Starvation

This condition is rare in civilized communities, especially from outright deprivation of food. In such extreme cases, life may be maintained up to a limit of about 40 days, if there is no deprivation of water and no exposure to cold.

During starvation, the tissues are exhausted in order inverse to their functional importance. Sugar and glycogen are used up within a few days, though sugar may subsequently be formed from protein. Fat is almost entirely exhausted, only about 1% remaining. However, in certain pathologic cases, there is interference with the oxidation of fat so that the patient dies, virtually from lack of the ability of performing the various metabolic processes, while a relative excess of fat remains. The bones, cartilages and dense fibrous tissues are almost entirely untouched and so also, are the heart and brain, during starvation, while the muscles and various glands are atrophied to a degree approximately corresponding to the ability of the body to spare their function.

If water as well as food is withheld, death occurs in about a week.

In the treatment of cases of starvation, great care must be taken not to give an abundance of food at once. Beginning with broths in small quantities, at intervals of one to two hours, small quantities of peptonized milk may be given; cereals may be added during the second day and anything like a full ration should not be given for four or five days. Meantime, hypodermoclysis and rectal injection of hot saline solution may be used.

While achylia gastrica does not, of itself, interfere materially with general nutrition, a similar condition involving the pancreatic and intestinal digestion necessarily causes death from the same essential condition as gross starvation. This occurs in some cases of Addison's disease.

Starvation also occurs in impermeable stenosis of the oesophagus, pylorus, upper bowel, congenital or acquired, unless a fistula is established. It is significant that nutriment introduced into the stomach and predigested or assisted with digestants and with lavage but which cannot pass through the pylorus, or nutriment introduced into the rectum, does not materially lengthen the duration of life. In other words, if food cannot pass through a considerable portion of the small intestine, death is to be expected within forty days. Starvation also occurs within the same limit, if half or thereabouts of the small intestine is resected. About one meter of the small intestine may be resected with impunity, barring surgical accidents, but the resection of two meters, or about a third, is likely to result in gradual inanition. Serious disease or short-circuiting of corresponding lengths, produces approximately the same results.

Overfeeding and various related conditions will be discussed under diseases of metabolism.

Hyperaemia, Anaemia, Infarction, Thrombosis, etc., are not directly influenced by diet either etiologically or therapeutically, except in ways discussed under various other headings.

Atrophy and Hypertrophy depend to some degree upon food supply but, more particularly upon the functional usefulness of the part affected. Thus, the heart or other muscle or any part not of too great density, such as teeth, bones, fibrous tissue etc., which is, for any reason, in a state of disuse, tends to atrophy and, with similar qualifications, any part of which excessive function is demanded, as the heart muscle when the valves are crippled, the voluntary muscles under increased use, a kidney after the extirpation of its mate, tends to hypertrophy, without much regard to diet.

Thus, increase of food without exercise does not cause hypertrophy of muscle, etc., nor, providing enough food is taken so that increased function is not prevented by general lack of strength, does deficient nourishment prevent hypertrophy.

However, it is advisable that the diet should correspond to the functional activity of the body, mainly that of its muscles.

Any marked change in muscular activity should be gradual. The special danger of athletics is that they produce a physiologic hypertrophy of the heart which is beyond the requirements of the body for subsequent business or professional life and the subsequent adjustment by atrophy is slow and often attended by unpleasant consequences.