(From the Department of Pediatrics, Faculty of Medicine, Tohoku. Imperial University, Sendai. Director: Prof A. Sato.)

Transcription

1 Further Report on Blood Picture of Lactating Women. 25th Hematological Paper. By Yutaka Kokubo. (From the Department of Pediatrics, Faculty of Medicine, Tohoku. Imperial University, Sendai. Director: Prof A. Sato.) Introduction. In the present paper I desire to describe the blood picture of 277 healthy lactating women. In literature there is not a single reference which treats of so many cases. This number-277-will make 377 when added to the 100 already related of in my preceding paper.1) As to the blood of lactating women who secrete Arakawa-positive and -negative* milk, the platelet count was reported by Kimura,2-4) the reticulocyte count by Shiraishi,5-7) and the prolongation of the short-timed peroxidase reaction of blood leucocytes by Chiba and Abe,8) Chiba,9) and Suzuki.10)11) The morphological blood picture 1) Y. Kokubo, Tohoku J. Exp. Med., 1936, 29, 373. * "Arakawa-positive " maybe used in two different senses. One of these is: Arakawa-positive in a biochemical sense. A sample of human milk is said to have become Arakawa-positive when it became blue on the addition of Arakawa's rea gent. Here it means that the sample was not negative to Arakawa's reaction. The other of these two senses is: Arakawa-positive in a clinical sense. A sample of human milk is clinically Arakawa-positive only when it shows such a reaction as 4 or?? in one minute of the addition of Arakawa's reagent. Another sample of human milk may be Arakawa-positive in the first described sense, but yet clinically negative. 2) J. Kimura, Tohoku J. Exp. Med., 1934, 23, ) J. Kimura, Tohoku J. Exp. Med., 1935, 27, ) J. Kimura, Tohoku J. Exp. Med., 1935, 27, ) Sh. Shiraishi, Tohoku J. Exp. Med., 1936, 28, 44. 6) Sh. Shiraishi, Tohoku J. Exp. Med., 1937, 31, ) Sh. Shiraishi, Tohoku J. Exp. Med., 1937, 31, ) M. Chiba and J. Abe, Tohoku J. Exp. Med., 1932, 19, ) M. Chiba, Tohoku J. Exp. Med., 1932, 19, ) T. Suzuki, Tohoku J. Exp. Med., 1934, 23, ) T. Suzuki, Tohoku J. Exp. Med., 1935, 25, 186.

2 158 Y. Kokubo was reported in a preceding paper1) by myself. Kimura asserted that lactating women with milk positive to Arakawa's reaction showed quite a normal number of blood platelets, and that mothers with Arakawa-negative milk showed a high platelet count. And a high platelet count was previously unanimously reported in the case of beriberi by Ido,12) Kubo,13) and Nakamura.14) Shiraishi investigated the reticulocyte count of lactating women with Arakawa positive and -negative milk and found a high reticulocyte count in the negative group. Kan,15) Kohda,16) Ikuji,'7) and Takasu,'8) Kuri moto, Aoyama and Sakai19) reported that in the case of beriberi a high reticulocyte count is seen. Suzuki'10-11) reported B**-avita minotic mothers show a prolongation of the shortest peroxidase stain time. In a preceding paper,1) I investigated the blood picture of lactating women with Arakawa-positive and -negative milk, and found that the white cell picture of normal lactating women with Arakawa positive milk will show a slight leucocytosis mainly resulting from a slight lymphocytosis and a slight nuclear shift to the left. Apparently healthy lactating women who are on the verge or already in a state of B-avitaminosis show leucocytosis resulting from neutrophilia as well as from lymphocytosis, and they show a severe nuclear shift to the left. Many authors12-14, 2c-29) reported in the case of beriberi the occurrence of a leucocytosis resulting from an increase of neutrophiles, sometimes from a slight lymphocytosis, and of a nuclear shift to the left. In the present paper I desire to describe the blood picture in a larger number of cases than in my preceding paper,1) and besides, I ** Throughout the paper Vitamin B means Vitamin B1. 12) Y. Ido, Fukuoka Ikadaigaku Zassi, 1912, 6, ) K. Kubo, Tokyo Iji Shinshi, 1921, No. 2237, ) M. Nakamura, Nippon Naikagakkai Zassi, 1925, 13, ) T. Kan, Rinsho Byorigaku Ketuekigaku Zasshi, 1935, 4, ) S. Kohda, Zika Zassi, 1935, No. 420, ) K. Ikuji, Zika Zassi, 1922, No. 265, ) K. Takasu, Tokyo Igakkai Zassi, 1903, 17, ) Y. Kurimoto, T. Aoyama and T. Sakai, Zika Zassi, 1922, No. 263, ) K. Miura, Ergeb. d. inn. Med. und Kinderheilk., 1909, 4, ) E. Kimizuka, Gun-idan Zassi, 1909, No. 1, ) F. Makita, Rinji Kakkebyo Chosakai Hokoku, ) K. Jinbo, Iji Shinbun, 1913, No. 875, ) M. Goto, Zika Zassi, 1914, No. 166, ) S. Hayashi, K. Kikko and N. Yoshida, Aichi Igakkai Zassi, 1924,31, ) T. Fushiki, Zika Zassi, 1925, No. 301, ) Y. Nakaya, Zika Zassi, 1926, No. 315, ) S. Sarai, Rinsho Byorigaku Ketuekigaku Zasshi, 1934, 3, ) R. Iijima, Rinsho Byorigaku Ketuekigaku Zasshi, 1935, 4, 531.

3 Blood Picture of Lactating Women 159 want to relate of eosinophiles, basophiles etc. in this paper, as I have not described these in the other. Method of Experiment. 1. Materials. 277mothers who visited our Dispensary. Blood was obtained in the morning between 10 and 12, so the mothers were in a fasting state. 2. Blood examination. Red cells were examined by use of Hayem's solution and white cells by use of Turk's solution. For the purpose of staining blood smears the Tohoku Pediatric Method,30) a modification of Sato and Sekiya's31) copper peroxidase reaction, was applied. The variety leucocyte count was judged by Sato Suzuki's32) Standard Table of Normal Blood Picture for Every Age, and on the basis of absolute numbers of different leucocytes. 3. Testing of Arakawa's reaction.33) Milk was examined with Arakawa's reagent. Cases were divided into three groups accord ing to the intensity of Arakawa's reaction. a. The Arakawa-negative group: Arakawa's reaction of milk from both breasts is almost or entirely negative even after five minutes. b. The weakly Arakawa-positive group: Arakawa's reaction of milk from one or both breasts is only weakly positive in one minute. c. The normally or strongly Arakawa-positive group: Arakawa's reaction of milk from both breasts is normally or strongly positive in one minute. Result of Investigation. In my investigation there were 40 cases-of the normally or strong ly Arakawa-positive group, 128 cases of the weakly positive group and 109 cases of the completely or almost completely negative group. 1. Red blood cells (Cf. Tables 5, A and B). As will be seen in Tables 5, A, in the Arakawa-positive group, 81% (17 cases) of all the 21 lactating women showed a normal red cell count. In 86%., (95 cases) of all the 109 mothers belonging to the weakly Arakawa-positive 30) A. Sato, T. Suzuki and Ry. Shibat a, Tohoku J. Exp. Med., 1934, 24, ) A. Sato and S. Sekiya, TohokuJ. Exp. Med., 1926, 7, ) T. Suzuki, Tohoku J. Exp. Med., 1937, 30, ) T. Arakawa, Tohoku J. Exp. Med., 1930, 16, 107.

4 160 Y. Kokubo TABLE Blood picture of the normally or ** M=myelocytes, W=metamyelocytes with slightly indented nuclei, T=meta myelocytes with deeply indented nuclei, II, III and IV= polymorphonucleus with two, three and four nuclear segments and V=polymorphonucleus with five or more nuclear segments.

5 Blood Picture of Lactating Women strongly Arakawa positive group. * Table of signs for showing different Arakawa's reaction. 1' 2' 3' 4' 5' 1' 2' 3' 4' 5' 1. 1(_??_) stands for _??????????_ 2. 1(_??_) stands for _??????????_

6 162 Y. Kokdbo Explanation to the table:- Take, for instance, the sign: 2 (_??_). This stands for Arakawa's reaction with the course (_??_)1' (_??_)2' (_??_)3' (_??_)4' (_??_)5'. The sign does not express any prompt result of the reaction, so the prompt reaction of the sign: 2(_??_) may be (-)0', ( })0', (+)0' or even (_??_)0', but this will not matter much, as the result of the reac tion in one minute is the most important. group, a normal red cell count was seen. In the Arakawa-negative group, 88% (80 cases) of all the 91 lactating women the count was within normal limits. Most cases of lactating women showed a normal red cell count. 2. White blood cells (Cf Tables 6, A and B). As will be seen from Table 6, A, if the normal leucocyte count is assumed to lie be tween 5,000 `7,000, then one will see that almost half of all the cases of each group show a leucocytosis, and that the grade of leucocytosis is the severer, the weaker the reaction of the group is. There is no case among the Arakawa-positive cases over the leucocyte count of 11, cases (13%) out of the weakly positive group and 12 cases (11%) of the completely negative group showed a leucopenia. As to the cases over 10,000, there were only 5%(1 case) of all the 22 cases in the Arakawa-positive group, while there were 22%. (13 cases) of all the 61 cases belonging to the weakly Arakawa-positive, and 23% (13 cases) of all the 59 cases in the Arakawa-negative group. As will be

7 Blood Picture of Lactating Women 163 seen from Tables 6, A and B, the fluctuation of leucocyte count is morn remarkable in the weakly Arakawa-positive and the Arakawa-negative groups (or the clinically* Arakawa-negative group) than in the Ara kawa-positive group. 3. Lymphocytes (Cf. Tables 7, A and B). As has been shown it Table 7, A, in the Arakawa-positive group, 80% (32 cases) of all the 40 cases showed a lymphocytosis. 60% (78 cases) of all the 128 mothers in the weakly Arakawa-positive group and 64% (69 cases) of all the 109 lactating women belonging to the Arakawa-negative grout showed an increase of lymphocyte count. A lymphopenia was seen it 5% (2 cases) of all the 40 cases with the Arakawa-positive milk and in 8% (11 cases) of all the 128 lactating women belonging to the weakl Arakawa-positive group. In all the 109 mothers who secrete milk negative to Arakawa's reaction, 4% (5 cases) showed a lympho penia. The grade of lymphocytosis and lymphopenia, and the fluctua tion of lymphocyte count were the same in each group. And yet the grade of lymphocytosis was larger in each group than that of lympho penia. From the above mentioned fact one can suppose that in eacl group a lymphocytosis is seen, and that an individual average of lymphocyte count is high in mothers with the Arakawa-positive mill and is low in mothers of the clinically Arakawa-negative group though there is a slight difference between the two groups of the clinically Arakawa-negative group. As a whole, lactating women showed a slight lymphocytosis, but as will be seen from Table 4, B an average of lymphocyte count in each mother seems to be a little large: in the Arakawa-positive group than in the clinically Arakawa-nega tive group. 4. Neutrophiles (Cf. Tables 8, A and B). As will be seen fron Table 8, A, in the Arakawa-positive group, 35% (14 cases, about one third of all the cases of the group) of all the 40 cases showed a neutro philia, 35% (14 cases, about one third of them) a normal count o neutrophiles, and 30% (12 cases, almost one third of them) a neutro penia. In the weakly Arakawa-positive group, 42% (53 cases, abou two fifths of all the cases of the group) of all the 128 cases showed,, neutrophilia, 20% (26 cases, about one fifth of them) a normal count of neutrophiles, and 38% (49 cases, almost two fifths of them) a neutro penia. In the Arakawa-negative group, 52% (56 cases, about half of this * The meaning of "clinically" here, see the foot-note in the introduction c paper.

8 164 Y. Kokubo TABLE Blood picture of the weakly

9 Blood Picture of Lactating Women Arakawa positive group.

10 166 Y. Kokubo

11 Blood Picture of Lactating Women 167

12 168 Y. Kokubo all the cases of this group) of all the 109 mothers showed a neutro philia, 17% (19 cases, about one sixth of them) a normal count of neutrophiles, and 31%(34 cases, one third of them) a neutropenia. The grade of the neutrophilia is the more intense, the weaker the reac tion of the group is. It is also the case with the grade of the leuco penia, though there are slightly more cases of leucopenia in the weakly Arakawa-positive group than in the completely Arakawa-negative. The fluctuation of the neutrophile count was larger in the weakly Arakawa-positive and -negative groups than in the Arakawa-positive group. An averaged count of neutrophiles, as will be seen from Table 4, A showed unexpectedly almost the same one in each group under the upper limit of a normal count. This rather strange coincidence will be due to the fact that there were cases with neutropenia as well as neutrophilia in about an equal number in the weakly Arakawa-positive and -negative groups.

13 Blood Picture of Lactating Women Basophiles (Cf. Tables 9, A and B). As to basophile leucocytes, my investigation of it showed, as can be verified from Table 9, A, a count within normal limits in three fourths of the whole cases of each group. Of the cases with a basophilia, only a very slight inclination to an increase of this cell was seen as the reaction of the group became strong. Table 4, A, shows that an average of basophile count was also within normal limits in each group. 6. Eosinophiles (Cf. Tables 10, A and B). In the Arakawa-posi tive group, 52% (21 cases, about half of all the cases of this group) of all the 40 lactating women showed, as enumerated in Table 10, A, an eosinophilia, 25% (10 cases, one fourth of them) a normal count of eosinophiles, and 23% (9 cases, about one fourth of them) an eosino penia. In the weakly Arakawa-positive group, 50% (64 cases, half of all the cases of this group) of all the 128 cases showed an eosinophilia, 16% (20 cases, about one sixth of them) a normal count of eosino

14 170 Y. Kokubo TABLE Blood picture of the completely or almost

15 Blood Picture of Lactating Women conapletely Arakawa-neqative aroup.

16 172 Y. Kokubo

17 Blood Picture of Lactating Women 173

18 174 Y. Kokubo TABLE 4, A. Average count of different blood cell elements of lactating women according to different A rakawa's reaction. * Cf. text as to their judgement.** Number in a bracket shows the fluctuation of absolute count of each cell element.

19 Blood Picture of Lactating Women 175 TABLE 4, B. Average count of different blood cell elements of lactating women according to clinically Arakawa positive and -negative reaction. *.** Cf. foot-note to Table 4, A.

20 176 Y. Kokubo TABLE 5, A. Distribution of cases of each group according to different red cell counts. TABLE 5, B. Distribution of cases of the clinically Aralcawa-positive and -negative groups according to different red cell counts.

21 Blood Picture of Lactating Women 177 TABLE 6, A. Distribution of cases of each group according to different leucocyte counts. TABLE 6, B. Distribution of cases of the clinically Arakawa positive and -negative groups according to different leucocyte counts.

22 178 Y. Kokubo TABLE 7, A. Distribution of cases of each group according to different lymphocyte counts. TABLE 7, B. Distribution of cases of the clinically Arakawa positive ant -negative groups according to different lymphocyte counts. philes, and 34% (44 cases, about one third of them) an eosinopenia. In the Arakawa-negative group, 45% (49 cases, about half of all the cases of this group) of all the 109 lactating women showed an eosino philia, 23% (25 cases, about one fourth of them) a normal eosinophile

23 Blood Picture of Lactating Women 179 Distribution TABLE 8, A. of cases of each group according to different neutrovhile counts. TABLE 8, B. Distribution of cases of the clinically Arakawa positive and -negative groups according to different neutrophile counts.

24 180 Y. Kokubo TABLE 9, A. Distribution of cases of each group according to different basophile leucocyte counts. TABLE 9, B. Distribution of cases of the clinically Arakawa positive and -negative groups according to different basophile leucocyte counts. count, and 32% (35 cases, about one third of them) an eosinopenia. The fluctuation of eosinophile count was the same in each group. As a whole, about half of all the 277 lactating women showed an eosino philia, about one third or one fourth of them an eosinopenia, and the remaining cases showed a normal count of eosinophiles. As has been shown in Table 4, A, an averaged eosinophile count lay a little over

25 Blood Picture of Lactating Women 181 TABLE 10, A. Distribution of cases of each group according to different eosinophile leucocyte counts. TABLE 10, B. Distribution of cases of the clinically Arakawa positive and -negative groups according to different eosinophile leucocyte counts. the upper limit of the normal count. It may be said that lactating women will show generally an inclination to a very slight eosino philia.

26 182 Y. Kokubo TABLE Blood picture of each group with eosinophilia In my investigation of blood pictures of lactating women, I found the cases with an eosinophilia over 1,000 in absolute count. These cases are 4 cases in the Arakawa-positive group, 18 cases in the weakly Arakawa-positive group, and 5 cases in the Arakawa-negative group. These blood pictures are tabulated in Table 11. This remarkable eosinophilia was presumably clue to parasitic infestation. The re

27 Blood Picture of Lactating Women over 1,000 in absolute number. markable leucocytosis was thus mainly due to the pronounced eosino philia. 7. Monocytes (Cf. Tables 12, A and B). As will be shown in Table 12, A and B, in the Arakawa-positive group, 25% (10 cases, one fourth of all the cases of this group) of all the 40 lactating women showed a monocytosis, 50% (20 cases, half of them) a normal monocyte

28 184 Y. Kokubo TABLE 12, A. Distribution of cases of each group according to different monocyte counts. TABLE 12, B. Distribution of cases of the clinically Arakawa-positive and -negative groups according to different monocyte counts. count, and 25% (10 cases, one fourth of them) a monocytopenia. In the weakly Arakawa-positive group, 25% (32 cases, one fourth of all the cases of this group) of all the 128 mothers showed a monocytosis, 42% (54 cases, about half of them) normal count, 33% (42 cases, about

29 Blood Picture of Lactating Women 185 TABLE 13, A. Relation between different groups and nuclear shift. TABLE 13, B. Distribution of such cases as with the nuclear shift to the left according to different Arakawa's reaction. one third of them) a monocytopenia. In the Arakawa-negative group, 32% (35 cases, about one third of all the cases of this group) of all the 109 lactating women showed a monocytosis, 48% (52 cases, about half of them) a normal count, 20% (22 cases, about one fifth of them) a monocytopenia. Generally about half of all the 277 lactating women

30 186 Y. Kokubo showed a normal monocyte count. About a half of the remaining cases showed a monocytosis and about half a monocytopenia. The fluctuation of monocyte count was generally the same in each group. As will be seen from Table 4, A, an individual average of monocyte count was within normal limits. 8. Nuclear shift (Cf. Tables 13, A and B). Before relating of the nuclear shift in lactating women I used the following expression in the below described sense. "Nuclear shift to the left" in the pres ent paper was understood to be as follows: If cells of Class I were more than 8% and Hensen's 34) index increased above 50, then the blood was taken to be of the nuclear shift to the left. And if Suzuki's35 index was over 1.0, then the blood was taken to be of the nuclear shift to the right. In the Arakawa-positive group, 15% (6 cases) of all the 40 lactating women showed the normal shift, 80% (32 cases) the shift to the left, and 5% (2 cases) the right shift. In the weakly Arakawa positive group, the normal shift was seen in 22% (28 cases) of all the 128 mothers, the left shift in 77% (99 cases), and the right shift in 1% (1 case). In the Arakawa-negative-group, 17% (18 cases) of all the 109 lactating women showed the normal shift, 81% (89 cases) the left shift, and 2% (2 cases) the right shift. Speaking generally, the left nuclear shift in about 80% of all the 277 lactating women was seen. In the present investigation the cases with the shift to the right oc curred in each group in a different percentage from that in the preced ing investigation. As to the shift to the left, as will be seen from Table 12, B, the grade of it was relatively intense in the Arakawa negative group. The result that the grade of the left nuclear shift was more marked in the Arakawa-negative group than in the positive group will be more clearly seen if the cases with over 10% of cells with rod- shaped nucleus are considered. Hensen's index above 50 was seen in 75% (30 cases) of all the 40 cases with the Arakawa positive milk, in 63% (80 cases) of all the 128 mothers belonging to the weakly Arakawa-positive group, and in 89% (97 cases) of all the 34) Hensen's index =I+II: I is the percentage of Class I in Arneth's neu trophile count, and II of cells of Class II in a given case. When this index increases above 50, it is a sign of a pathological condition (Quoted from I. Nagao and T. Maki's Paper, Cf. Nyujigaku Zassi, 1929, 5, 514). 35) Suzuki's index= 4(IV+V)/ I+II+III: I, II, III, IV and V are numbers of cells be longing to Classes I,.II, III, IV and V respectively in Arneth's count. If Suzuki's index is larger than I, there is a shift to the right (T. Suzuki, Tohoku J. Exp. Med., 1937, 30, 378).

31 Blood Picture of Lactating Women lactating women showing the Arakawa-negative reaction. As will be seen in Table 4, A, an average of cells Class I in each group showed almost the same count, but the fluctuation was larger in the weakly Arakawa-positive and Arakawa-negative groups than in the Arakawa-positive. Comment. According to a number of papers published from this Laboratory, we believe that healthy lactating women with no complaint and with milk strongly or normally positive to Arakawa's reaction should mostly be considered as normal, or at least not suffering from B-avita aninosis. On the other hand we believe that apparently healthy mothers with the Arakawa-negative milk are generally on the verge or already in a state of B-avitaminosis. Then what is the normal blood TABLE 14. Standard Table of Normal Blood Picture for Lactating Women. *, ** Cf. the foot-note to Table 4, A.

32 188 Y. Kokubo picture of lactating women? As to the total white cell count, lym phocytes and neutrophiles, the result was equal to that shown in my preceding paper.1) The normal blood picture of mothers shows a slight leucocytosis chiefly resulting from a slight and absolute increase of lymphocytes and slight nuclear shift to the left, while in B-avita minotic mothers the leucocytosis results from neutrophilia as well as from lymphocytosis. As will be seen from Table 7, A, in the Arakawa positive group, 80% (32 cases) of all the 40 lactating women showed a lymphocytosis, and a lymphopenia was seen in only 5% (2 cases). 60% (78 cases) of all the 128 mothers belonging to the weakly Arakawa positive group showed a lymphocytosis, and 8% (11 cases) a leuco penia. 64% (69 cases) of all the 109 lactating women with the Ara kawa-negative milk showed a lymphocytosis, and a lymphopenia was seen in only 4% (5 cases). And yet the grade of lymphocytosis was larger in each group than that of lymphopenia; in other words, the increase of the lymphocyte count was to the extent of 3,000-4,000, while the decrease of it was only to the extent of about 1,300. From the above related fact, one can see that a lymphocytosis is more re markable in the Arakawa-positive group than in the Arakawa-nega tive group. TABLE Sato-Susuki's Standard Table of Normal Note:-* Suzuki's index= 4(IV+V)/I+II+III: I, II, III, and V are numbers of If Suzuki's index is larger than I, there is a shift to the right.

33 Blood Picture of Lactating women 189 In adult cases of beriberi, Ido,12) Jinbo23) and Kubo13) reported a decrease of red cell count, but Sarai28) stated that the decrease was only slight. My own result showed a normal count in most cases with the Arakawa-negative milk as well as in most cases with positive Arakawa's reaction. Eosinophiles: Makita22) reported an increase in number of them in the case of beriberi. In the same disease, Ido12) stated that the eosinophile count either increased or decreased, but I examined his result on the basis of absolute count, and it showed an increase of the eosinophile count in about 65% of all his cases. Jinbo23) reported that eosinophiles had no relation to beriberi, though the average count showed 334 in number in his paper, but examining his own result basing on absolute count, an eosinophilia was seen in 39% of all his cases. Kubo13) stated that they did not increase in most cases of beriberi, but 46% of all his cases showed an eosinophilia in absolute number according to my calculation. Sarai28) noticed an increase of eosinophiles in a certain period in the course of beriberi. In my own result, the eosinophile count showed a slight increase not only in mothers with the Arakawa-negative milk, but also in the lactating women belonging to the Arakawa-positive group. Then it will be 15. Blood Picture for Every Age. cells belonging to Classes I, II, III, IV and V respectively in Arneth's count.

34 190 Y. Kokubo known that lactating women are slightly prone to eosinophilia. Monocytes: Makita,22) Kubo13) and Sarai28) did not relate of these cells in beriberi, but in my own calculation on the basis of count in their papers, monocyte count lay within normal limits. Jinbo23) reported an increase of monocyte count in a very slight grade, though the monocytosis occurred in only 33% of all the cases. In my own investigation, B-avitaminotic mothers with negative Arakawa's reaction as well as mothers with the positive showed a monocyte count within normal limits (Cf. Tables 12, A and B). Basophiles: Of basophiles in the case of beriberi, most authors reported that no variation of the count was seen. In my own result, they showed a normal count in the healthy mothers with the Arakawa negative milk as well as in those with the Arakawapositive milk. Standard Table of Normal Blood Picture of Lactating Women. Starting from the above shown blood picture of 40 healthy mothers with the Arakawa-positive milk, I compiled a Standard Table of Normal Blood Picture for Normal Healthy Lactating Women or Mothers with Normal Arakawa's Reaction (Cf. Table 14). Summary and Conclusions. Basing on the result of investigation in 277 "healthy" lactating women with Arakawa-positive and -negative milk, I have come to the following conclusions: 1. The blood picture of lactating women with Arakawa-positive milk will show a slight leucocytosis mainly resulting from a slight lymphocytosis and a very slight eosinophilia, and a slight nuclear shift to the left. It is very probably the blood picture of healthy lactating women. 2. Apparently healthy lactating women with milk negative to Arakawa's reaction or who are probably on the verge or already in a state of B avitalninosis show a leucocytosis chiefly resulting from a very slight eosinophilia as well as from lymphocytosis and neutro philia. 3. Red blood cells, basophiles, and monocytes will not show a remarkable deviation from within the normal limits in all the "healthy" mothers. 4. A Standard Table (Table 14) of Normal Blood Picture for Healthy Lactating Women is compiled.