302 DISTURBANCES OF CIRCULATION 



blood becomes less than that of a 0.46 per cent. NaCl solution (Lim- 

 beck), while swelling may occur whenever the strength is below 0.8 

 per cent. The specific gravity of the erthrocytes is decreased;^^ 

 the depression of the freezing point increases,^^ while the viscosity 

 falls. The number of platelets is high. 



Regeneration of the blood begins very soon, and for some time the 

 number of corpuscles exceeds the proportion of hemoglobin. During 

 this time the amount of iron in the liver and spleen is decreased, it 

 being taken up to be used in the formation of new hemoglobin. The 

 rate of regeneration is much increased by a meat diet, but not by 

 iron administration.^^ Red corpuscles do not regenerate in animals 

 kept on an incomplete protein diet (ghadin). If the hemorrhages 

 are numerous and the condition of anemia prolonged, secondary 

 changes in the viscera may occur, fatty metamorphosis being most 

 marked, supposedly because of decreased oxidation. Indeed, many 

 observers state that repeated bleedings greatly increase body weight 

 by causing increased fat deposition. 



Metabolic Changes. — Gies*^ studied the metabolism of dogs after withdrawing 

 a total amount of blood equal to 11.5 per cent, of the body weight during four 

 bleedings, and found that a slight and temporary increase in nitrogenous elimina- 

 tion followed the bleedings, owing to an increased protein katabolism. Basal 

 metabolism may also be increased in anemia.^'' Sugar increases in the blood, 

 while albumin and lactic acid appear in the urine. After each successive hemor- 

 rhage the proportion of fibrin and the coagulability of the blood increase, while 

 the proportion of the ash obtained from both blood and serum remains practically 

 unchanged (Meyer and Gies). Baumann" states that in regeneration after hem- 

 orrhage the serum albumins increase more rapidly than the globulins, while others 

 have observed the opposite relation. The urine in secondary anemia shows the 

 effects of increased protein katabolism, its specific gravity, total solids, and total 

 nitrogen being raised; the total amount of urine is at first diminished because of 

 lowered blood pressure, but it soon rises above normal and later falls back to 

 normal. The view formerly held that oxidation is decreased in anemia has been 

 considerably modified by more recent investigations;"^ in fact, respiration studies 

 indicate heightened gas exchange in secondary anemia.^* 



Secondary anemia due to cachexia, or to malnutrition, is ac- 

 companied by a general decrease in all the elements of the blood, both 

 cellular and chemical. The proteins of the plasma, particularly, show 

 a decrease in starvation, being drawn on by the cells for food, and 

 the total quantity of blood as well as of each of its constituents is de- 

 creased (Panum),'''' but the proportion of blood to body weight re- 

 mains about normal. With protracted starvation there is only a 



« Bonninger, Zeit. exp. Path., 1912 (11), 1. 



" Iloesslin, Ilofnicister's Beitr., 1906 (S), 431. 



6^ Hooper and Whipple, Amer. Jour. Physiol, 1918 (45), 573. 



"American Med., 1904 (8), 155 (r6sum 6 of literature). 



68 Review by Tompkins el al., Arch. Int. Med., 1919 (23), 441. 



" Jour. Physiol., 1903 (29), 18. 



68 See Mohr, Zeit. exp. Path., 1906 (2), 435. 



sfGrafe, Dent. Arch. klin. Med., 1915 (118), 148. 



90 Virchow's Arch., 1864 (29), 241. 



