CHAP. III.] THE BLOOD IN DISEASE. 171 



Two cases which the Author has had the opportunity of studying 

 do not, however, support this fascinating theory. In one of these 

 cases the amount of fat in the blood was exceedingly great, yet 

 a most scrupulous investigation of the lungs, the kidneys and the 

 brain, conducted by Dr Dreschfeld, led to the conclusion that no 

 emboli were present. In the second case the amount of fat in 

 the blood (or rather the amount of matters soluble in ether) was 

 not larger than usual, and in this case also a most painstaking search 

 shewed the absence of emboli. 



Quincke, who has rejected the 'Acetonaemia theory' of diabetic 

 coma, is inclined to consider it as a condition which, like uraemia, 

 is probably induced by a combination of circumstances, and by 

 the toxic action of more than -one product of tissue metabolism, 

 amongst which may be the body which is excreted in the urine, and 

 is coloured red by perchloride of iron. Whatever may be the toxic 

 agent or agents, it is difficult to see cases of diabetic coma without 

 coming to the conclusion that the condition is one due to a toxic 

 action and not to a suddenly-developed nervous lesion. As bearing 

 upon this question it is worthy of rnention that in the first of the two 

 cases of which the notes are given below, the liver was found, after 

 death, to be the seat of intense fatty infiltration, similar to that 

 observed in cases of poisoning by phosphorus. 



The following .are brief notes of two cases previously referred to, in 

 which the Author has had the opportunity of examining the blood of 

 patients suffering from diabetic dyspnoea and coma. 



I. X, a man of about 35 years of age, a patient in the Manchester Royal 

 Infirmary, under the care of Dr Roberts, F. R. S., had been suffering from 

 diabetes of two and a half years duration. Since his admission into the 

 hospital his urine had amounted to 300 ounces per diem with a specific 

 gravity of 1030-1035. The patient exhaled a peculiar ethereal (acetone- 

 like 1 ?) odour which pervaded the whole ward and attracted the attention 

 of the other patients. On 9th July, 1879, after returning from a walk, the 

 patient was seized with intense dyspnoea ; the exaggeration of inspiratory 

 and expiratory movements was equally marked ; there was no evidence of 

 venosity of blood ; the exaggerated respiratory movements continued uni- 

 formly without any rhythmical variation in intensity. At first the patient 

 was conscious, but he subsequently became comatose, and died 21 hours 

 after the commencement of the attack. 



During the attack of coma the blood was examined microscopically 

 without any deviation from the normal appearance being noticed. Some 

 blood was drawn from tfye arm by venesection ; it coagulated normally, 

 and there separated from it a serum distinctly milky, though not more so 

 than is compatible with a physiological condition. At the post-mortem 

 examination a considerable quantity of blood was collected from the cavity 

 of the chest. The broken-up clot mixed with serum was placed in a 

 bottle. After some hours a creamy layer had floated to the surface of 

 the liquid, this layer being about one-sixth of the total volume of ^ the 

 liquid. The milkiness was found to depend upon oil globules of various sizes. 



