EFFECTS ON THE BLOOD 239 



chronic forms, particularly in protein deficiencies (malnutritional edema). 

 On the other hand, anhydremia, with concentration of the blood, often occurs, 

 especially during thirst. 



The erythrocytes rarely show structural changes (anisocy tosis, poikilocy tosis) , 

 although there is evidence of their increased destruction in severe inanition, and 

 the frequent appearance of nucleated red cells in the circulating blood indicates 

 intensive regeneration, especially upon refeeding after inanition. During 

 human inanition, the erythrocyte count is often within normal limits, but 

 sometimes increased (especially in total inanition and earlier stages), or decreased 

 (especially in chronic and late stages). In animals, the red cell count appears 

 more frequently increased in the earlier stages of total inanition, often decreasing 

 later. In hibernation, the erythrocyte count is variable. 



Among the various types of partial inanition, in malnutritional edema (due 

 chiefly to protein deficiency), hydremic anemia is very characteristic in both 

 man and lower forms. The results of a dietary deficiency of iron are variable, 

 but apparently anemia may be produced in young animals. In rickets the 

 blood is sometimes normal, but there is usually anemia, somewhat proportional 

 to the severity of the rickets. In vitamin B deficiency (beriberi) there is usu- 

 ally well marked anemia. In vitamin C deficiency (scurvy), the erythrocytes 

 are variable; but there is usually a secondary anemia, often of the chlorotic 

 type, with hemoglobin disproportionately low. In experimental scurvy of 

 guinea pigs, the blood changes are usually slight. Aqueous deficiency (thirst) 

 on dry diets usually produces in human and animal experiments an increased 

 red cell count (in extreme cases nearly doubled) through concentration of the 

 plasma. 



The leukocytes likewise rarely present morphological changes, though 

 cytoplasmic and nuclear degeneration has occasionally been noted. The 

 total leukocyte count during inanition in human adults is variable, often show- 

 ing an early increase, with a later decrease. In atrophic infants, it is usually 

 increased, sometimes normal or decreased. In animals it is variable, but 

 usually decreased. During hibernation, there is in all cases a remarkable 

 decrease in the number of leukocytes, which apparently migrate out of the 

 vessels. Also during malnutritional edema there is a marked leukopenia. 

 In pellagra and rickets, leukocytosis is usually found. In human and animal 

 beriberi, a leukocytosis has been observed in most cases, though sometimes a 

 leukopenia. In infantile scurvy there is usually a leukocytosis, but in human 

 adults and in guinea pigs the total leukocyte count is nearly normal. During 

 thirst the leukocyte count is variable. 



The differential leukocyte count is in general quite variable during inanition. 

 In fasting human adults, the polymorphonuclear percentage is variable, usually 

 increased at first, with decrease in later stages. The lymphocytes are also vari- 

 able, usually decreased, but the eosinophiles are generally increased. In 

 atrophic infants the polymorphonuclears frequently show a relative increase, 

 sometimes also the lymphocytes; the other varieties are normal or variable. 



In animals, starved with or without water, the polymorphonuclears are usu- 

 ally decreased. The lymphocytes are variable, most frequently showing a 



