Other authors infer a relative and not an absolute increase in the number of red corpuscles. E. Grawitz, for example, has expressed the opinion that the raised count of corpuscles may be explained chiefly by increased concentration of the blood, due to the greater loss of water from the body at these altitudes. The blood of laboratory animals which Grawitz allowed to live in correspondingly rarefied air underwent similar changes. Von Limbeck, as well as Schumburg and Zuntz, object to this explanation on the ground, that if loss of water caused such considerable elevations in the number, we should observe a corresponding diminution in the body weight, which is by no means the case.
Schumburg and Zuntz also regard the increase of red blood corpuscles in the higher mountains as relative only, but explain it by an altered distribution of the corpuscular elements within the vascular system. In their earlier work Cohnstein and Zuntz had already established that the number of corpuscles in the capillary blood varies with the width of the vessels and the rate of flow in them. If one reflects how multifarious are the merely physiological influences at the bottom of which these two factors lie, one will not interpret alterations in the number of the red corpuscles without bearing them in mind. In residence at high altitudes various factors bring about alterations in the width of the vessels and in the circulation. Amongst these are the intenser light (Fülles), the lowering of temperature, increased muscular exertion, raised respiratory activity. Doubtless, therefore, without either production of microcytes or production _de novo_, the number of red corpuscles in capillary blood may undergo considerable variations.
The opposition, in which as mentioned above, the views of Grawitz, Zuntz, and Schumburg stand to those of the first mentioned authors, finds its solution in the fact that the causes of altered distribution of the blood, and of loss of water, play a large part in the sudden changes. The longer the sojourn however at these great elevations, the more insignificant they become (Viault).
We think therefore that from the material before us we may draw the conclusion, that after long residence in elevated districts the number of red blood corpuscles is absolutely raised. The therapeutic importance of this influence is obvious.