

PATHOLOGICAL METABOLISM OF THE BLOOD 583 



have studied the nuclein metabolism in chronic lymphatic leukemia, have 

 noted an output of uric acid which was normal or on the upper limits of 

 normal. 



In the paragraphs on the nitrogen metabolism in leukemia attention 

 was called to a possible explanation of the variations observed. It is not 

 unlikely that in this instance also the same natural fluctuations in the 

 pathological processes and in the clinical course, which characterize this 

 disease, may explain the variability of results obtained in the studies on 

 the elimination of the puriii bodies. 



That no definite parallelism exists between the quantity of uric acid, 

 excreted and the number of circulating leukocytes appears fairly certain 

 from the work of the majority of investigators (Mohr(i)). High values 

 have been found associated not only with large numbers of leukocytes, but 

 also with relatively small numbers. The same lack of parallelism has been 

 observed between the degree of leukocytic disintegration produced by the 

 rontgen-rays and by radium and the quantity of uric acid excreted in 

 the urine. This aspect of the subject will receive fuller consideration in 

 the paragraphs relating to the effects of the actinic rays on metabolism 

 in blood diseases. 



The Partition of Other Nitrogenous Constituents of the Urine. 

 The effect of anemia on the elimination of certain of the other urinary 

 nitrogenous substances has been studied quite extensively. The main in- 

 terest in these observations lies in the knowledge which they give concern- 

 ing the influence of a paucity of hemoglobin on the synthesis of urea by 

 the liver, the development of acidosis as indicated by the excretion of 

 ammonia, and the metabolism of the amino-acids. 



The results of the determinations of the partition of urinary nitro- 

 gen in experimental and clinical posthemorrhagic anemias are somewhat 

 discordant. Observations on the influence of hemorrhage in animals upon 

 the nitrogen partition have been made by Haskins(a) and more recently 

 by Buell (&). After the removal of 250 c.c. of blood from a dog, Haskins 

 noted a decrease in the urea and creatinin nitrogen, the former dropping 

 13.7 per cent and the latter 7.8 per cent; while the ammonia nitrogen 

 increased to the extent of 11 per cent. Buell, on the other hand, observed 

 no change in the elimination of urea, ammonia, and creatinin, the only 

 difference noted being an increased output of creatin. The cause of this 

 creatinuria is not quite clear. It may better be explained, according to 

 Buell, by the occurrence of an alteration in the course of nitrogen metabol- 

 ism following hemorrhage, rather than by the development of an acidosis, 

 which does not, 'as a rule, follow hemorrhage. 



In the acute and chronic posthemorrhagic anemias of man, the older 

 work, reviewed by Strauss (e) and by Mohr(i), points to little variation 

 from the normal nitrogen partition. The fluctuations which have been 

 noted are all within the normal physiological limits. Occasionally, a high 



