856 HAROLD BAILEY 



hydrate in the maternal circulation because of the rapid diffusion of 

 dextrose through the placenta leads, indirectly, to an increased elimination 

 of the creatin. If we reexamine the charts of E wing's pernicious vomit- 

 ing cases, where the supposition is reasonable that a liver degeneration 

 existed, we will find that there is no increase in the actual amount of 

 creatinin in the urine. The same statement does not hold for the excre- 

 tion of creatin in the experimentally produced degeneration in the dog 

 to which hydrazin was administered by Underbill and Kleiner. Here, 

 while the creatinin excretion was variable, there was a relatively large 

 output of creatin. In the delayed chloroform poisoning in dogs, Howland 

 and Richards found that the creatin was increased in both dogs that were, 

 severely poisoned but not in the control animal. 



Wolf and Osterberg in their experimental degeneration of the liver 

 in dogs by means of phlorizin found a marked increase in the creatin 

 output and suggested that it, might be due to the increased formation of 

 creatin or to the inhibition of the processes whereby creatin is converted 

 into urea. It was formerly held that creatin and uric acid were con- 

 verted to urea in an unknown but definite proportion of their entire 

 amount. 



Ten of the total of 19 cases of eclampsia in Caldwell and Lyle's list 

 show an increase to 2 mg. in the creatinin content of the blood. Of itself 

 this fact might be considered of only moderate importance for so little is- 

 known of the metabolism of creatin and creatinin. It demands attention 

 for in conjunction there is marked retention in the uric acid, representing 

 nuclear metabolism, and the kidneys are also eliminating considerable 

 amounts of these substances. 



Attention should be given to the ability of the kidney to excrete 

 creatinin. Orlovius found that the excretion in normal pregnancy averaged 

 for 11 cases 1.23 gm. and that the kidney function could be estimated by 

 the time limits necessary for the elimination of stated amounts of crea- 

 tinin, administered by intramuscular injection. Normal kidneys elimi- 

 nate 1.5 gm. in 12 hours and degeneration of the kidneys leads to a slow 

 excretion lasting over 24 hours. In the non-pregnant the elimination is 

 from 0.7 to 1.1 gm. per kilogram of body weight. 



In chronic nephritis there is an increase in the creatinin fraction in 

 the blood and it would appear that it is the last of the metabolites to be 

 retained by the kidneys. In nephritis, however, there is a lessened output 

 in the urine. 



To summarize the theories accounting for the increase of creatin and 

 creatinin in the urine and the increase of creatinin in the blood, they are 

 as follows: 



1. Retention from inability of a damaged kidney to excrete creatinin. 



2. A supply of creatin from the fetus which is synthesized. 



