Metabolic Effects of Polycythemia. 



The excretion of total sulfur in the urine has been found to run 

 approximately parallel with that of nitrogen. The fluctuations in 

 the amounts of total phosphorus in the urine do not allow of any 

 definite deductions at the present time. 



The defibrinated blood, after being filtered by suction, was in 

 all cases moderately hemolytic, a change produced by the act of 

 defibrination. Nevertheless, in the great majority of cases the urine 

 passed after transfusion did not contain any hemoglobin, the organ- 

 ism of the dog apparently disposing of the same, completely stor- 

 ing its derivatives in the different structures of the body, especially 

 the liver, which on post mortem examination proved to be of a 

 dark brown, almost black color and contained large amounts of 

 hemosiderin in the ferric state, as shown by microchemical exami- 

 nation of sections. In some instances very concentrated bile was 

 found in the gall bladder. Accordingly there was a decided increase 

 in the coloring matter of the feces and especially in the urine, con- 

 ditions which, after a series of blood transfusions, were very greatly 

 emphasized, the urine containing a large amount of urobilin. 



All experiments ended with the death of the animal, the 4th 

 or 5th transfusion of blood invariably proving fatal. It was pos- 

 sible to predict close approach to the danger line from the appear- 

 ance in the urine of coagulable protein. Coagulable protein never 

 was found in the urine until after a third or fourth transfusion had 

 been made ; its appearance preceded a rapid decline of the animal, 

 the urine examination showing the presence of granulated casts and 

 epithelial cells. The succeeding transfusion usually sufficed to 

 produce hemolysis accompanied by hemoglobinuria, from which 

 condition the animal never recovered. On microscopic examina- 

 tion, a section from such a dog's kidney showed, besides enormous 

 hemorrhagic areas, parenchymatous degeneration of the epithelial 

 cells of the tubuli contorti. In these respects experimental poly- 

 cythemia resembles the polycythemia occurring in human beings, 

 the latter disease terminating fatally in almost all cases, the urine 

 containing coagulable protein and granulated casts. 



With reference to the nutritive value of blood transfusion hardly 

 anything can be said in favor of it, the body weight which is natu- 

 rally higher immediately after transfusion gradually sinking to or 

 even below the initial level. Even in fasting animals the transfusion 



