EFFECTS ON THE BLOOD 247 



thickening is due to an excessive consumption of the plasma, resulting in a high 

 red cell count (" Pseudopolyglobulie ") . There is also a leukocytosis, with relative 

 increase of mononuclear and transitional forms. Thinning of the blood is due 

 to a hydremia associated with edema, and may be due chiefly to protein inani- 

 tion. Further data upon this topic will be cited in connection with infantile 

 malnutrition and also under the various types of partial inanition. 



Changes during Malnutrition in Infants. — In considering the blood changes 

 in atrophic infants, it must be kept in mind that pedatrophy is usually the result 

 of gastrointestinal or other chronic disorders, and in many cases represents toxic 

 effects as well as those of chronic inanition. 



Parrot ('77), who described infantile athrepsia, considered progressive leu- 

 kocytosis a characteristic symptom. D'Orlandi ('99), however, found the total 

 and differential leukocyte counts unmodified in hypothrepsia (mild or moderate 

 uncomplicated inanition). In acute and chronic athrepsia, Cuffer ('78) ob- 

 served an increased red cell count (up to 9 millions) as well as increase in total 

 leukocytes (10,000-40,000). Cantalamassa ('92), claimed that anemia results 

 in children who are starved as well as in cachexia from chronic diseases. 



Schlesinger ('03) found that in moderate infantile atrophy there is a variable 

 anemia, due to dilution of the plasma; but in more severe cases the anemia may 

 be masked by loss of the plasma. In uncomplicated atrophy, the leukocyte 

 count may be normal or below normal, with normal differential; but in gastro- 

 enteritis the blood is increased in density, with increased red cell and leukocyte 

 count, showing lymphatic and polynuclear hyperleukocytosis. Just before 

 death, there is a marked and rapid fall in the density of the blood, with decreased 

 red cell count. 



Thiercelin ('04) claimed marked and constant blood changes in athrepsia. 

 At first, the blood appears concentrated; but later there is progressive anemia 

 and the red cell count may decrease to 3 million, or even below 1 million (Luzet). 

 The red cells are also malformed, and often nucleated. There is considerable 

 leukocytosis. The blood is easily coagulable ; hence frequent venous thromboses 

 may occur in the brain, lungs and kidneys. Rieber ('05) noted leukopenia in 2 

 moderately severe cases of pedatrophy, with an increase of polymorphonuclears 

 during severe complications. 



Arneth ('05) concluded that the characteristic leukocytosis found in newborn 

 infants is not due to the deficient nutrition during that period. 



In chronic athreptics, Minet ('07), found 19 showing an increased erythro- 

 cyte count (5-7 millions) due to dehydration; while only 5 showed a decrease 

 (below 5 million). Nucleated red cells were found in 9 out of 19 cases. Pro- 

 gressive leukocytosis (11,000-37,000) appeared in 15 cases; and a decrease 

 (below 9,000) in 4. A relative increase in polymorphonuclears occurred in 18 

 out of 19 cases; often with indistinct nuclei and neutrophile granules scarce or 

 absent. The polynuclear eosinophiles appeared rare (0.5-1 per cent) or absent. 

 The neutrophile myelocytes or basophiles were constant (0.2-3 per cent). 

 Minet also noted that digestive leukocytosis occurs as in normal infants, and is 

 sometimes very marked, especially in late stages of cachexia (confirmed by 

 Villa '18). 



