

 albuminuria, with decreased amount of urine. The kidneys showed hemor- 

 rhages, round cell infiltration, and atrophic degeneration (cloudy swelling, 

 granulation) in the epithelium of the renal tubules. In a large man of 64 years 

 who died from voluntary starvation, Voelkel ('86) reported the urinary 

 bladder empty and the kidneys "normal, nur etwas schlaff." 



Porter ('89) in autopsies on victims of the Madras famine (226 men, 155 

 women and 78 children) found in the men an average weight of 2.87 ounces 

 (range i/^ - 6^ oz.) in the right kidney and 3 ounces (i-io 1 ^) in the left kidney. 

 In the women (excluding 1 horseshoe kidney weighing 5^ ounces), the right 

 kidney averaged 2.64 ounces (i/1r~4M oz -)> an d the left kidney 2.7 ounces 

 (%~5% oz.). The ratio of kidney weight to body weight in the men was 1 : 214; 

 in the women, 1:192. Porter concluded that although these weights of the 



