

PATHOLOGICAL METABOLISM OF THE BLOOD 581 



certain periods in the course of the diseases of this group, the elimination 

 may he high. Thus Schmidt in two patients with severe anemia noted an 

 increased elimination of purin nitrogen and Rosenqvist, as a result of his 

 studies of pernicious anemia and bothriocephalus anemia, reports large 

 outputs of uric acid, sometimes twice the normal Pepper and Austin (c), 

 on the other hand, found in their careful meta-bolic study of a patient 

 with pernicious anemia, a uric acid output, which never exceeded normal 

 limits (Table 6). Their interesting finding of a decrease of 22 per cent 

 in the uric acid elimination after splenectomy will be considered later. 



The observations of Rosenqvist on the uric acid matabolism in bothrio- 

 cephalus anemia are of great importance because the toxic agent in this 

 type of anemia is known. He found that after the extrusion of the 

 tapeworm from the body, there is first an increased elimination of purins 

 and then a return to the normal. This initial rise has been explained as 

 the result of an increased metabolic activity of the blood and somatic cells 

 following the removal of a toxic substance. 



It is not improbable that some toxic factor may play a part also in 

 the increased nuclein metabolism noted in congenital hemolytic jaundice. 

 In one form of hemolytic icterus produced experimentally by the injection 

 of hemolytic serum into animals, Jackson and Pearce found the elimina- 

 tion of purin bodies increased. Similarly, high figures for uric acid 

 have been reported by Tileston and Griffen, McKelvy and Rosenbloom, 

 and Goldschmidt, Pepper and Pearce, in patients with congenital 

 hemolytic jaundice (Table 7). According to McKelvy and Rosenbloom, 

 the large output of purin, noted in this disease, may be due to the greater 

 formation of nucleoprotein resulting from the destruction of red cells. 

 Pearce and his co-workers, however, are inclined to the view that the 

 increased cellular metabolism is attributable, in part at least, to the toxic 

 influence on the somatic cells of bile products. They point out that the 

 sallow discoloration of the skin in the disease is indicative of the general 

 dissemination of a substance absorbed directly or indirectly from the 

 bile, the toxic action of which may explain the widespread cell disintegra- 

 tion with the resulting increase in the products of nuclein metabolism. 

 The remarkable effect of splenectomy in decreasing the uric acid output 

 in this disease almost to one-half the initial amount will be discussed in 

 its proper place. 



The Elimination of Uric Acid and Purin Bases in Leukemia. 

 Studies of purin metabolism in diseases of the blood have a particular 

 interest in leukemia. In general, it might be expected that the enormous 

 increase in the nucleoprotein-containing tissues and blood-cells, which 

 occur in this disease, would give rise to a greatly increased catabolism of 

 nucleins, with the consequent appearance of greater amounts of uric 

 acid and of purin bases in the urine. Urinary findings, however, have 

 been very variable in this respect. Whereas, some workers have noted a 



