LEUKEMIA 257 



leukemia ; Askanazy l reports finding what he describes as Bence- 

 Jones albumose in one case of lymphatic leukemia, but this was 

 afterward found to be a case of multiple myeloma. 2 Kolisch 

 and Burian 3 not only found nucleoproteid constantly, and 

 albumose frequently, but in one case of lymphatic leukemia 

 they found histon in the urine, which undoubtedly came from 

 nucleoproteid decomposition. 



Proteid Metabolism. Stejskal and Erben 4 studied the 

 metabolism of a case of myelogenous and of a case of lymph- 

 atic leukemia, and found the nitrogen loss much greater in the 

 myelogenous form, although food-absorption was better than in 

 the lymphatic ; they consider that proteid-destroying forces are 

 at work in myelogenous leukemia, similar to those of cancer 

 cachexia, so that nitrogenous equilibrium cannot be attained. 



As the most characteristic products of decomposition of 

 nucleoproteids are the purin bases, one would also expect to 

 find them present in leukemia, and early writers mention the 

 finding of purin bases and uric acid in the blood and spleen. 

 The urinary findings in this respect have been very variable. 

 Ebstein 5 observed the complication of leukemia with gout, 

 which he considered a coincidence, and also noted uric-acid 

 concretions in the urinary passages in four cases. Numerous 

 other authors have described increased uric-acid elimination, 

 while some have observed increase in the purin bases, either with 

 or without uric-acid increase. Magnus-Levy 6 observed a par- 

 ticularly large uric-acid output in acute leukemias, but also found 

 that the relation between the number of leucocytes and the uric 

 acid is extremely variable. Sometimes the nitrogen loss is very 

 great even as much as 20 gm. per day and, corresponding 

 with the destruction of nucleoproteids and the resulting uric-acid 

 formation, phosphoric-acid excretion is often greatly increased 

 even up to 15 gm. per day. On the other hand, the results 

 obtained by many other writers have been in every respect 

 extremely variable; some have found no increase in uric acid, 

 some even report a decrease ; likewise the P 2 O 5 has been found 

 even less than normal. For example, in a carefully studied case 

 of lymphatic leukemia, Henderson and Edwards 7 found during 

 six months no excessive excretion of uric acid or phosphoric 



1 Deut. Arch. klin. Med., 1900 (68), 34. 



2 See " Myeloma," Chap. xvii. 



3 Zeit. klin. Med., 1896 (29), 374 (literature on albuminuria in leukemia). 



4 Zeit. f. klin. Med., 1900(39), 151. 



3 For literature see re'sume' by Walz in Cent. f. Pathol., 1901 (12), 985. 



6 Virchow's Arch., 1898 (152), 107. 



7 Amer. Jour, of Physiol., 1903 (9), 417. 



17 



