PATHOLOGICAL METABOLISM OF THE BLOOD 599 



excretion after operation. The ammonia output, however, was increased 

 in one patient and the uric acid in another during the post-splenectomy 

 period. 



Definite changes in the nitrogen metabolism and in the partition 

 of certain of the nitrogenous constituents of the urine have been noted 

 to follow removal of the spleen in hemolytic jaundice. After splenectomy 

 in their patient, Goldschmidt, Pepper and Pearce observed a tendency 

 toward nitrogen retention, a decrease in the elimination of uric acid to 

 the extent of 4Y per cent of the preoperative level, and an increase in 

 the quantity of creatin at the expense of the creatinin. 



Whether the changes noted in the post-splenectomy period in per- 

 nicious anemia and in hemolytic jaundice are the result of the improve- 

 ment of the anemia or due to the removal of a perverted splenic function, 

 it is difficult to determine. Before this question can be satisfactorily 

 answered, it will be necessary to carry out more observations before and 

 after splenectomy on the metabolism of essentially normal individuals or 

 of those with simple lesions of the spleen attended by the development 

 of an anemia. 



The determinations of iron elimination before and after splenectomy 

 in man are few in number (Table 8). Bayer (a) (6) and also Roth report 

 an increased output of iron following the removal of a normal spleen 

 for rupture of this organ. Since no determinations were made before 

 operation, it is difficult to interpret these results, more particularly as 

 wide variations in the iron figures are known to exist in normal indi- 

 viduals. 



Thus far, the patients studied by Pearce and his co-workers are the 

 only recorded instances in which careful observations were made on the 

 iron elimination before and after removal of the spleen in blood dis- 

 eases involving this organ. In the patient with pernicious anemia, the 

 iron output, although never above normal, showed a decrease of 40 per 

 cent after operation. A similar decrease was noted after splenectomy in 

 a patient with congenital hemolytic icterus. In this instance, there was 

 a great loss of iron in the pre-splenectomy period, which it is most plausible 

 to assume was the result of excessive blood destruction produced by a 

 toxic factor in the diseased spleen, the removal of which effected a 

 restoration of the iron balance to a more normal state. 



Observations on the metabolism of fats are limited to two patients 

 with hemolytic icterus (McKelvy and Rosenbloom, Tileston and Griffin). 

 Examination of the feces of these patients both before and after splenec- 

 tomy failed to establish the existence of any definite influence of the 

 pathological spleen on the utilization of fat, the results in these respects 

 coinciding with those found in normal animals. 



In summary, it seems justifiable to conclude from the available evi- 

 dence that removal of the spleen in the hemolytic anemias is, as a rule, 



