822 GEOKGE K. MINOT AND ARLIE V. BOCK 



ino- the work of Von Noorden, Krause, Ribbert, an$ others, states that the 

 fatty infiltration and degeneration of tissues occurring in chronic anemia 

 is an indirect result of the low hemoglobin content of the blood. He 

 assumes that the excessive effort of the tissue cells to procure oxygen 

 from the anemic blood produces such an alteration in the cells as to 

 predispose them to fatty infiltration. Until recently the only available 

 metabolic observations in anemia were those made upon scattered cases by 

 various observers, and those which concern the effect of acute hemorrhage 

 in animals. Xo precise agreement in either series of observations is 

 apparent. There often has been found in anemia of all types a negative 

 nitrogen balance, usually not great. The notable exceptions to this finding 

 occur in the work of Von Xoorden, Goldschmidt, and his associates, Mosen- 

 thal(d) and Minot(a). The problem of nitrogen excretion after hemor- 

 rhage in normal animals is somewhat different, but Haskins and others 

 have found an increase in protein metabolism which is only temporary. 



Studies of basal metabolism in anemia have also shown great varia- 

 tions. Anemia does not necessarily result in a sluggish metabolism, since 

 the demand for oxygen may be somewhat greater than in health. Meyer 

 and DuBois determined, the metabolism in five cases of pernicious anemia 

 and found an increase of from 2 per cent to 33 per cent. Tompkins, 

 Brittingham and Drinker have shown that the basal metabolism in anemia 

 may vary within normal limits, or be above or below normal. Although 

 they found no close parallelism between the degree of anemia and the basal 

 metabolism, they concluded that the cases of anemia with acute symptoms 

 have a high metabolism while the chronic cases have a diminished oxygen 

 consumption. Zuntz(.fr) and his associates showed that muscles poorly sup- 

 plied with oxygen are functionally less efficient. Accessory muscles are 

 therefore called upon for the accomplishment of any task, as in respira- 

 tion, thus increasing the demand for additional oxygen, a factor which 

 may account for part of the increased metabolism in some cases, according 

 to Meyer and DuBois. Lusk(/i) expresses the view that the general oxida- 

 tion of the body is normally maintained in anemia provided the anemia 

 is not of extreme severity, and that lack of oxygen renders the anemic 

 individual incapable of great muscular work without quick exhaustion. 



In view of the fact that in anemia the body suffers from decreased 

 function of many organs, and in view of the possibility of a normal or 

 augmented metabolism in the presence of anemia, the question arises as 

 to how the oxygen requirements of the body may be met. Certain phe- 

 nomena may be mentioned which may for long periods of time partially 

 compensate for the oxygen deficit. These are increased rate of blood flow, 

 increased ventilation by the lungs, and increased utilization of oxygen 

 in the blood. Often the immediate purpose of transfusion is to relieve 

 the body of these excessive compensatory efforts and thus to restore normal 

 function. 



