BLOOD EXAMINATION. 365 



count. This may be dependent upon a temporary concentration of the 

 blood, or dependent perhaps upon an actual increase of cells which are re- 

 latively poor in hemoglobin, as told by their histological character and the 

 fact that the hemoglobin did not significantly rise with the increased count. 

 The relatively slight histological abnormalities noted about the red cells, 

 the achromia, anisocytosis, occasionally polychromatophilia, are those asso- 

 ciated with slight or mild secondary anemia. 



The white counts, in general, average 9,500, but little higher than normal 

 (normal average, 7,300). With Squad B, who had not been so long on reduced 

 diet, the white counts showed no alteration. The evidence is therefore 

 negative so far as the white counts alone are concerned. 



The white cells are evidently of the normal types, but their normal pro- 

 portion is disturbed. This is evidenced by the fact that the average per 

 cent (36) and the average absolute number (3,400) of the lymphocytes are 

 unusually high for individuals in this vicinity, the average normal lymphocyte 

 count being 22 per cent (though the upper normal limit may be 40 per cent) 

 and the average normal absolute count being 1,724.^ In Squad B, in cer- 

 tainly 8 out of 12 cases, the lymphocytes definitely increased, both relatively 

 and absolutely, under observation, while, though variations occur in Squad 

 A, the average lymphocyte count is certainly well above the normal average. 

 This increase is perhaps at the expense of poly nuclear neutrophile production, 

 for the polynuclear per cent, both squads, averages 56 per cent, which is 

 slightly lower than the normal average, 64 per cent. However, the average 

 absolute number of polynuclears is not so significantly altered from their 

 normal average (4,895) as are the lymphocytes. This increase of lympho- 

 cytes is not an unusual finding in chronic secondary anemia. 



The other white cells show no definite significant alteration, though in 

 some instances the eosinophiles are very slightly more numerous than normal. 

 Satisfactory data concerning the blood platelets, the third formed element of 

 the blood, originating from myelogenous tissue, are unfortunately lacking. 

 One usually finds them increased in secondary anemia, although when 

 associated with decreased blood formation, they may become decreased. 



The secondary anemia present in these cases may be dependent, perhaps, 

 in some manner upon a decreased rate of blood formation, possibly similar 

 to that which occurs in myxedema. 



It is interesting to speculate as to what might happen to the blood of these 

 individuals if they were kept on this same diet for a considerably longer 

 period of time. I am inclined to believe that, under such circumstances, a 

 greater degree of secondary anemia than the most marked case shows would 

 probably not occur, or that it would be but very slightly greater. In other 

 words, it seems to me that their blood would stay at a new level, one which 

 we would interpret as a mild secondary anemia. However, I think that, if 

 for any considerable time the blood remained at this new level, it would prob- 

 ably be quite difficult, perhaps impossible, for it to return to its previous 

 normal level, and that if it did return to normal, it would probably do so very 

 slowly. This is because, from clinical experience, the blood of cases of chronic 

 mild secondary anemia, dependent upon various minor causes, not infre- 

 quently improves only slightly following prolonged appropriate treatment. 

 It would seem in some such instances as if some "trap had been sprung" 

 which could not be entirely repaired to let the completely normal hemopoetic 

 function take place again. This may be well seen in certain rather marked 

 and unusual cases of anemia dependent upon chronic benzol poisoning — 

 a drug which causes an aplastic type of anemia. 



George R. Minot, M. D. 



1 S. R. Miller, Johns Hopkins Hospital Bulletin, 1914, 25, p. 317. 



