Eight days later, 12th November, a qualitative, and quantative analysis of the urine was again made, with the following result:--
24 HOURS' URINE. Quantity (33 oz.) . . . . . . . 1023 c.c. Reaction . . . . . . . . . . . Acid. Specific gravity . . . . . . . 1017. Urea . . . . . . . . . . . . . 15·345 grammes. Uric acid . . . . . . . . . . . ? Bile acids . . . . . . . . . . None. Bile pigment . . . . . . . . . Abundant. Sugar . . . . . . . . . . . . . Increased. { 80} Tyrosine, and leucine[25] . . . In small quantity. Solids (total) . . . . 23·426 Organic matter . . . . . . . . 17·698 Inorganic . . . . . . . . . . . 5·728
[Footnote 25: On precipitating the urine with the acetate of lead, filtering, and freeing the clear liquid from the excess of that reagent by means of sulphuretted hydrogen, and again filtering, the liquid, on evaporation, was found to deposit small crystals of tyrosine, and to have floating in it, and on its surface, round balls of leucine.]
Here, is now to be observed, the rapid downward progress of the case. Stomachal digestion, as indicated by the amount of urea, is much impaired. The general health, as indicated by the sugar, is sadly affected, and, to crown all, tyrosine, and leucine, the indicators of atrophy of the liver, have made their appearance. So unfavourable was the result of this analysis considered, that Dr. Prance felt himself bound to fulfil a promise he had made to the family some time previously, of warning them of approaching danger, when we had no longer any hope of the patient's recovery.
Some time afterwards, in the beginning of December, we again saw the patient together, and made a physical examination of the hepatic organ, the result of which only confirmed our suspicions. The liver was decidedly smaller. The epigastric tenderness was increased. The { 81} jaundiced tint deeper. Petechial spots had now appeared on the trunk, and arms. The lower extremities were oedematous, and the abdomen two-thirds filled with fluid.
On the 31st December, I received a sample of urine, and a note saying that the patient had slightly rallied. But on examining the urine, it was found to have a neutral reaction--it had previously always been acid--to be of a specific gravity of 1019, and on standing, to deposit a copious sediment of lithates, coloured intensely yellow with the bile pigment. Curiously enough, the bile-acids had reappeared; but only in quantity sufficient to admit of their being detected. In spite of these trifling changes for the better, the ominous one of an increased amount of sugar was still there.