840 



HAROLD BAILEY 



TABLE I 

 NITROGEN PARTITION OF THE UBINE. ACUTE YELLOW ATROPHY. (From Ewing and Wolf) 



In cases Nos. 30. 31 and 33 autopsies allowed that considerable autolysis or 

 necrosis existed. Note the reduction in the urea and the moderate rise in the ammonia 

 and undetermined nitrogen. 



typical of the entire group. These figures resemble those of the yellow 

 atrophy cases but in addition they have the creatinin and uric acid deter- 

 minations and show how the separation of these fractions may reduce 

 the so-called undetermined nitrogen. The figures will be given from two 

 cases of pernicious vomiting. Case 7, Table II, is typical of the nitrogen 

 partition in this disease and such figures are substantiated by others, as 

 \vill be brought out later. Case 12, although fatal, never showed any 

 increase in the ammonia fraction. 



According to the clinical history of the last case (No. 12) the patient 

 was unable to eat and apparently the nitrogen in the urine was entirely 

 the result of the endogenous metabolism. The total nitrogen is exceed- 

 ingly low and in comparison the undetermined nitrogen is high and, as 

 a matter of fact, nearly as high as any of their figures in the toxemic 

 cases. It would seem that the contention of defective deamination would 

 hold good in this case as in the others ; however, apparently from the fact 

 that the ammonia is low throughout, they offer two possible explanations 

 for the results. One is that the disease arises from some other source than 

 a disturbance in metabolism, which may be a secondary feature, and the 

 other, that the initial process of defective deamination was successfully 

 met by the organism ; but in the meantime other organs in the body had 

 been so seriously damaged that the symptoms continued and death resulted 

 in the absence of the original factors. 



This case is exceedingly instructive and eliminates any stated ammonia 

 percentage as a criterion to the condition of the patient, In the light of 

 our present knowledge as regards urea formation there is the possibility 

 that the small amount concerned in the endogenous metabolism is formed 

 elsewhere than in the liver and it leaves for further consideration the 

 reason for this high rest nitrogen. 



Ewing and Wolf, while recognizing the significance of acidosis as a 



