METABOLISM IN CANCER 511 



eralization" b}' Robin,''* but no alteration in the excretion of chlo- 

 rides.'^ As in other cachexias, the creatin content of the muscles 

 is decreased.'" FraenkeP' finds evidence that there may be some diffi- 

 culty in tryptoj)hano inc^tabolisni in tumors and in tumor patients, 

 especially marked with melanotic tumors. Extensive respiratory 

 studies by Wallersteiner-^ showed enormous variations in the amount of 

 heat production in different cases, in about 10 per cent, of which figures 

 as hip;h as those of severe fevers or exophthalmic goiter were obtained 

 repeatedly; most of the cases showed high normal figures. Nitrogen 

 loss did not ordinarily occur if the calorimetric findings were considered 

 in the calculations; nitrogen equilibrium was maintained if sufficient 

 nourishment was obtained and utilized. In general, metabolism in 

 cancer resembles that of fever, and warrants the assumption of a toxic 

 stimulation of tissue destruction. It is entirely possible that the pro- 

 ducts of cancer protein destruction are responsible for this toxicogenic 

 metabolic abnormality, since Vaughan has demonstrated that the 

 effects of bacteria and foreign proteins are quite the same in their 

 pyretic and toxic action. 



Salkowski demonstrated that the amount of colloidal nitrogenous 

 material, precipitated from the urine by strong alcohol, is increased in 

 cancer. Numerous observers have corroborated this, but find that a 

 similar conchtion obtains in other cachectic diseases, although in cancer 

 the amount of colloidal nitrogen seldom is as low as normal unless the 

 tumor is removed. ^^ Much of this colloidal nitrogen seems to be in the 

 form of "oxy-proteic acid" (Salomen and Saxl),-'* which is a mixture 

 of incompletely oxidized polypeptids, containing much unoxidized sul- 

 phur." The proportion of neutral sulphur in the total sulphur in the 

 urine seems to be increased in cancer (Weiss), but not so constantly 

 or characteristically as to be of great diagnostic value." Much clinical 

 investigation has been made of these urinary changes, which has gen- 

 erally substantiated the fact that there usually is more increase in 

 colloidal nitrogen and ethereal sulphate in the urine of cancer than 

 in other diseases, but that in no sense are these changes specific for 

 cancer, and the fundamental metabolic disturbances responsible have 



^^ Quoted by Lewin, he. cit.^^ Clowes et al. (5th Ann. Rep., X. Y. State Dept. 

 of Health, 1903-4) report observing a slight chloride retention in cancer patients, 

 and review the literature of metabolism in cancer. 



'8 Robin, Compt. Rend. Acad. Sci., 1913 (156), 1262. 



20 Chisholm, Biochem. Jour., 1912 (6), 243. 



=' Wien. klin. Woch., 1912 (25), 1041. 



22 Deut. Arch. klin. Med., 1914 (116), 145. 



23 See Mancini, Deut. Arch. klin. Med., 1911 (103), 288; Semenow, Foha Urol., 

 1912 (7), 215; de Bloeme et al, Biochem. Zeit., 1914 (65), 345. 



2* Wien. klin. Woch., 1911 (24), 449. 



25 Killian reports finding in the blood two to three times the normal amount of 

 nonprotein sulphur while the total sulphates remain normal. ("Cancer: Its 

 Nature, Causes, Diagnosis and Treatment." By R. H. Greene, New York, 1918.) 



2« Stadtmijller and Rosenbloom, Arch. Int. Med., 1913 (12), 276; Interstate 

 Med. Jour., 1916 (23), No. 2; bibliographv. Kahn, Jour. Cancer Res., 1917 (2), 

 379. 



