EFFECTS ON THE BLOOD 255 



('17), Jansen ('18), Burger ('20), Enright ('20), Mann, Helm and Brown ('20), 

 Lubarsch ('21a) and Tallquist ('22). 



As to the detailed blood changes associated with this edema, Woltmann 

 described anisocytosis, polychromatophilia, marked leukopenia and lympho- 

 cytosis. Budzynski and Chelchowski found the hemoglobin reduced 50 per 

 cent, but only slightly decreased red cell count; also a definite leukocytosis, 

 mainly due to increase in lymphocytes, which equalled or surpassed the polymor- 

 phonuclears. Eosinophilia was almost constant. Maase and Zondek found 

 decreased hemoglobin (50-70 per cent), red cell count (3-4 millions) and leu- 

 kocytes (4-5 thousand) ; with marked increase of lymphocytes (up to 45 per 

 cent) and large mononuclears and transitionals (n-25 per cent). Gerhartz 

 noted a tendency to low leukocyte count. Jansen found the red cell count 

 1.5-4 millions; and leukopenia (below 5,000) in 60 per cent of the cases, with 

 relative lymphocytosis (30-55 per cent). Schittenhelm and Schlecht ('19) also 

 noted a relative lymphocytosis. Burger observed variable counts; the red cells 

 usually slightly decreased (4 millions) and the leukocytes usually normal. 

 Enright found a typical count of erythrocytes 3.5 millions (hemoglobin 60); 

 leukocytes 4,000; polymorphonuclears 36, lymphocytes 48, and mononuclears 

 16 per cent; eosinophiles normal. Tallquist claimed that the increase in 

 mononuclears is not a specific symptom, although lymphocytosis is charac- 

 teristic. Lubarsch found a marked destruction of erythrocytes, with hemor- 

 rhages into the connective tissues, resembling scurvy. In famine edema in 

 Russia, Abel ('23) described a slight decrease in erythrocyte count, and moderate 

 leukopenia with decrease in neutrophiles and occasional lymphocytosis. 



Hydremic anemia has also been noted in various animals on protein-poor 

 diets; by Friedberger and Frohner ('08) in draft oxen and horses; by Frohner 

 and Zwick ('15) in sheep and cattle; by Hoare ('15) in sheep, cattle and pigs; and 

 by Hutyra and Marek in various domestic animals. Kohman ('20) produced 

 edema with anemia in rats by an aqueous diet poor in protein and fats; and her 

 results were confirmed by Maver ('20) in rats, dogs and guinea pigs. 



In pellagra, Marie ('08, '10) concluded that secondary anemia is apparently 

 frequent, though not constant. Leukocytosis is infrequent, probably due to 

 complications. The differential count is uncertain, but there is probably an 

 increase of large mononuclears. Findlay ('20) stated that although observers 

 in Italy and Roumania have reported an increase in large mononuclears, this 

 has not been generally confirmed. Thus Bardin ('13) and Hillman ('13) in 

 America noted a definite increase in the small lymphocytes. Woodcock ('18) 

 found some lymphocytosis in Turkish war prisoners, but Paton ('18) obtained 

 a normal differential leukocyte count. In Armenian refugees, Findlay noted an 

 increased total leukocyte count, with a relative increase in lymphocytes and 

 decrease in neutrophiles. Huck ('23) has recently given an extensive review of 

 the literature on the subject (including several references in addition to those 

 above mentioned). He concludes that in all stages of uncomplicated pellagra 

 the blood picture shows a secondary type of anemia, with normal leukocyte and 

 platelet counts. The differential count shows an increase in lymphoid elements 



