UNDERNUTRTTION 7 



ably was caused by the depletion of the carbohydrate store of the body. 

 Then for five days there was essentially no gain or loss of water. "On 

 the ninth fasting day the mucous membranes of the mouth and the lips 

 were dry. On the eleventh day the lips were desquamating (at the same 

 time seborrhea of the scalp appeared), and this continued until the fifteenth 

 day of the fast and did not occur again. The decrease of these signs 

 promptly followed the prescribed intake of larger quantities of water." 

 (Benedict (d), 1915.) Coincident with the change in skin condition it is 

 noticed that water began to be retained by the body in fairly large amounts. 

 Thus when seven hundred and fifty cubic centimeters of water were taken 

 by mouth by Levanzin, he was showing early signs of water hunger ; nine 

 hundred cubic centimeters, however, were sufficient to overcome them. 



In connection with the storage of water later in the fast, it should be 

 mentioned that in animals both the fat and fleshy tissues of the body 

 have a higher percentage of water on fasting. In poorly nourished chil- 

 dren, babies with marasmus, there is occasionally an edema. This edema 

 has been found to be associated with one of two conditions : the retention 

 of chlorides in the body or a diet with a preponderance of carbohydrate. 

 This latter condition has been called by the Germans "Mehlnahrschaden" 

 (Rietschel, 1911), and the edema is usually found in undernourished chil- 

 dren who have been fed sweetened condensed milk or a diet almost wholly 

 of cereals and without milk. This edema is readily overcome by a change 

 of diet. In the war there have been a number of reports of nutritional 

 edema in certain localities, and analysis shows that the explanation is very 

 similar to that in the marantic babies. In general, the main facts in the 

 nutritional edemas are to be summarized as follows : ( 1 ) water retention 

 occurs with retention of sodium chloride; (2) water is always retained 

 with a carbohydrate-rich diet ; taking away carbohydrate leads to a diminu- 

 tion of the preformed water in the body ; (3) the water content of the body 

 flesh and body fat is increased in fasting. Thus the fat in obese indi- 

 viduals has been found to contain thirteen and two-tenths per cent water, 

 and in emaciated persons twenty-eight and two-tenths per cent. (Bozen- 

 raad, 1911.) The body flesh in emaciation also is shown to contain a 

 higher percentage of water (Engels, 1903). 



Energy Metabolism 



Body Temperature. The body temperature in starvation tends to be 

 slightly lower than normal and to decrease slowly as fasting progresses. 

 However, the temperature does not become what would be called patho- 

 logically abnormal until just before death. The body temperature of 

 Levanzin at 7 A. M. each morning during his thirty-one-day fast is given 

 in Table 2. 



