312 DISTURBANCES OF CIRCULATIOX 



also occasionally in the freshly drawn blood of leukemics. Poehl^s believes thorn 

 to be the same as Bottcher's spermin crystals, and derived from decomposed 

 nucleins. Schreiner considers that these spermin crystals are phosphoric acid 

 salts of spermin (C2H5N), or, as Majert and Schmidt give it, C^HioXo, with the 



structure UN <nH"_r'TT^> NH, thus being similar to, although not identiral 



with, piperazin. The entire question of the composition of spermin is still un- 

 settled, ^^ however; and it is probable,' furthermore, that the crystals found in 

 leukemia are not identical with the crystals observed in semen. 



Crystals that appear similar are also found in asthmatic sputum, empyema, 

 and ascites fluid, bone-marrow, and tumors, and it has been suggested that they 

 are derived from or related' to the oxyphile granules of the eosinophiles.*"^ This 

 view implies an agreement with Gumprecht's opinion that the crystals seen in 

 bone-marrow, asthmatic sputum, etc., are not spermin, but of protein nature. 

 As can be seen, the nature and significance of Charcot's crystals are, at the pres- 

 ent time, quite undetermined. 



Summary. — The chemical changes observed in leukemia depend 

 upon the excessive quantity of leucocytes and lymphoid tissue, which 

 undergo processes of disintegration at irregular intervals, with the 

 result that the products of nucleoprotein destruction (uric acid, purine 

 bases, and phosphoric acid) appear in the urine in increased quantities. 

 As the large neutrophiles contain abundant autolytic enzymes, the prod- 

 ucts of cell autolysis (proteoses, amino-acids, and products of nucleo- 

 protein destruction) may appear at times in the urine and in the blood; 

 because of the small amount of such enzymes in the lymphocytes, these 

 changes are all much less marked in lymphatic leukemia. Charcot's 

 crystals, which are perhaps derived from leucocytic nucleoproteins, 

 may be found in the blood and tissues. The changes in the red cells 

 are chiefly those of a secondary anemia, with occasionally some chlo- 

 rotic features. The chemical findings of leukemia throw no light 

 whatever upon the cause of the disease. 



Pseudoleukemia and Hodgkin's disease show only the evidences of 

 a secondary anemia, without the chemical changes of either leukemia 

 or pernicious anemia. There seems to have been little study of tlu' 

 chemical processes of these diseases. Moraczewsld^i reports a study 

 of metabohsm in one case, designated by him as pseudoleukemia and 

 so quoted in subsequent literature, although the only leucocyte count 

 mentioned in the original article was 171,000. This case showed some 

 retention of nitrogen and calcium, with little change in the phosphorus 

 and purine bases in the urine. 



HYPEREMIA 

 Active Hyperemia 



This condition is associated with but few chemical changes. Cei- 

 tain chemicals may cause active hyjxM-emia; some locally, as in the 



" Deut. med. Woch., 1895 (21), 475. 



^* Literature, see HaTiimarsten, Amer. Transl., lUOl, p. -120. 

 ■•» Literature, see Floderer, Wien. klin. Woch., 190:i (16), 276; Predtetschenskv, 

 Zeit. klin. Med., 1<)0() (5«)), 29. 



*' Virchow's .Vrch., 1898 (151), 22. 



