574 SAMUEL H. HUEWITZ 



has been likewise attributed to the very active metabolism of young 

 white cells. But it is doubtful whether the high metabolism is entirely 

 due to the leukocytes. Grafe's experiments on the metabolism of blood 

 do show an increased oxygen consumption in leukemic blood. It has been 

 estimated, however, that only 10 per cent of the total oxygen consumption 

 can be referred to the leukocytes, whereas the rise in the basal metabolism 

 may range at times from 40 to 60 per cent. Murphy, Means and Aub have 

 plotted the leukocyte counts and the heat production noted in their own 

 patient with chronic lymphatic leukemia, as well as in the recorded cases 

 (Table 4) to see whether there was any relation between the leukocyte 

 count and the level of the metabolism. They foiind a certain parallelism 

 to exist in individual cases, the fall in leukocytes being always much 

 greater than that in the metabolism (Fig. 3). Among different cases, 

 however, there was no such relation. But the lack of such relationship 

 does not, according to these workers, disprove Grafe's theory, since the 

 determining factor is the rate of production of white blood-cells and not 

 their total number. 



Protein Metabolism. The Nitrogen Balance in Anemia. The 

 earliest work on the changes in protein metabolism in the anemic organ- 

 ism was carried out on animals. Although many of these studies were 

 made by very defective methods, according to present-day views, the results 

 obtained appear nevertheless to coincide with those of later workers. 



Bauer was the first to study the effect of hemorrhage on the nitrogen 

 elimination in the dog. In a well-nourished animal, in nitrogen equi- 

 librium, he found the average daily elimination of nitrogen for four days 

 before bleeding to be 16.6 grams. After a hemorrhage amounting to 2 

 per cent of the body weight, the nitrogen output for three days following 

 the bleeding averaged 19.9 grams. By the sixth day, the nitrogen balance 

 was again restored, the average elimination between the sixth and ninth 

 day being 16.1 grams nitrogen. In the fasting animal, Bauer obtained 

 essentially similar results. From an average nitrogen output of 3.27 

 grams before bleeding, the figure rose to an average of 4.75 grams after 

 blood-letting. These results lead Bauer to the conclusion that external 

 hemorrhage temporarily increases protein catabolism, and that the effect is 

 relatively greater in fasting animals than in well-nourished ones. 



With the exception of Ascoli and Draghi, who demonstrated a de- 

 creased rather than an increased protein catabolism in acute posthemor- 

 rhagic anemia, the conclusions of subsequent investigators coincide, in 

 the main, with those of Bauer. Jiirgensen, for instance, working on 

 fasting dogs, in nitrogen equilibrium, found that whereas small hemor- 

 rhages produced little change, losses of blood equal to 1.2 per cent to 3.4 

 per cent of the body weight result in an increased urea elimination in 

 the urine. 



It is of interest that the more carefully planned observations of later 



