PATHOLOGICAL METABOLISM OF THE BLOOD 591 



phosphoric acid been found excessive. The figures obtained by Magnus- 

 Levy 0) are exceedingly remarkable. One of his patients with acute leu- 

 kemia showed a loss of about 15 grams of phosphorus pentoxid in fifteen 

 hours. The loss of phosphorus, while decided, was not so remarkable as 

 the loss of nitrogen. Similar, though less striking, losses have been ob- 

 served by others. EdsaH's(6) patient, for instance, on a diet containing 

 7.25 grams of nitrogen, and 1.84 grams of phosphorus eliminated in the 

 urine 29.534 grams of nitrogen and 3.05G grams of phosphorus pentoxid. 

 The loss of phosphorus in the urine and f eces of this- patient was probably 

 over 2 grams. 



In the chronic forms of leukemia the excretion of phosphorus fluctu- 

 ates somewhat, as does the elimination of nitrogen, with the rapid changes 

 in the pathological processes which underlie this disease. Thus von 

 Moraczewski(c), and Musser and Edsall found a retention of phosphoric 

 acid in myelogenous leukemia, whereas von Stejskal and Erben( noted 

 a slight, increase in this form of the disease and a moderate retention in 

 a patient with lymphatic leukemia. 



It appears, on the whole, that the abnormally high values for phos- 

 phoric acid excretion were observed usually nly in severe cases, and for 

 the most part towards the end of life. The retention of phosphates noted 

 in certain instances of leukemia has been attributed to the rapid building 

 of leukemic tissue, a tissue especially rich in phosphorus. 



Calcium and magnesium excretion in leukemia and the ratio which 

 phosphoric acid bears to these has been studied especially in connection 

 with the question of the source of the increased quantities of phosphoric 

 acid. Considerable variability of results is to be found in the literature. 

 Sometimes a retention, at other times an increased excretion, and at still 

 other times equilibrium between the intake and output have been re- 

 ported. Those who have found the excretion of calcium and magnesium 

 considerably greater than the excretion of phosphoric acid have been in- 

 clined to the view that the increased quantities of phosphoric acid elimi- 

 nated arise from the disintegration of osseous tissue. Calculations, how- 

 ever, of the ratio between the nitrogen and uric acid eliminated and 

 the phosphorus excreted point rather to the conclusion that the increased 

 output of phosphoric acid, in those conditions in which it occurs, is to 

 be referred to the decomposition of nitrogenous substances, especially 

 those containing the nuclein radical. 



Sulphur Metabolism. It is well known that the excretion of 

 sulphur, and more especially of neutral sulphur, runs more or less parallel 

 with the intensity of protein metabolism, so that, in a sense, a knowledge 

 of the quantity of sulphur excreted serves as a check on the elimination 

 of nitrogenous substances. Whereas, in some instances of anemia and 

 leukemia, the excretion of sulphur has been found to parallel the output 

 of nitrogen, this finding has not been constant. 



