604 SAMUEL H. HUKWITZ 



limits throughout. In view of the normal creatinin values and because 

 in the most severe cases urea accounted for only 20 per cent of the non- 

 protein nitrogen fraction, Martin and Denis suggest that the blood in 

 leukemia 9ontains, possibly as a constituent of the white blood-cells, some 

 nitrogenous substance or substances not differentiate by our present 

 methods of micro-blood analysis. 



It has been shown that radium may exert an equally marked effect 

 on the nitrogen and phosphorus metabolism in leukemia (Knudson and 

 Erdos ; Ordway, Tait, and Knudson). They observed in two patients with 

 myelogenous leukemia, under radium treatment, very remarkable increases 

 in the total nitrogen, urea nitrogen, ammonia nitrogen, and phosphorus. 

 During the first seven days the total nitrogen excretion of one patient in- 

 creased 115 per cent, the urea nitrogen 140 per cent, the ammonia nitro- 

 gen 150 per cent, the uric acid nitrogen 28 per cent, and the phosphorus 

 174 per cent. After the seventh day all of the excretory products showed 

 a slight drop, but remained at a higher level than at the beginning of 

 treatment. Subsequent applications of radium again brought about a rise 

 in the elimination of these urinary constituents, the excretion of phos- 

 phorus exhibiting the most remarkable increase of all. Ten days follow- 

 ing the third series of radiations the phosphate output had increased 445 

 per cent over the elimination of the first day of the experiment. 



The comparatively low percentage increase in the uric acid excretion 

 is surprising in view of the great destruction of tissue rich in nuclein 

 material which is known to occur in leukemia. In explanation of this 

 observation, it has been suggested that radium emanations, which have 

 been shown to decompose uric acid in vitro (Sarvonat), may also bring 

 about the same result in the body, possibly by activating the ferments 

 concerned with the cleavage of uric acid (Gudzent and Loewenthal). 



There is also a great paucity of data regarding the blood changes 

 produced by radium in leukemia. Determinations of the non-protein 

 nitrogen and creatinin of the blood in one patient during treatment 

 showed only a slight increase of the former constituent and no change 

 in the latter (Ordway, Tait and Knudson). 



The nature of the process by which the rontgen-rays and radium 

 produce their remarkable effect on metabolism is little understood. Most 

 observers are inclined to attribute the changes in the nitrogenous metabol- 

 ism to tissue autolysis, due either to the elaboration of certain toxins 

 in the blood (Linser and Sick) or to the stimulating effect of both 

 forms of radiant energy upon enzyme activity in general, and more par- 

 ticularly upon the enzymes which bring about proteolysis (Musser and 

 Edsall ; Sarvonat). 



Benzol. Like the rontgen-rays and radium, benzol exerts a de- 

 structive action not only on the parenchymal cells of the hemopoietic 

 organs as a whole, but more especially on the myeloid tissue and the 



