

PATHOLOGICAL METABOLISM OF THE BLOOD 597 



tion of iron amounting to 21.6 per cent ten days after operation and to 

 148 per cent three months later. As this animal was the only one to 

 show any unusual elimination of iron after splenectomy, they are in- 

 clined to attribute the rise in iron excretion to the anemia, rather than 

 to the absence of the spleen. 



Nor has any gross abnormality been made out in the utilization of 

 fat by splenectomized animals. The experiments of Pearce and his co- 

 workers in this connection are unique in the literature and are of interest 

 in view of the fact that splenic function has been- thought to influence 

 in some way the metabolism of fat. 



Clinical Observations. -Whereas the results of metabolism experi- 

 ments on splenectomized animals are essentially negative, definite changes 

 have been observed after the removal of the chronically diseased spleen 

 in man. The reason for this difference is not far to seek. Splenectomy 

 in man is done usually in the presence of an anemia of more or less 

 severity, which may account in large measure for the changes noted. 

 Furthermore, the reversion to more or less normal conditions after sple- 

 nectomy is to be regarded as the result of the removal, not of a normal 

 function of the spleen, but rather of an altered function which expresses 

 itself in a hemolytic or toxic activity. 



Metabolic studies made before and after the removal of the diseased 

 spleen in man are few in number. The only available contributions are 

 those of Umber (&), Minot(a), Goldschmidt, Pepper, and Pearce, Pepper 

 and Austin (c), and Denis (d). 



In Banti's disease, Umber found it easier to obtain nitrogen equi- 

 librium after splenectomy, a fact which he. attributes to the pathologic 

 destruction of protein resulting from the toxic action of the diseased 

 spleen. Denis, on the contrary, found the nitrogen elimination practi- 

 cally unchanged in a patient with Banti's disease and in one with "atypi- 

 cal splenic anemia." The uric acid elimination was diminished in the 

 first patient and increased in the second. 



Metabolism studies following splenectomy in patients with pernicious 

 anemia have likewise yielded discordant results. In Minot's patient, re- 

 moval of the spleen converted a slightly negative into a slightly positive 

 balance and caused an increase in the percentage of urea nitrogen. On 

 the other hand, the nitrogen balance in Pepper and Austin's patient was 

 slightly positive before operation. Splenectomy in this instance caused 

 an increased retention of nitrogen fourteen days after removal of the 

 spleen, the balance returning to the pre-operative level one month later. 

 An observation of interest in this patient was the elimination of uric acid 

 which showed a decrease after splenectomy of 22 per cent from the 

 normal figure of the pre-operative period (Table 6). Denis, however, 

 could not substantiate this finding. In neither one of her two pernicious 

 anemia patients did she observe any constant effects on the total nitrogen 



