476 JACOB ROSEXBLOOM 



Labbe and Bith found that an increased amino-acid excretion occurs 

 in insufficient amino-acid destruction on the part of the liver, in cases 

 where pathological destruction of proteins is going on, and in conditions 

 of acidosis, whether diabetic or of another nature. Of 40 cases of hepatic 

 disease, all cases which showed a marked injury to the tissues showed an 

 equally marked increase of amino-acid in the urine. Normal values occur 

 in uncomplicated gall-stones and catarrhal jaundice. The same is true in 

 the cases of early Laennec's cirrhosis, but in the later stages of the disease 

 the excretion is increased. Abnormally high values also occur in fatty 

 degeneration, cases of primary tumor, cirrhosis secondary to cardiac dis- 

 ease, and in cases of phosphorus and chloroform poisoning. In cases of 

 marked diabetic acidosis, values of from 0.92 to 3.04 gm. of amino-acid 

 nitrogen per day were found, these values representing 8.4 to 18.4 per cent 

 of the total nitrogen output. In a number of diseases of the gastro-intes- 

 tinal tract, in gout and chronic rheumatism, normal values were found. In 

 those acute and chronic diseases which are accompanied by an abnormal 

 breaking down of protein tissue, such as occur in the late stages of typhoid, 

 in the crisis of pneumonia and during the absorption of pleuritic and other 

 exudates, in leukemia, etc., constant increased amino-acid excretion was 

 observed in the urine. As a functional test, designed to show the inability 

 of the liver to perform its normal amino-acid decomposition, Labbe and 

 Bith recommend the administration of 20 gm. of peptone while the patient 

 is on a simple milk diet. If under these conditions an increased amino- 

 acid excretion is observed, in all probability this indicates an affection of 

 the liver. 



Galambos and Tausz have found an increased excretion of amino acids 

 in diabetes and in diabetic acidosis they found very high values. Loffler 

 and also myself have found the same. 



In these cases there is present some defect in the ability of the liver or 

 other tissues to take up these amino acids and for this reason they are 

 excreted. 



The presence of the sulphur containing amino-acid cystin will be dis- 

 cussed under cystinuria. 



The amino acids tyrosin and leucin were first observed by Frerichs(gr) 

 as urinary sediments in a case of acute yellow atrophy of the liver. It is 

 to be recalled that these substances have been found in the urine in many 

 diseases such as erysipelas, typhus, typhoid, variola, rabies, leucemia, gout, 

 diabetes, cystinuria, and acute phosphorus poisoning, but are present in 

 solution and not as spontaneously precipitated crystals. They are most 

 often found associated with acute yellow atrophy of the liver, but the 

 crystals have also been found in other conditions. Boston (d) found them 

 in a case of jaundice with enlargement of the liver ; Kirkbride in a case of 

 erysipelas and osteomalacia ; Mann in cases of hepatic congestion due to 

 cardiac disease; Juge in a case of diabetes mellitus with albuminuria; 





