244 INANITION AND MALNUTRITION 



held that the human blood is relatively resistant during fasting. There is a 

 tendency to increase in the red cell count; and in long underfeeding a notable 

 decrease in the number of leukocytes, especially the neutrophiles. Lazarus 

 ('13) similarly concluded from the available evidence that total inanition in 

 man and lower animals does not produce anemia; but in chronic inanition the 

 results are more uncertain. 



Howe and Hawk ('12) in 2 men fasting 7 days noted an initial rise in the 

 number of polymorphonuclear leukocytes, with a decrease below normal at the 

 end. The lymphocytes have an opposite tendency. One man showed a pro- 

 gressive increase in eosinophiles. Mann and Gage ('12) found an increased 

 staining capacity in the leukocytic nuclei of man and frog, upon refeeding after 

 a fasting period. 



Gruner ^-14) concluded from a review of the literature on the differential 

 leukocyte count during starvation that the number of lymphocytes, after a 

 preliminary decrease, remains nearly constant; while the neutrophiles show a 

 progressive increase. He attempted to explain the blood changes in relation to 

 those in the hemopoietic system. Schwartz ('14), in an exhaustive review of the 

 eosinophiles, concluded that, while variable, they usually show a tendency to 

 increase during inanition, especially in human fasting. 



Ash ('14, '15) reviewed the literature on the blood changes during inanition, 

 showing the variable and often discordant results. He also made careful daily 

 observations on the blood (hemoglobin, erythrocyte and leukocyte count, total 

 and differential), together with some observations on coagulation time, density, 

 etc., in the case of Levanzin, who fasted 31 days on water only, with loss of 21.9 

 per cent in body weight. In general, the blood appeared very stable in composi- 

 tion, with fluctuations not exceeding the normal range, and no significant change 

 in the size, form or structure of the blood cells. As shown in Fig. 72, the ery- 

 throcyte count ranged between 6 and 7 million, and the hemoglobin between 85 

 and 93 per cent. There was, however, a transient marked rise in the total 

 leukocyte count, from 6,000 up to 12,400 on the 3d fast day, decreasing to nearly 

 normal in the latter half of the fasting period (Fig. 74). The polymorphonu- 

 clear neutrophile count closely parallels the total leukocyte count (Fig. 74), 

 rising from 60 to 79 per cent on the 3d fast day, decreasing irregularly thereafter, 

 but about normal in the latter half of the test. There is no significant change 

 in the lymphocytes and large mononuclears. The transitional form shows 

 transient rises (to 5.0-6.5 per cent) on four different days (Fig. 73), and the 

 eosinophiles show a decrease in the second half of the fasting period. 



Gage ('20, '21), using the dark-field microscope, studied the fat particles 

 (hemokonia or "chylomicrons") which appear in the blood after ingestion of fat, 

 and gradually disappear during fasting. 



Reiss ('21) reviewed the effects of malnutrition (war diet) on the blood. 

 Lubarsch ('21a) emphasized the extensive destruction of blood corpuscles as an 

 evident effect of the malnutrition (chiefly due to mixed deficiencies in the diet) 

 during the war period. Stefko ('23) concludes from an extensive study that the 

 blood during starvation may be either thickened or thinned. The thickened 

 blood may collect in the inner organs, leaving the periphery anemic. The 



