Blood Chemistry.pdf

II.
STUDIES OF THE BLOOD CHEMISTRY OF LEPROSY
ANALYSIS OF FINDINGS OF FIFTY OASES
P. MORALES·OTERO and L. G. HERN!NDEZ
F'rom tho School of Tropical Medicine of the University of Po rt o Rico und er
th e auspices of Columbia Unlv eraity,
Last year the authors (1) published data on the chemical COIlstituents
of th e blood in leprosy. Determinations were made on nonprotein
nitrogen, urea nitrogen, uric acid, creatinine and sugar.
Proceeding further in our studies we have made determinations on
serum calcium , cholesterol, chlorides, phosphorus, and icteric index.
LITERATURE.
Determinations of serum calcium in leprosy have been made previously
by other authors. Cruz, Lara and Paras f") , working in the
Philippine Islands, found normal valu es in patients suffering fro m
leprosy, Typ e, duration, stage of lesions and antileprosy tr eatm ent
did not affect the serum calcium values of th eir cases. They thought,
however, that the serum calcium values were lowered in lepra fever.
Und erhill, Honij and Bogert(3) found that th ere is a definite
retention of calcium in leprosy. The more advanced the disease the
. greater the r etention, conclude the authors. Moreover. they are of
th e opinion that this behavior in part of the leprous individual may
be taken as an indication that th e organism is in need of calcium.
The result of this investigation suggests, the au thors concluded, that
in leprosy, administration of calcium may be of benefit as an additional
therapeut ic measure to r etard or arrest the progress of the
hone changes characteristic of the disease.
Lemann, Liles and -Iohansen (~) , studying fifty -four cases in the
National Leprosarium, r eached th e conclusion, that blood-serum calcium
in lepers is normal ; that there is no relation between the calcium
content of the blood and bone absorption in leprosy. That the cal~
-cium content of blood in lepers is not affected by lepra fever nor by
the administration of chaulmoogra oil.
Boulay an d Lager-C") after studying three cases report a marked
retention of calcium in the less-advanced cases and a notable loss of
calcium in those far-advanced.
Conception and Saleedo t") studying the same problem conclude
40i3

444 PORTO RICO JOURNAL OF PUBLIC HEALTH AND TROP . MEDICINE
in their work that serum calcium is within normal limits in leprosy,
that it is not affected by ty pe, duration or treatment of the disease,
but it is 'slightly increased in recovered cases.
The writers believe that the difference of opinions between th e
investigators cited is of interest and leaves the subjec t open to further
study.
Gomez, Leitas, Pereira and Wancollecr) studying the cholesterol
content of the blood in leprosy found a reduction proportional to
the gravity of the case and a further decrease in febrile reerudescense :
they observed further that chaulmoogra-oil treatment increased
cholesterol and that patients with high cholesterol rarely developed
severe forms of leprosy.
Boyd and Roy (8), working in India, found that cholesterol was
reduced in the early st ages of the disease and that in advanced cases
ciphers were still lower. They observed further that in advancedtreated
cases cholesterol does not return to normal.
'We have found only OD e study in the literature where the chloride
eontent of lepers' blood was 'studied. This was mad e by P aras f")
who found them normal.
In the literature available we have been unable to obtain data
as to the phosphorus content and icteric index in leprosy.
METHODS.
The det erminations were done on blood serums only. Blood
samples were conveniently collected and allowed to coagulate at room
temperature. The blood clot was removed bv centrifu gation and
pipetting th e clear supernatant blood serum.
In determining serum calcium , Clark and Collips f!") modification
of the Kramer method WBS used. For cholesterol determinations,
Sackett's(ll) modification of Bloor's method. The chlori des were determined
by the Van Slyke method as modified by Wilson and
Ball. (1%)
For phosphorus Brigg's modification of tb e Bell and Doisv
method was used and the Icteric Index was determined by the
Jfeul engoraeht method.
Pindings are correlated with abnormalities in th e nrines, type of
leprosy, and extent and duration of the disease. Diet and drug
therapy are also taken into consideration.
As controls, a group of apparently normal persons is studied. A
~peon d group was selected among non-lepers with nephritis.
The data is presented in thirteen tables . In tables I to III lepers

STUDIES OF THE BLOOD CH EM ISTR Y OF I,EP ROSY 445
are classified as to ty pe of the disease. I n tabl es IV to VI they are
classified as to th e extent of their lesions. Tables VII and Vln
show findings in lepers treated with mer eurochrome or ethyl ester of
chau lmoogra oil. Tables IX and X include leper: with normal urines
and lepers with nephritis. Table XI show's findings in non-lepers
with nephritis. Table XII shows finding in apparently normal p eople
and in table XIII th e group aver ages are summarized,
If we compare tables I , II. and III representing types of leprosy
we see that th ere are wide individual variations. If "'e compare
group aver ages of th e same tables, cholesterol seems to be slightly
ligher in the mixed and neural groups, while the icteric index seems
to be higher in the nodular and mixed groups . th e group averages
of th e oth er ingredients stu died remaine about th e same.
I n table, IV, V and VI in which classification of cases is made
on the basis of the degree of leprous envolvernent we again noti ce wide
individual variations. If we compare th e group avera ges of th ese
thr ee tables we find that the cholesterol ciphers are higher in the
g-roup of cases with slight lesions and lower in the advanced and
moderate cases. Ciph ers for chlorides, serum calcium and phosphorus
ar e about the same in all the th ree groups.
.Comparing th e group averages of those t reated with mercurochome
and those treate d with th e ethyl esters we find that cholesterol
is s l i g'h tl ~· higher in the cases that arc treated with Chaulmoogra oil.
F igures for serum calcium chlorides, and phosphorus are about the
same in both groups.
Compar ing tables IX, X. and XI which show findings in lepers
with normal urines, lepers with nepln-it u and non-lepers apparently
normal, we oh erve about the same figures for serum calcium and
phosphorus. 1'11t' chloride RI'e increased in the group of lepers with
nephritis while th ey remain about normal in th e group of I pel'S with
normal urines and non-Iepei- ap pnrent lv normal. In spite of th e
fact th at some of the lepers have kidn ey impairment. cholesterol is
diminished in th e group of lepers as compared to th e group of
normal cases. Table XTI, which shows the findin g of non-lepers with
nephritis, also shows that figur es fOl' chlorides, cholesterol and phosphorus
art' increased and seru m calcium remain s about normal. If
th ese figures are compared with table X, that. is, lepers with nephritis,
n wide difference may be not iced in th e choler terol ciphers, indicating
that cholesterol is much lowered in th e group of lepers wit h nephr itis
than in th e gronp of non-lepers with nephritis. in spite of th e fact
th at chlorides and phosphoru s values are increased in both groups
of cases.

U6 PORTO RICO JOURNAL 01' PUBLIC HEALTH AND TROP. IOIDICINlI
SlJ1lD[A~.
'I'hs results of chemical 'studies of the blood of fifty lepers with
regard to chlorides, cholesterol, serum calcium, phosphorus, Icteric
Index is reported.
Lepers are classified as to type, extent of the disease, treatment
of the disease and urinary findings.
Two control groups, one of apparently normal persons with normal
urines and one of non-lepers with nephritis are also studied.
The results arc tabulated separately and II table of group average
is also published.
OONOLUSIONS.
1. Leprosy in itself all'ects very little, if at all, the concentration
of serum calcium, blood chlorides or phosphorus, regardless of the
type extent, or duration of the disease.
2. If a definite increase of these ingredients is found in leprosy
it is usually due to some other concurrent condition.
3. Cholesterol was found to be slightly reduced in lepers when
compared with normal groups. Usually the group of cases treated
with the ethyl esters of chaulmoogra oil had slightly higher cholesterol
values than the untreated cases or those treated by other methods.
BmLIOGRAPHY.
1. Morales-Otero and Hernandez. (1928) Porto Rico Review of
Public Health & Trop. Med. 3: 507.
2. Cruz. Lara and Paras. (1928) Jour. Philippine Island Med.
Assoc., 8: 216.
3. Underhill, Honeij and Bogert. (1920) Jour. Exper. Med., 32: 41.
4. Lemann, Liles, Johansen. (1927) Am. Jour. Trop. Med. 7: 61.
5. Boulay and Leger. (1922) Bul, Soc. Path. exot., Paris, 15: 86)').
6. Concepcion and Salcedo. (1926) Jour. Philippine Island Med.
Assoe., 9: 151.
7. G6mez, Leitao, Pereira, Wancolle. (1927) Rev. Biol. e Hyg., Sao
Paulo, 1: 39.
8. Boyd and Roy. (1927-28) Indian Jonr. Med. Research, 115: 643.
9. Paras. (1926) Philippine -Iour, Sc., 30: 219.
10. Clark and CoUip. (1925) Jour. BioI. Chem., 63: 461.
11. Sackett. (1925) Jour. BioI. Chern. 64: 203.
.12. Wilson and Ball. (1928) Jour. Biol, Ohem., 79: 221.
13. Brigg'S. (1922) Jour. Biol. Ohem., 53: 13.
14. Meulengrackt. (1926) Deutsche Arch. f. Klin. Moo., 132: 285.

STUDIES 'OF THE BLOOD CH EMISTRY OF LEPROSY
447
TABLE No. I
GBOUP OF NEURAL CASES
I
.!i e "2 rJ
I;
! ~ " 21
~ -§" .c
c, u ::I ri ne
i'lJ.itlal s
" if '" 5 ] I:l "
- '0
0 ::l ";
" ]
~ ,!l, "" tl :a .c l;J " E.:l
w -< 0 ;;" A c I'< ~ Alb . Casts
~
'"
H. M .. .. .. F 42 Neural Adv.. . IS 4\/S.9 105.2 8 .0 5.0 4. 2 N egat i" e Negative
C.R. .. . .. . F 41 Neural Bligh t . 19 68.~ . 0 135.0 12.0 3.1 6.8 P ositive P ositive
R. C .. .. . .. M III Neural Mod . . 7 004.5 HI .3 8.4 2.9 6.1 Posit tve . P ositive
E . M . .. . .. M 21 N eu ral Mo d .. 7 469. 1 211. 1 9.7 4 .8 3 .2 Ne gntl " e :-IegaUv e
P . E . .. .. .. M 35 Ne ural SlIgb t. 9 525.8 100.6 10. 1 3.9 3.9 Negative Negatlve
C. M ... .. .. F 50 Neural Slight . I M9.9 142.9 8. 2 3.3 2.1 P osit ive . P ositive
E . L . . .. .. . F 44 N eural Ad'·.. . 24 514.8 19\. 9 10.6 2.9 2.11 Negat ive Negativ8
E.S.. . .. . .. M 52 Neural Adv . . . a ~03 . 1 111.4 11,3 2.5 1.8 P ositi ve . Poslt.ive
L. V..... .. F 50 Ne ura l All\'" . ~O 506.0 118.2 10. 1 2.1 2.9 Negative Negatlv
A ,·& ags .. .... .... ........ .... .... .... . 517.3 IW .4 9 .8 3.3 3.7
I\Ig. per 100 ce, 01hlood.
TABLE No . II
GROUP OF MIXED CASES
::l
.. '0 '" ..
"§
~ 8
]
" .. Ur ine
"",
Initial,
s"" i E '~ " g :::I "';
~
e OJ] -­
,!l, "" " ~ '" 1:1 :a t;:::~ ..c
w
---- - '"
-< A c 0 25 I'< Alh. Casts
'" --- '" - - -­ '" - - - - - ---
L .B . . .. . . . F 27 M ixed Ad v .. . 11 526.5 158.5 9.3 4.5 3.4 Posit ive . P oslth'e
L . B.. .. ... . F 23 M ixed M od . . II 667. 4 115.8 9.5 3.5 4 .7 P ositive. P ositive
J . T .. .... .. F 27 Mil ell Mod . . II 571.6 161.6 10.:1 3.8 5 .9 Postt ive. Pos it ive
.,. S.. .. . .. F 35 ~1i18 d Adv.. . 29 ,1)15 . 1 150.0 8.9 4.9 .1.i P ositi ve. P ositive
F. R .. ... .. :-'1 25 Mixed Blight. 7 4Y8. 8 IU.'. ~ 9. 1 2.9 3.9 Negat ive Negati ve
J .O.... .. .. F 55 Mixed Mod .. 4 1i79 .7 llil .4 9 .6 3.7 6.8 P oslt ive . Postt lve
M. lt .. . . . . p U M ixed Ad v,. . 16 505.4 209 .4 9.2 2.8 2.5 P o.il tl vc. P osltlve
....'·emgo. . .... .... ........ .. .. .. . ...... 543.5 163.5 9.4 s .7 4.5
Mg . per 100 ce, 01 blood.
'I'ABLE No. III
GROUP OF NODULAB. CASES
'" 1::
~
~ ] a
::l
~ .c " Urine
DO>
Initials

448 PORTO RICO JOURNAL OF PUBLIO HEALTH AND TROP. HEDIOINB
T ABLE xo. IV
CASES WITH SLIGHT LESIONS
., '2
r:l
,5 " -0 :3" ~ .. Tr ine
,, 0
:::l
In it ials .~
.. c if " :;"
~ ,,-
Erti ~
0 - - - --- ­
ee .3 '" ::= .l: ~il is
----- " -.-. :5 ~ 0 0 E; ~ Alb. Casts
'" - - - '" --- - -- tn
- - - - ----
C . B . . . . . . . F 10 ~o J. Slight . 1 502.5 1 .7 7.6 4.5 7.9 Nega tive Negative
R . ;\1. .. . .. }' 41 ~ od .. : Slight . S 458.4 112.9 9.1 2.1 Nega t l...e Tegat h' e
r.. R F 41 • eura l Sllg h t . 19 585.0 t35 .0 12.0 3.1 ~ : ~ Posit l...e . P osi tive
c.n.::::.. I' 39 • TO

STUDIES OF THE BLOOD CHEM ISTRY O~' LEPROSY t4:9
TABL E No. VII
GROUP OF OASES TREATED WITH MEROUROCHROME
'" ~ e 2'"
0
~ .s= 'C'" ::l .; ... Crine
't: i c.."
.. .. a .. 0
"0 § ~
co .S ;: ;; :c ~.5
0> :0"
~ A C o
- G ~
- - -- .... Al b. C"sl.:;
"" '" '" " - ----- -
In it ials .. ;;; -"'='
J,. S. . .. . . . . F 23 Mixed Mod .. 9 607.4 115 .8 9.5 3. 5 4.7 P oslt lve. P ositi ve
E. I\I . .. . .. . M 21 Neural :\1od . . 7 469. 1 111.1 9.7 4.8 3.2 Nellath'e X egat lve
A. S.... .. .. F 35 Mixed Adv... 29 I ~ O 8 .9 4.9 .\.i Po sitive. Posittve
P.E... .. .. . M 35 Neural SlighI. 9 m:J 166 .6 10 .1 3.9 3.9 Ne~ ati\"e Negative
F. R . .. .. .. :\1 17 Nod.. . :\[od .. 8 573.3 124.6 10.6 3 .6 8 .1 Posltlve. Positive
A verage.. ... . .... ........ ........ ..... . 538.1 133 .6 9 .7 4 . 1 4.9
Mg. per 100 cc, 01 b lood .
l u lUllls ...
'"
T A BL E No. Yill
GROUP TREATED WITH ETHYL ESTERS
. ~
C::I
~ ~ ..
< is -
~
- -
c
.§
5
:5
--­
~
-5
i:
~
0
-
t
....
(;
rs
6
-- ­
!!l
§ ~
...c
Urine
E; 'o o~ ~ ~
2i! .-0
I ---~---
Jj
Alb. Cl\.m
-­e
E3
­ -­- - -­-
C. B .. F 10 Nod SlIgb t . 1 ~2 .5 198.7 7.6 4.5 7.9 Negative Negath'e
0 .1\1. .. F so Nod Adv.. ; 12 525.9 142.5 10.7 2.9 3.1 P ositive. Positive
J . R .. F 30 Nod :\1od .. 6 549.9 132.4 9 .4 2.R 2.3 P ositi ve . Postt fve
L. B .. F 2. Mixed Adv.. ; 14 .';26.5 158.5 9 .3 4. 5 3.4 PosItive. Posltlve
C.R
C.R
J . La T
L. R
F. R
E . B
F. C
E . ~I..
A.S
D. O
P. V
C.:\L
L .l.
F. R
J.O
J. C
G. D
S. R
M . R
..
.
. .
..
..
F
F
F
M
M
xr
41
39
27
22
Ii
18
62
M
. M 21
.. F 35
.. M 60
.. M 13
. F 50
.. M 45
. M 25
. F 55
.. M 18
.. M ao
.. ),1 23
.. F 41
Neural
Nod.. .
Mixed
Nod
Nod
Nod
N od
N eural
Mixed
Nod. ..
Nod. ..
,'eu ra l
Nod...
Mixed
M ixed
Nod. ..
Nod
Nod
M ixed
~Ill . per 100 ec, of blood.
Sli ght.
SlIgbt.
:\lod..
Adv. . ;
),10

450 PORTO RICO JOURNAL OF PUBLIO HEALTH AND TROP. JllllDlClNB
TABLE No, X
OASES WITH NEPHRITIS
:g
.l!l 2 e 8
is .s" 3 ::I i!J
,,0>
Urine
c .. ṣ. l!l 8 'u
.t:l
- '0
"
0> ~ 0
"0 ::lc 0
I nitials .. .,; ~ '" :a .1
In ltiRI. '" .~ .;j !f;;; c.
0
:a .a ~5 ]]
.t:l
-_.__. 0 0 ell Po< ...
"
R. O. R.. . .. 407.5 180.0 8.4 2.1 3.1
L . R. No.. .. 4118 .0 IllO.0 8.8 2.9 4.5
A.deL.. ... 4llO.2 123.0 10.0 2.5 4.2
M . T.A .. .. 510.0 1114 .0 8 .4 2.1 5.1
P.C.M. 50ll.4 119.9 9 .8 3.3 4 .8
M.O.O .. : : 487.9 128.0 8 .9 2 .9 4.9
J. M . J,.. . .. 427.1 1112 .0 8 .4 2.8 4 .4
J . fl. '1'.. .. .. 444.6 135.9 9 .1 3 .4 4 .9
R.V.M. .. . 4~9.2 117 4 9 .2 2.1 4.1
J.A. A .. . .. 468.8 129.4 8 .1\ 3.5 4 .1
L. V.A... .. «4.0 115.0 9.6 2.1 a.s
P. J . 8 .. .... 458.9 125.3 9.2 3.1 2.9
L. C. D ..... ~211 . 5 125.6 8.4 2.3 2.1
F.R.D.. .. 497.3 171.5 9.7 2.7 4.1
R. F .. .. .... 540.4 129.4 9.2 2.9 5.7
D. M. O, .. . 538.2 198. 4 8.9 2.6 4.6
J. M. L.. .. 536.5 102. 9 8.8 2.3 4.2
E.W L .. 542.9 129. 4 9.1 2.9 3.2
E.L. 5014 .1 214. 2 9.8 2.2 6.1
J.M.. ::::: : 49CU 122.9 8.4 2.5 6.8
M .L. M ... 468.4 1~2.3 9 .1 2.1 8.6
E . MeR .. .. 525.9 142.8 9.1 2.7 6.3
C. P . 4n.2 111.1 8.7 2.8 6.2
A. H .. :: : :: : 473.e 106.5 8.7 2.1 3.2
1. P... . .. . .. 443.9 142.3 9.5 2.8 3.1
.4.ver.llle.. 484.7 148.2 9.0 2.6 4.4

STUDIES OF THE BLOOD CHEMISTRY OF LEPROSY 451
TABLE No. XII
OaleB of nephr1ttB or nephrOlI1I
'0
al g e
'Q ..
Q,
-., 'Q "'
~ ".. II
:a ..a :;S" .c ~.9 .,
0 0 ell p.., ...
InlUa ls ~ El "Q ""
-----'- ----------­
F. B . . . . . . . . 59S.4 272.3 7. 1 7.1 5.4
II. F.. . .. ... &78.9 260 .4 7.6 6 .3 4.8
D.O. D . . .. 615.4 m.9 8 .5 7.2 5.Y
1.1. S .. ... . . . 601.0 278 .3 8 .1 6.4 4.2
A. I. .. .. .... 568 3 254.3 7.Y 5.4 ' .3
c. J......... 638 .3 22;;.8 R.9 3.1 a.a
c. 7. ..... ... ~ .O 26~ .3 8.3 4.6 3.8
A. M .. .. .. . 575.7 209.0 9.2 3.2 4.1
P.II. .... ... 60«. 4 241.3 s.a 4 5 s.IS
C. R . .. . . . . 552.8 221 9 R.6 4.7 5.1
AVfrage.. . 681. 7 252.1 8.2 5.2 4 . .5
Mi. per 100ce. of blood.
TABLE No. xrn
GROUP AVERAGEB
Ch lor- Ch olll'l- Serum Pb o;l· Icteric
Gro ups Ide' terol cslctnm phorus I ndex
- - - -
~ pare ntly N orm al P e....ons ... ...... .. . .. ..... ... 486.7 14 ~ 2 9 .0 2.6 4.4
on lepe rs nephr it is or nephrosis ... ... . .. :....... 681.7 252.1 8 .2 6.2 4.6
Group of Neural Cas es.... . . . . .. . ....... ...... . .. . 517.3 150.4 9 .8 3 .3 3.7
Group 01 M ixed Cases ... . . .. . .. .. .. .. . ..... .. . .. . 543.5 163.5 \/.4 3.7 4. 5
Uroup 01Nodular C9.Ses . . .. .. .. . .. . .. .. .. . .. .. .. . 542.1 131U 9.4 3.5 4.3
Gr oup 01 C.Se3 with Blight Lesions . .. ..•.•.... . . ~. 6 151. 9 II 3 3 .6 4.6
Group 01 Case. with Moderate Lesions . ...... .. .. 556.0 133.9 9.3 3.6 4.4
OrOUI' 01 Ceses wit h Advanced Leslons. . . ...... . . 523. 1 140.1 9.8 3.3 3.7
Group 01Cases T re'\l"d wit h mercur echrome . ... . 538.1 133 .1.' 9.7 4. t 4 .9
Group 01 Cas e~ Treated wi th Ethyl E sters. ..... . . MI. O 145.8 9.6 3 .5 4.2
O roup 01 Oases with Normal Urlnes . .. . .... .. . .. . 489.7 147.7 9.2 3.4 4.1
O roup of Onses with Nephritis.. .. . . .... . .. . .. . . . . 555.8 139.6 9 .6 2.8 2.6
Mg . per 100ce. of blood .