310 DISTURBANCES OF CIRCULATION 



As the most characteristic products of decomposition of nucleo- 

 proteins are the purine bases, one would also expect to find them 

 present in leukemia, and early writers mention the finding of 

 purine bases and uric acid in the blood and spleen. The urinary 

 finding's in this respect have been very variable. Ebstein ®* observed 

 the complication of leukemia with gout which he considered a coin- 

 cidence, and also noted uric-acid concretions in the urinary passages 

 in four cases. Numerous other authors have described increased uric- 

 acid elimination, while some have observed increase in the purine 

 bases, either witli or without uric-acid increase. ]Magnus-Levy ®^ 

 observed a particularly large uric-acid output in acute leukemias, but 

 also found that the relation between the number of leucocytes and 

 the uric acid is extremely variable. Sometimes the nitrogen loss is 

 very great — even as much as 20 gm. per day — and, corresponding 

 with the destruction of nucleoproteins and the resulting uric-acid 

 formation, phosphoric-acid excretion is often greatly increased — even 

 up to 15 gm. per day. On the other hand, the results obtained by 

 many other writers have been in every respect extremely variable ; 

 some have found no increase in uric acid, some even report a decrease ; 

 likewise the PoO-, has been found even less than normal. For ex- 

 ample, in a carefully studied case of lymphatic leukemia, Henderson 

 and Edwards ^*^ found during six months no excessive excretion of 

 uric acid or phosphoric acid. Zalesky and Erben found likewise no 

 considerable increase in the uric acid in lymphatic leukemia, but in 

 myelogenous leukemia the uric acid was much increased ; on the other 

 hand, the amount of elimination of purine bases was reversed in the 

 two forms, and creatin M^as decreased in both. Lipstein ^' found no 

 excessive elimination of amino-acids even in myelogenous leukemia. 

 An increase in calcium is quite constantly observed, and attributed to 

 the bone destruction ^^ occurring in this disease. 



Undoubtedly these variations in results depend upon the known 

 fluctuations in the course of the pathological processes of leukemia ; the 

 number of leucocytes, the size of the lymphatic organs, and the general 

 condition of the patient all vary greatly from time to time, often with 

 remarkable rapidity, and the excretion of products of metabolic ac- 

 tivity must vary likewise. It can hardly be questioned that the 

 enormous increase in the amount of lymphoid tissue in the body and 

 blood must give rise to a greatly increased nuclein catabolism, with 

 conse(iuent appearance of its products (uric acid, purine bases, and 

 phosphoric acid) in the urine. This seems to be well demonstrated 

 by the increased elimination of uric acid and purine bases, together 

 with a general increase in the nitrogen output that has been frequently 



84 For litoraturo soo rr'smiH' bv Walz in Cent. f. I'atliol.. lOOl (12). 985. 



85 Virchow's Arch., ISOS (152). 107. 

 soAmer. Jour, of Physiol., 1!)03 (0), 417. 

 87 Loc. cit. inf. 



