644 .LOUIS BAUMAN 



Opie and Alford, Rettig) ; feeding carbohydrates before administering 

 chloroform or salvarsan may therefore be a desirable prophylactic pro- 

 cedure (Bailey and Mackay). The formation of sugar from glycerol, 

 glyceric aldehyde and lactic acid and the degradation of glucose to lactic 

 acid have been observed during perfusion of the surviving liver of the 

 dog (Barrenscheen). Considerable amounts of lactic acid are formed on 

 perfusing a glycogen rich liver, but little or none is formed when the 

 liver is poor in glycogen (Embden and Kraus). 



The Liver and Fatty Acids. The normal liver contains about 2 per 

 cent of fat. In phlorhizin glycosuria, diabetes, starvation, acidosis, phos- 

 phorus poisoning and in other conditions, the liver may contain as much 

 as 70 per cent of glycerides that have all the chemical properties of 

 ordinary depot or stored fat. In this regard the liver differs from all other 

 organs for these contain fatty acids which are more desaturated than those 

 of adipose tissue. It appears to be the function of the liver to desaturate 

 fatty acids, possibly to synthesize them into phosphatides, and thus to 

 prepare them for utilization by the cells of the other organs of the body. 

 Le Count and Long found that the fat-lecithin ratio is similar in fatty and 

 normal livers but that the cholesterol-fat ratio is higher in the former. 



Embden and his pupils, as well as Friedmann(rf), have shown that of 

 the fatty acids from acetic to decoic, those with an even number of carbon 

 atoms are readily oxidized to acetoacetic acid by the surviving liver, but 

 not by the kidney or muscle. They found that when glycogen was present 

 in the liver the formation of acetoacetic acid was inhibited. Dakin. and 

 Wakeman have described two f erments in the liver ; the one reduces aceto- 

 acetic to hydroxybutyric acid, and the other accomplishes the reverse 

 reaction. 



2H 



CH 3 COCH 2 COOH ^ CH 3 CHOHCH 2 COOH 

 O 



In ordinary conditions of health acetoacetic acid is further oxidized, 

 probably by way of acetic acid, but in the absence of carbohydrate or 

 when carbohydrates cannot be utilized, then acetoacetic and hydroxy- 

 butyric acids are formed in such quantities that they accumulate in the 

 blood and tissues and lead to the condition known as acidosis. Many 

 observations speak for the important role of the liver in the degradation of 

 fatty acids. By oxidation, the liver first desaturates the higher acids, such 

 as stearic and palmitic, then breaks them up into fragments which yield 

 acetoacetic acid and this is ordinarily burned to carbon dioxid and water. 

 The rapidity with which the liver turns to fats when carbohydrates cannot 

 be utilized or are not available is well illustrated in the recent work of 

 Embden and Isaacs. These observers found that the surviving liver of a 

 depancreatizecl dog cannot convert glucose into lactic acid, but oxidizes fat 



