518 THE LIVER [CH. XXXIII. 



patients smell strongly of acetone ; hence the term acetoncemia. This 

 apple-like smell should always suggest the possible onset of coma and 

 death, but it is exceedingly doubtful whether acetone (which can 

 certainly be detected in the urine) is the true poison ; ethyl-diacetic 

 acid, which accompanies, and is the source of the acetone, was regarded 

 by some as the actual poison, but these substances, when introduced 

 into the circulation artificially, do not cause serious symptoms. The 

 principal poison is amido-hydroxy butyric acid. The alkalinity and 

 carbonic acid of the blood are decreased, and the ammonia of the urine 

 is increased ; this indicates an attempt of the body to neutralise the 

 poisonous acids. 



The Nerves of the Liver. 



Claude Bernard observed that an increase of sugar in the blood is 

 brought about by stimulation of the central and peripheral ends of 

 the divided vagus, and that on the section of both vagi sugar dis- 

 appears from the blood, and glycogen from the liver and tissues 

 generally. These results have been confirmed in recent experiments, 

 and it has been in addition found that stimulation of the coeliac 

 plexus also leads to a loss of glycogen in the liver, with a correspond- 

 ing production of glucose that passes into the blood. The disappear- 

 ance of glycogen from the liver cells after the stimulation of these 

 nerves can also be seen histologically (Cavazzani). These results are 

 due to a direct influence of the nerves on the liver cells, for they are 

 obtained after the circulation is stopped by ligature of the aorta and 

 portal vein (Morat and Dufourt). 



Vaso-motor nerves. The vaso-constrictor fibres for the portal vein 

 leave the spinal cord in the third to the eleventh thoracic nerves 

 inclusive (Bayliss and Starling). The nerves of the hepatic artery 

 are constrictors contained in the splanchnic, and dilators in both 

 splanchnic and vagus. 



