AND DIABETES 161 



cases both these causes are combined, as when a 

 patient with a perforated gastric ulcer, who has 

 absorbed nothing for hours, is given chloroform. 

 The vomiting induced by the acetonasmia of course 

 prevents the retention of carbohydrate food, and so 

 the bad becomes worse. 



Salicylates presumably act by paralysing that 

 function of the tissues which enables them to take 

 up sugar from the blood. As we shall see, this is 

 also the pathology of diabetes. The tissues, starved 

 of sugar, break down the fat to acids and acetone 

 instead of to carbon dioxide and water. With 

 reference to the acidosis of pregnancy, some un- 

 published observations by Statham, made at the 

 Bristol Royal Infirmary, show that in addition to 

 the acidosis of pernicious vomiting, in which probably 

 starvation is a factor, there is constantly an increase 

 in the ammonia nitrogen ratio in the urine in the 

 pre-eclamptic state as well as in eclampsia ; usually 

 there is diacetic acid present, but not always. If 

 the patient is kept on glucose, the nitrogen ratio 

 becomes normal soon after delivery, but not before. 



THE MECHANISM OF POISONING IN ACIDOSIS 

 AND ACETONiEMIA. 



Neither acetone, diacetic acid, nor /3-oxybutyric 

 acid is poisonous, except in enormous doses. Why 

 then do such marked and indeed fatal symptoms 

 occur when they accumulate ? 



The blood is normally alkaline. All the functions 

 of the tissues are attuned to a medium of a particular 

 alkalinity. If this alkahnity is greatly reduced, 



II 



