PATHOLOGICAL METABOLISM OF THE BLOOD 567 



due to a loss of a normal stimulus to blood-formation. Then, too, the 

 divergent results may be better explained if it be remembered that re- 

 moving the spleen takes away only one organ of a system composed of 

 liver, spleen, lymph nodes, and bone-marrow, and it is not unlikely that 

 the interrelations which exist in the system may at times bring into play 

 compensations of the greatest importance in determining the degree of 

 blood destruction and regeneration. 



Metabolism in Diseases of the Blood 



A. Basal Metabolism in Anemia and Leukemia. A great impetus to 

 the study of basal heat production and respiratory metabolism in blood 

 diseases followed the development of improved methods of direct and 

 indirect calorimetry. Critical reviews of the earlier and the more recent 

 work on this subject have been written by Strauss(e), Mohr(f), Meyer 

 and Du Bois, Murphy, Means and Aub and Tompkins, Brittingham and 

 Drinker. 



Experimental and Clinical Observations. Studies of the basal 

 metabolism in animals have been limited, for the most part, to posthemor- 

 rhagic anemia. Bauer was among the first to show that the with- 

 drawal of a considerable quantity of blood, amounting to 20 to 28 per cent 

 of the calculated blood volume, may result in a lessened oxygen consump- 

 tion and a diminished carbon dioxid production on the day following the 

 bleeding. As a result of these experiments, the view became prevalent 

 that a paucity of hemoglobin seriously impaired the oxidation processes 

 and lowered the metabolic functions of the body. Subsequent investiga- 

 tions, however, proved that this hypothesis was incorrect inasmuch as no 

 permanent departure from the normal metabolism could be demonstrated 

 following blood-letting in animals. Finkler, and Pembrey and Giirber, 

 for instance, found the respiratory metabolism in experimental secondary 

 anemias normal and Delchef normal or slightly diminished; whereas, 

 Fredericq, Lukjanow, and Hari(6) demonstrated the existence of a some- 

 what elevated metabolism. The increase noted by the last three investi- 

 gators is not striking. Fredericq, who measured the heat production with 

 the D'Arsonval compensation calorimeter, obtained results which have 

 been shown to be well within the experimental error. Lukjanow found a 

 10 per cent increase in oxygen consumption immediately after the with- 

 drawal of blood, but this did not persist on the day following the bleeding. 

 And only once did Hari, using a Kubner calorimeter, find an increase of 

 12 per cent in the heat production of a dog after bleeding. It appears, 

 therefore, that the variations noted by different observers are not sig- 

 nificant, and that the tendency is distinctly toward a normal metabolism 

 in posthemorrhagic anemia. Such diversity of results as have been 



