fill metabolic study, however, Pepper and Austin (c) found a marked 

 increase in the iron of the feces only after removal of the spleen. 



Although an increased iron excretion in pernicious anemia may occur 

 at times in the presence of greater blood destruction, it should be empha- 

 sized that the quantity of iron eliminated is no quantitative index of 

 the amount of blood destroyed because unknown -amounts of iron derived 

 from the broken down hemoglobin are stored in the various organs and 

 tissues of the body (Queckenstedt). 



An excessive loss of iron from the body in hemolytic icterus has been 

 a constant finding. Such a liberation of iron from broken-down hemo- 

 globin would be expected in a disease in which hemolytic jaundice is 

 combined with an increased fragility of the red blood-cells. In their 

 patient, McKelvy and Rosenbloom found a marked increase in the excre- 

 tion of urinary and fecal iron, the total loss for the five day metabolism 

 experiment amounting to 0.1199 gram. Goldschmidt, Pepper, and 

 Pearce, who limited their determinations to the fecal iron, also report a 

 large loss of iron before splenectomy, followed by a decrease of 40 per 

 cent after operation. This large output of iron in the period before 

 splenectomy is due, according to these observers, to the increased quan- 

 tities of iron freed in the body consequent to the excessive destruction 

 of red cells. The decreased elimination after splenectomy is probably the 

 result of a cutting off of this loss with a return to a nearly normal balance 

 between intake and output. 



More difficult to explain is the increased excretion of iron observed 

 in certain instances of leukemia (Hoffmann, Kennerknecht). The pa- 

 tients studied by Kennerknecht had had shorter or longer exposures to 

 the rontgen-rays. In two of the cases in which the leukocyte counts 

 changed very slightly, following radiation, the total iron output was 

 found to be 36.68 and 22.96 milligrams. The urinary iron in these 

 instances amounted to 1.55 and 7.21 milligrams respectively. The large 

 output of iron in the urine in the latter patient cannot be explained by 

 the greater leukocyte destruction, since the counts were only slightly re- 

 clucebl by the action of the rays. It appears not unlikely, according to 

 Kennerknecht, that the increased elimination noted in these patients as 

 well as in the untreated ones is the result of a diminished iron storage 

 by a diseased spleen. 



In the third patient in whom rontgen-ray exposures caused a drop 

 in the white cell count from 90,000 to 44,000, the output of iron reached 

 68.61 milligrams per day. That this high iron elimination is not entirely 

 the result of the destruction of leukocytes follows from the study of 

 the other patients. More plausible is the explanation that it is the result 

 of a concomitant breaking down of erythrocytes which not infrequently 

 follows exposure to the rontgen-rays. 



Metabolism of Phosphoric Acid, Calcium, and Magnesium. The 



