240 INANITION AND MALNUTRITION 



decreased percentage, sometimes after a preliminary increase. The mononuclear 

 and transitional forms are variable. The eosinophiles are usually normal or 

 increased, though sometimes decreased. 



During malnutritional edema, a lymphocytosis is very constant and char- 

 acteristic. In pellagra, the results are variable and inconclusive. In rats on 

 vitamin B deficiency, a marked lymphopenia has been observed. In human 

 scurvy (especially adult) a relative lymphocytosis is usual; and a decrease in 

 polymorphonuclears has been observed. There are no marked changes in 

 scurvy of guinea pigs. 



The blood platelets have been studied but little during inanition, but seem 

 as a rule to show no marked changes. A progressive decrease in number has 

 been found during deficiency in vitamin A. In scurvy, they are normal or 

 increased, hence they cannot be responsible for the hemorrhagic tendency in 

 this disorder. 



On refeeding after inanition, the blood as a rule quickly recovers its normal 

 condition, although a transient hydremia may occur, due to the more rapid 

 regeneration of the plasma. Following prolonged or severe types of inanition, 

 however, there may be a considerable delay in the recovery, doubtless due to 

 delayed regeneration in the hemopoietic system. Regeneration of the blood 

 is much retarded on protein-poor diets. During convalescence in human scurvy 

 the erythrocyte count is sometimes remarkably high. 



(.4) Effects of Total Inanition, or on Water Only 



After an introductory discussion, the results will be considered first in man, 

 adult and infant, followed by a review of the results in lower animals. 



On account of the intense interest in the blood, and the ease with which it 

 may be examined, even during life, an enormous literature has accumulated 

 upon the subject, including the effects produced by various forms of inanition. 

 Harvey (1651), who discovered the circulation of the blood, concluded that it is 

 to be considered a tissue of the body, rather than merely a liquid food, since it 

 remains in quantity during starvation in man and animals. 



Opinions have varied widely concerning the extent of loss in the blood during 

 starvation. The earlier authors were impressed with the general appearance of 

 anemia, both during life and at autopsy. Rokitansky ('54), for example, con- 

 cluded that in starvation, or atrophy from other causes, the loss is relatively 

 greatest in the blood, exceeding even that in the adipose tissue. A general 

 condition of anemia at death from starvation was likewise claimed by David 

 (1815), Collard de Martigny (1828), Tiedemann ('36), Taylor ('20), Voelkel 

 ('86), Porter ('89) and many others. Claude Bernard stated that the dimin- 

 ished resistance of starved animals is doubtless due to the decreased mass of 

 blood. On the other hand, microscopic examination revealed surprisingly 

 little structural change, so that Carl v. Voit ('81) and others held that the blood 

 is one of the tissues least affected by inanition. According to Heidenhain 

 ('57), Cyr ('69), Falck ('81), Cohnheim ('89), Grawitz ('95) and most recent 

 authors, the atrophy in total mass of the blood during inanition is, in general, 

 proportionate to that of the whole body. 



