The morbid anatomy of infantile malnutrition in Cape Town.

In recent years several detailed descriptions have been published of the morbid anatomical findings in malnourished children. Waterlow (1948) reported fatty liver disease from the West Indies and suggested that the children died from hepatic failure, while Hill (1951), working in the same area, described the condition of serous hepatosis. Davies in discussing kwashiorkor in Uganda (Trowell, Davies and Dean, 1954) felt that atrophy of the pancreas and other enzyme-secreting glands was the most important aspect of the condition, while the type of malnutrition seen in Johannesburg is still regarded as infantile pellagra by Gillman (Gillman and Gillman, 1951; Gillman and Gilbert, 1954). As a result of these papers one has an impression of several somewhat distinct pathological forms of malnutrition occurring in different parts of the world. These apparent distinctions, however, largely reflect differences of terminology and interpretation rather than of pathological findings, which, with the exception of those described in serous hepatosis, present a fairly constant pattern of retarded growth, fatty liver, pancreatic atrophy and skin lesions. The findings to be presented in this paper deviate only in their detail from this general pattern. Apart from these regional differences, various clinical forms of malnutrition have been recognized and include kwashiorkor or its local equivalent, simple nutritional oedema, marasmus, paedatrophy and others. Although a clinical distinction between kwashiorkor and marasmus is made in Cape Town, chiefly on the absence of oedema in marasmus, a preliminary study of the material to be reported here showed that pathological distinction between these conditions was not feasible and in this paper they will be regarded as essentially similar expressions of the single entity of malnutrition. No attempt will be made to cover the vast literature dealing with infantile malnutrition: this has been done by the authors already cited and by the many others included in their bibliographies. Material and Methods