ACUTE YEIJ.OW M'linl'IIY or Till: LIVER 543 



They arc iiearl}- constantly present (in thirteen out of fourteen cases 

 studied by Riess),*** tyrosine being usually the more abundant. 

 Deutcro-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, in- 

 creased, probabl}- resulting from the nuclear destruction in the liver. 

 There is often an increase in ethereal sulphates (Salkowski),"^ and 

 in })h()sp]i()rus poisoning various bases have been found in the urine,"- 

 Avhich i)resumably might also be found in acute yellow atrophy if 

 sought for. The total elimination of nitrogen is increased °^ (par- 

 ticularly if the scanty intake is considered), and the proportion that 

 appears as urea is decreased, largely because of the presence of much 

 ammonia,"* part of which, at least, is eliminated combined with or- 

 ganic acids. Chief of these acids is sarcolactic acid, but of partic- 

 ular interest is the supposed appearance of oxymandelic acid, 



HO / \ CHOH— COOH, 



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



HO <(^ ^ Cn,— CH ( XH, ) —COOH, 



by the splitting out of the NHo 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-oxyphenyl-lactic 

 acid, 



HO < > CH„ — CHOH — COOH 



which can be demonstrated in the urine of dogs poisoned with 

 phosphorus, and which represents a simple deaminization of tyrosine 

 without further oxidation. It is evident from the urinary findings, 

 therefore, that oxidation is decreased, which is presumably because 

 of the destruction of liver tissue with its important oxidizing func- 



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

 uria witliout hepatic atrophy (X. Y. ^led. Jour., Sept. 1!), 1914). 



80 Rerl. klin. Woch., 1905 '(42), Xo. 44 a., p. 54. 



90 Salkowski (Berl. klin. Woch., inO,5 (42), 15S1 ) found in the urine of a case 

 of acute yellow atrophy a large quantity of nitrogen in a colloidal but non- 

 protein form, apparently of carbohydrate nature. Mancini (Arch, di farm, 

 sperim., 1906, Bd. v) also observed an increase in the colloidal nitrogen of the 

 urine in liver diseases. 



oiVirchow's Arch., 1909 (198), 188. 



92Takeda. Pfliigcr's Arch., 1910 (133), 365. 



93 See Welsch, Arch. int. pharm. et th^r., 1905 (14), 211. 



94 See Voegtlin, .Johns Hopkins Hosp. Bull., 1908 (19), 50: White, Boston 

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



95Zeit. physiol. Chem., 1910 (65), 397 and 402; also Fromherz, ibid.. 1911 (70), 

 351. 



