PATHOLOGICAL METABOLISM OF THE BLOOD 585 



put in a patient with pernicious anemia, whereas von Jaksch(j), and 

 Halpern record a normal nitrogen partition of urea, ammonia, and ammo- 

 acids in a number of instances of severe anemia including some cases of 

 bothriocephalus anemia. And Denis (d) in her study of two patients with 

 pernicious anemia before and after splenectomy also reports normal varia- 

 tions in the output of creatin and creatinin. 



Three complete metabolism studies of patients with hemolytic icterus 

 are available for analysis. Tileston and Griffen in a patient with "chronic 

 family jaundice," on a purin-free and creatin-free .diet, found the elimi- 

 nation of creatinin and urea to be essentially normal, ammonia somewhat 

 high, and as already mentioned, the uric acid distinctly increased. Mc- 

 Kelvy and Rosenbloom came to the same conclusion. Their patient with 

 congenital hemolytic jaundice also showed a normal excretion of urea, 

 ammonia, amino-acids and creatinin, with a decided increase in uric acid 

 elimination. These findings have been confirmed by Goldschmidt, Pepper 

 and Pearce. The temporary change which occurred in the partition of 

 creatinin and creatin, following the removal of the spleen in- their' patient 

 will be referred to in the paragraphs on splenectomy. 



Determinations of the partition of urea, ammonia, amino-acids, creatin 

 and creatinin in leukemia have been carried out by many workers (Mag- 

 nus-Levy (c), von Stejskal and Erben(a), von Jaksch(/), Halpern). The 

 figures obtained are, on the whole, within the limits of normal physio- 

 logical variation. Inasmuch as the details of these observations have 

 already been presented in previous reviews of this subject, they will not 

 be further discussed here. 



Mineral Metabolism. The paragraphs on mineral metabolism will 

 be devoted to a consideration of the behavior of iron, phosphoric acid and 

 the earthy metals and of sulphur. These substances have an especial in- 

 terest in diseases of the blood because of the intimate relationship of iron 

 to hemoglobin metabolism, and of phosphoric acid and sulphur to the 

 catabolism of nucleoprotein and of body tissue protein, which, as has 

 been pointed out, may at times be greatly accelerated in diseases affecting 

 the blood and the blood-forming organs. 



Iron Metabolism. The importance of iron as a constituent of 

 hemoglobin makes it a factor of great importance in the study of the 

 anemias. But the progress which has been made in this phase of metabol- 

 ism in disease has been limited to a large extent by the lack of accurate 

 information concerning the assimilation and elimination of iron in health. 



What knowledge we possess concerning the metabolism of iron has been 

 concisely summarized by Pearce : "Iron is absorbed to only a very limited 

 extent from the gastro-intestinal tract, so that when abundant in the food 

 it passes from the intestine for the most part unchanged. As much as 

 is absorbed is taken up chiefly from the small intestine and carried by 

 the lymph, to be deposited in the liver and. to a lesser extent in the spleen, 



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