881 THOMAS ORDWAY AXD ARTHUR KXUDSON 



The cause of these effects on metabolism is at present difficult of 

 explanation. One may ascribe the effects of x-rays either to a stimulating 

 ehVet upon autolytic enzymes or as Keuberg(a) does to an inhibitory action 

 of x-rays and radium rays upon the other intracellular enzymes without 

 c-orrcsponding deleterious effect upon the autolytic enzymes present. This 

 hypothesis agrees with the facts at hand but more details concerning the 

 eih'cts of these rays upon various enzymes are needed. 



Effect on Metabolism in Disease. The metabolic changes produced 

 l;v x-rays and radioactive substances in various diseases have been studied 

 quite extensively. The protein destruction by these agents arising partly 

 from the lymphatic structures has led to their study particularly in 

 connection with the treatment of leukemia. Following the therapeutic use 

 of x-ray and radium in leukemia there has been observed a marked effect 

 on metabolism. 



Lossen and Morawitz in a case of myeloid leukemia treated by x-rays 

 found that the volume of urine was decreased, that total nitrogen, uric 

 acid and phosphorus excretion lowered. Heile found an increase in both 

 uric acid and purin bases in three cases. Konigcr in myeloid leukemia 

 found that under influence of Roentgen rays the uric-acid excretion in- 

 creases parallel with the diminution in size of the spleen and the break- 

 ing up of the leucocytes and that the uric-acid excretion is a positive 

 measure of cell breakage, but not an index to the extent of the cell destruc- 

 tion. Ammonia and phosphates were also increased at times, generally 

 parallel with the nitrogen increase and also with the betterment in the 

 leukemic symptoms. Xo increase in the total nitrogen or uric acid 

 could be found, however, by Cavina in a case of lymphatic leukemia treated 

 with Roentgen rays. 



In this connection the observations of Musser and Edsall are of interest. 

 In those cases in which the roentgen ray caused a reduction in number 

 of white cells and there was clinical improvement, there was a definite 

 increase in uric acid and purin base output, a marked loss of nitrogen 

 and an increased elimination of phosphates. In a case in which x-rays 

 had no beneficial effect clinically, there was likewise no effect or very 

 little on the nitrogenous metabolism. 



O 



Murphy, Means and Aub studied the basal metabolism of a man with 

 chronic lymphatic leukemia. Observations were made before and after 

 exposure to x-ray and also after exposure to radium. When first observed 

 the metabolism was 44 per cent above the average normal, falling a little 

 with rest in bed. Intensive treatment with x-rays caused a drop in the 

 leucocyte count but did not appreciably affect the level of the metabolism. 

 Water elimination through the skin and respiratory passages was unusually 

 high. Direct and indirect calorimetry gave total results which were al- 

 most identical and no abnormal respiratory quotients were found. After 

 treatment with radium a further very marked fall occurred in the leuco- 



