248 INANITION AND MALNUTRITION 



Herter ('08) found a variable degree of simple anemia in infantilism resulting 

 from chronic intestinal infection. Benjamin ('08) stated that severe infantile 

 malnutrition causes a polynuclear leukocytosis; but in atrophy (decomposition) 

 the lymphocytes are decreased. The eosinophiles tend to disappear and the 

 large mononuclears are mostly replaced by younger forms. 



Lenoble ('08) in a 7 months' infant convalescent from malnutrition found 

 slight anemia. The differential count shows 77 per cent of lymphocytes and 2.3 

 per cent of eosinophiles, the other varieties diminished. Lesage ('n) stated 

 that atrophic infants in general show a variable degree of anemia, and often 

 leukocytosis (especially lymphatic). 



Lust ('11) found that acute nutritional disturbances in infants usually cause 

 a concentration of the blood, which may change to hydremia in terminal stages. 

 In chronic malnutrition, however, the blood usually changes but slightly in water 

 content. 



Rosenstern ('11), however, concluded that in (total) complete inanition there 

 is no change in concentration of the blood, contrary to the earlier views. The 

 total quantity of blood decreases in proportion to the body. There is a decreased 

 leukocyte count. In chronic malnutrition the effects are variable. There may 

 be hydremia upon refeeding. 



Nobecourt and Maillet ('14) found that the minute fat granules (hemokonia), 

 visible in the blood through the ultramicroscope, usually decrease in number or 

 disappear during infantile malnutrition, but reappear during recuperation when 

 milk diet is resumed. These granules evidently correspond to the "chylomi- 

 crons" of Gage ('20, '21) above mentioned. 



Nobecourt ('16) reviewed the literature of blood changes in hypotrophic and 

 cachectic infants. The changes appear variable, with more or less anemia, but 

 sometimes an increase in erythrocyte count. The leukocytes are also variable 

 and may be normal, increased or decreased in number. The differential count 

 may be nearly normal. 



Meyer and Japha ('19) described 3 types of infantile anemia, associated with 

 hydremia. These may be caused by toxic influences, constitutional weakness 

 (aplastic anemia) or alimentary deficiencies. 



Schindler ('10) thought that the increased pigmentation of the iris in mal- 

 nourished infants may be hematogenous in origin, due to increased destruction 

 of erythrocytes. The hemosiderosis observed by Helmholz ('09) and others 

 in the liver and spleen may be similarly explained. 



Bergel ('19, '21) believes that the fats and lipoids exert a specific chemotac- 

 tic effect upon the lymphocytes; and that the lymphocytosis in the blood during 

 fasting is due to the characteristic lipemia associated with the mobilization of 

 the reserve body fat. 



Marfan ('21) found the data upon blood changes in malnourished infants 

 obscure and contradictory. In mild or moderate malnutrition (hypothrepsia) 

 there is usually anemia with reduction in the erythrocyte count to 3 or 4 millions, 

 the leukocytes being unchanged. But in severe stages (athrepsia) the blood is 

 concentrated through dehydration, with erythrocyte count of 5 or 6 millions; 

 also marked leukocytosis (up to 30,000), with relative increase of polynuclears 

 and decrease in mononuclear forms. 



