PATHOLOGICAL METABOLISM OF THE BLOOD 603 



with myelogenous leukemia treated by the rb'ntgen-rays Lessen and Mora- 

 witz found a diminished excretion of total nitrogen, uric acid, and 

 phosphorus pentoxid. On continued treatment, the uric acid content de- 

 creased, the nitrogen elimination remained the same and the ^phosphorus 

 content increased. With the exception of Cavina, who noted no increase 

 either in the total nitrogen or uric acid excretion of a patient with lym- 

 phatic leukemia under rb'ntgen-ray treatment, the majority of workers 

 (IIeile(&) and Musser and Edsall) have been able to confirm the findings 

 of Lessen and Morawitz. 



In view of the greater cellular destruction which occurs under radia- 

 tion, the behavior of the uric acid is of particular interest. Although 

 in some instances of leukemia, the uric acid output was found to be 

 high during treatment, and to fall coincidently with the leukocyte count, 

 this was not the case in other patients in whom the uric acid elimination 

 continued high even in the presence of a leukopenia. This absence of 

 parallelism between the quantity of uric acid excreted and the degree of 

 leukocvtic disintegration has also been observed by other workers 

 (Mohr(t)). 



The findings of Musser and Edsall are especially interesting in this 

 connection. These observers noted that where the rontgen-rays have no 

 beneficial effect clinically, they also have little effect on the nitrogenous 

 metabolism; whereas evidences of clinical improvement went hand in 

 hand with a considerable increase in the elimination of nitrogen, uric 

 acid, purin bases, and phosphorus pentoxid. In one patient the rise in 

 the excretion of these substances expressed in the form of percentage of 

 the amount previously eliminated was in round numbers: nitrogen about 

 70 per cent, uric acid about 60 per cent, purin bases about 260 per cent, 

 and phosphates about 200 per cent. This striking phosphorus excretion 

 after rontgen-ray exposure is all the more remarkable because of the 

 retention of phosphorus which has been noted by these observers during 

 certain periods of the development of the leukemic process, a retention 

 which they attribute to the constant construction of tissues that are rich 

 in phosphorus. 



As yet, little is known concerning the chemical changes brought about 

 in the blood of patients with leukemia treated by the rontgen-rays. In 

 a very recent contribution, Martin and Denis report some observations 

 on four patients with myelogenous leukemia, in whom analysis of the 

 blood for non-protein nitrogen, uric acid, and creatinin were made both 

 before and after radiation. They noted that the non-protein nitrogen 

 fraction which was extremely high before ' treatment fell steadily after 

 exposure to the rays. On the other hand, the uric acid content, also high 

 before treatment, showed no appreciable decrease, notwithstanding the 

 fall in the number of white cells which occurred as a result of rontgen- 

 ray exposure. The creatinin content of the blood remained within normal 



