594 SAMUEL H. HURWITZ 



and Myers in pernicious anemia. The practical significance of this obser- 

 vation is apparent when it is recalled that cholesterol has an antihemolytic 

 action and that it may increase noticeably in the blood consequent upon 

 improvement in the blood picture, whether this result from a spontaneous 

 remission or whether it be brought about by transfusion or splenectomy. 



The Influence on Metabolism of Some Measures Used 

 in the Treatment of Diseases of the Blood 



Diet. The employment of forced feeding and more particularly 

 of high protein diets in pernicious anemia and allied conditions is of 

 great interest in view of the doubt which still exists as to whether or 

 not it is possible to effect an assimilation of protein in anemic states. 

 The problem is closely linked with the question of increased protein 

 destruction in anemia and leukemia, a discussion of which was taken up 

 in the paragraphs on protein metabolism. 



Whereas some investigators have experienced difficulty in obtaining 

 a nitrogen balance in certain anemic conditions (von Stejskal(a), Rosen- 

 qvist, Timber (6), Minot(a), McKelvey and Rosenbloom), there appears to 

 be little doubt that even the most severe anemias may run their course with- 

 out injury to the body protein, and without any appreciable disturbance in 

 the nitrogenous metabolism. It has been possible not only to maintain 

 some patients with pernicious anemia in nitrogen equilibrium on approxi- 

 mately the same small quantity of protein as would be required in health 

 (Bernert), but also to obtain a retention of nitrogen in these patients 

 to a greater or lesser extent (Goldschmidt, Pepper arid Austin (c), Mosen- 

 thal(d), Peppard). 



Mosenthal(d), in particular, has succeeded in obtaining markedly posi- 

 tive nitrogen balances in three patients with pernicious anemia and in one 

 patient with chronic myelogenous leukemia, complicated by secondary 

 anemia. These patients received from 50 to 60 calories per kilogram 

 per day and showed on this intake an average nitrogen retention of from 

 3 to 6 grams daily. Similar results have been obtained recently by 

 Peppard, who recommends a dietary yielding from 60 to 65 calories per 

 kilogram per day, this to be given in proportions of protein 16 per cent, 

 fat 42 per cent, and carbohydrate 42 per cent. 



Transfusion. Thus far only a limited number of observations have 

 been carried out on the influence of transfusion upon gaseous and nitrog- 

 enous metabolism. Delchef and Hari(&) have reported the only me- 

 tabolism studies on. true transfusion in experimental anemias. Imme- 

 diately after the anemic animal received the injected blood Delchef found 

 the oxygen consumption greatly elevated. Similarly, Hari found the 

 metabolism somewhat increased on the injection of fresh blood into normal 



