582 SAMUEL H. HURWITZ 



greater uric acid elimination, and others have observed an increase in 

 the purin bases, either with or without a uric acid increase, there are 

 those whose results show the variations found in health. The reasons 

 for these fluctuations will be considered later. 



The few available metabolic studies carried out on patients with acute 

 leukemia have led, on the whole, to some uniformity of result. The 

 evidence points out only to a rapid destruction of body protein in the 

 acute forms of leukemia, as indicated by the enormous loss of nitrogen 

 in the urine, but also to an accelerated nuclein catabolism with increased 

 elimination of uric acid. The careful observations both of Magnus-Levy 

 (c) and of Edsall(&) support this view. The former studied three such 

 patients on a purin-poor diet. In one of these, he found the uric acid 

 nitrogen 2.91 grams two days before death, and in the other two patients 

 observed over longer periods, he noted an average uric acid nitrogen ex- 

 cretion of 0.655 and 0.523 gram respectively. 



In the chronic types of leukemia, this phase of metabolism has been 

 more extensively studied. From a review of the literature of this subject, 

 the conclusion may be drawn that, during the ordinary clinical course of 

 the disease, the excretion of uric acid and the purin bases may be within 

 normal limits, but that during periods of rapid leukocyte formation, and 

 more especially during periods of rapid leukocyte destruction, the change 

 may be indicated by fluctuations in the output of these bodies. Such 

 fluctuations, however, do not always occur. 



A comparison of the results obtained in the two forms of chronic 

 leukemia are of interest. Both Magnus-Levy (c) and von Stejskal and 

 Erben(a) among the earlier workers report higher values for uric acid 

 nitrogen in the myelogenous than in the lymphatic form of leukemia. 

 Thus von Stejskal and Erben record an output of 0.354 gram of uric acid 

 nitrogen in a patient with myelogenous leukemia as compared with an 

 elimination of only 0.232 gram in an instance of the lymphatic type. 

 These observations have, in the main, received support from later inves- 

 tigators (Schmidt, Galdi, Rotky, Lessen and Morawitz, Goodall). 



In Goodall's case of chronic myelogenous leukemia, there was a high 

 endogenous uric acid elimination, but this showed marked variations, 

 which had no relation to the total nitrogen excretion or to the rate of 

 leukocyte destruction. This worker concluded, therefore, that the de- 

 structive process might be carried beyond the uric acid stage, and that 

 under certain conditions, retention of uric acid might occur for the 

 purpose of the new formation of leukocytes. 



Certain it is that not all patients with chronic leukemia show an 

 increased uric acid elimination. This is particularly true of the lymphatic 

 form of the disease. With the exception of Wende, who reports a case 

 of lymphatic leukemia with a uric acid excretion of 5 grams, most investi- 

 gators (Henderson, Vas, Rzentkowski, Murphy, Means and Aub), who 



