ACUTE YELLOW ATROPHY OF THE LIVER 551 



Frerichs. While we now know that these and other amino-acids 

 may occur in the urine in any conditions in which there is a great 

 breaking down of tissue within the body, yet it is true that in no 

 other con(Ution are they found so abunchmtly as in acute hepatic 

 atrophy (as high as 1.5 gm. of tyrosine per diem has been found). ^' 

 They are nearly constantly present (in thirteen out of fourteen cases 

 studied by Riess),^^ tyrosine being usually the more abundant. Deu- 

 tero-proteose is also frequently (but not constantly) found, as further 

 evidence of abnormal protein splitting.-" Uric acid and other purines 

 are often somewhat, but not characteristically, increased, probably 

 resulting from the nuclear destruction in the liver. There is often an 

 increase in ethereal sulphates (Salkowski),^^ and in phosphorus poi- 

 soning various bases have been found in the urine,-- which presumably 

 might also be found in acute yellow atrophy if sought for. The total 

 elimination of nitrogen is increased-^ (particularly if the scanty intake 

 is considered), and the proportion that appears as urea is decreased, 

 largely because of the pi'esence of much ammonia,-^ part of which, at 

 least, is eliminated combined with organic acids. Chief of these acids 

 is sarcolactic acid, but of particular interest is the supposed appearance 

 of oxijmandelic acid, 



H0<^ ^CHOH— COOH, 



which might be derived from tyrosine (Schultzen and Riess), 



ho/ ^CH2— CH(NH2)— COOH, 



by the splitting out of the NH2 group, the benzene nucleus failing 

 to be completely oxidized as it normally is. The researches of El- 

 linger and Kotake,^^ however, make it probable that the supposed 

 oxymandelic acid is something else, most likely p-oxyphenijl-ladic 

 acid, 



ho/ \ch2— choh— cooh 



1* An interesting exception has been reported by W. G. Smith (Practitioner, 

 1903 (70), 155) who found great quantities of leucine in the urine of a young 

 woman who was apparently not at all ill. Rosenbloom has found tyrosine crys- 

 tals in the urine of a healthy pregnant woman, and cites other cases of tyrosin- 

 uria without hepatic atrophy (N. Y. Med. Jour., Sept. 19, 191-4). 



'^ Berl. khn. Woch., 1905 (42), No. 44 a., p. 54. 



-"> Salkowski (Berl. klin. Woch., 1905 (42), 1581) found in the urine of a case 

 of acute 3'ellow atroph}^ a large quantity' of nitrogen iii a colloidal but non-protein 

 form, apparently of carbohydrate naWre. Mancini (i\jch. di farm, sperim., 

 190G, Bd. v) also observed an increase in the colloidal nitrogen of the urine in liver 



21 Virchow's Arch., 1909 (198), 188. 



" Takeda, Pfliiger's Arch., 1910 (133), 365. 



23 See Welsch, Arch. int. pharm. et ther., 1905 (14), 211. 



2* See Voegtlin, Johns Hopkins Hosp. Bull., 1908 (19), 50; Wliite, Boston 

 Med. and Surg. Jour., 1908 (158), 729. 



" Zeit. physiol. Chem., 1910 (65), 397 and 402; also Fromherz, ibid., 1911 (70), 

 351. 



