650 LOUIS BAUMAN 



normal functions, while another, the seat of mild parenchymatous de- 

 generation, may show evidence of disturbed function. In fact, it is 

 probable that functional disturbances occur in the absence of gross or 

 microscopic changes. A consideration of the literature teaches that it is 

 well to know the state of several functions of the liver before arriving at a 

 conclusion regarding the presence or absence of disease. 



The levulose and galactose tolerance tests were first used by Strauss (/) 

 and Bauer (a), respectively. 100 grams of levulose or 40 grams of galac- 

 tose are administered in the morning before breakfast. Following the in- 

 gestion of these carbohydrates, a normal person will usually excrete little 

 or no levulose and less than 3 grams of galactose. In the event of liver in- 

 sufficiency, a considerable quantity of sugar may be excreted. As far 

 as the writer knows, no one has studied the blood sugar curves after the 

 ingestion of these carbohydrates, though it is apparent that helpful in- 

 formation might be obtained by this means. 



The urea, ammonia and amino acid fractions of the urine and blood 

 have been studied in diseases and in experimental lesions of the liver. 

 In quite a few instances the methods have been inadequate and in others 

 the results are open to criticism for one reason or another. The accurate 

 gasometric determination of amino nitrogen was employed by Levene and 

 Van Slyke in their study of the urine of animals poisoned with phosphorus 

 and chloroform. No increase of amino nitrogen was observed even when 

 the liver was extensively degenerated. In two cases of human cirrhosis, 

 the amino acids of the urine were not increased. 



In the toxemia of pregnancy, a condition often associated with necrosis 

 of the liver, Losee and Van Slyke failed to find an increase of amino 

 acids in the blood or urine though the urea nitrogen in the latter was 

 diminished. 



At the present time it appears that, with the possible exception of 

 acute yellow atrophy, an increase of amino acids in the blood or urine 

 is an infrequent occurrence in hepatic disease. 



The behavior of the ethereal sulphate excretion before and after the 

 administration of a. known amount of one of the phenols has also been 

 used as a test of liver function. Certain factors detract from the value 

 of this test. It is known that some of the phenol may be oxidized or com- 

 bined with glycuronic acid and that other organs besides the liver may 

 conjugate phenols with sulphuric acid. 



Whipple(6) and others have found that the concentration of fibrinogen 

 in the blood is diminished in experimental lesions and diseases of the liver. 

 In some cases no fibrinogen at all was found. 



Goodpasture(a) has noted that the clotted blood of patients suffering 

 from liver disease may liquefy in the course of 4 hours. Normal clotted 

 blood remains unchanged for several days. This phenomenon is appar- 

 ently due to the presence of a proteolytic ferment. 



