242 INANITION AND MALNUTRITION 



distinct granulation. The ameboid movement is preserved. The nuclei may- 

 appear larger and more vesicular. The differential leukocyte count is often 

 modified. 



In fasting insane patients, Andreesen ('83) found that the red cell count at 

 first increases, later decreases. Ingestion of water causes a transient decrease, 

 through dilution of the blood plasma. Refeeding may likewise cause a tempo- 

 rary decrease in the red cell count. 



Senator ('87) in Cetti's 10 day fast (with loss of 11. 14 per cent in body 

 weight) found the initial red cell count 5,720,000, decreasing to 5,287,000 on 

 the 4th day, and increasing to 6,830,000 on the 9th day. After 2 weeks of refeed- 

 ing, the count decreased to 5,730,000. The leukocyte count on the 9th fast day 

 (not observed earlier) was 4,200, the ratio to red cells being 1 : 1,619. On the 

 2nd day of refeeding, it was 12,300 (1:533). The hemoglobin, by Fleischl's 

 hemometer, decreased from (initial) 110-118 to 85-90 on the 9th day of fasting. 



Luciani ('89, '90), in the 30 day fast of Succi, noted slight fluctuations in 

 the red cell count (usually between 4.5 and 5 millions), ascribed chiefly to varia- 

 tions in dilution of the plasma due to water ingestion. The leukocytes de- 

 creased from 14,536 (initial) to 861 on the 7th day; increased to 1,550 on the 

 9th day; with slightly higher counts later. On the whole, the blood appeared 

 relatively resistant to change. 



Von Limbeck ('92) claimed an increase in the red cell count and hemoglobin 

 content during fasting. Lehman et al. ('93), in Breithaupt's fast, found an 

 increase in the red cell count from 4,953,000 to 5,150,000 on the 2nd day; with 

 4,801,000 on the 6th day, and 4,812,000 on the 2nd day of refeeding. 



Tauszk ('94a, '96), in a repeated 30 day fast by Succi, found (as in the 

 previous fast) but slight variations in the red cell count (range 4,840,000-5,472,- 

 000). The form of the erythrocytes remained normal throughout. The 

 leukocyte count decreased progressively from 9,600 on the 3d day to 4,200 on 

 the 30th day. Differential count showed a relative increase in the eosinophiles 

 (2.7-4.7 per cent) and in the polymorphonuclears (64.1-79.2 per cent), but a 

 decrease in the mononuclears, including lymphocytes (33.1-16.0 per cent). 



Grawitz ('95) reviewed the results of inanition upon the blood of man and 

 animals. He concluded that there is in general a decrease in total quantity, 

 proportional to that of the body; but relatively slight change in composition, 

 aside from a variable degree of hydremia, which may also appear upon refeeding. 

 Extensive reviews of the literature on the subject were likewise made by 

 Schwinge ('98), Pashutin ('02), Benzancon and Labbe ('04), Bardier ('13), 

 Ash ('15), and Morgulis ('23). 



Cabot ('04) stated that fasting causes a temporary increase in the red cell 

 count by concentration of the blood. In chronic malnutrition the leukocytes 

 may decrease to 3,000. Opie ('04) found that starvation may decrease the 

 eosinophile leukocytes to less than 0.5 per cent; but Meyer ('05) observed an 

 increase of eosinophiles from 3.4-3.7 to 6.5 per cent in a healthy man after a fast 

 of 24 hours. 



In a 14 day fast (1 liter of water taken daily), the observations on the blood 

 by Charteris ('07) are summarized in the accompanying table. 



