POISONING BY CHLOROFORM 181 



the subject upon animals, and in demonstrating 

 that adrenalin has a peculiar power in bringing on 

 the ventricular fibrillation which is the particular 

 danger of a light chloroform ansesthesia. A number 

 of deaths have now been recorded from this cause 

 in medical literature. The adrenahn-ether combina- 

 tion appears to be safe. 



DELAYED CHLOROFORM POISONING. 



The third danger is subtle and unexpected ; it has 

 been recognized only recently, and we do not know 

 how to treat its symptoms. 



In Chapter X. reference is made to the remark- 

 able process of abnormal decomposition of fats which 

 may take place when the amount of glucose suppHed 

 to the tissues by the blood is deficient. In 

 these circumstances, /3-oxybutyric acid, diacetic (or 

 aceto-acetic) acid, and acetone are produced, and 

 the patient is poisoned by the acids, while the ace- 

 tone imparts a sweet odour to the breath and urine. 

 We saw that starved patients and diabetics were 

 particularly liable to this condition of "acidosis " or 

 " acetonaemia," as it is variously called. Fat chil- 

 dren and sufferers from peritonitis are frequently 

 the subjects of acidosis after operations in which 

 chloroform has been used, and there is greater danger 

 if there has been a long interval between the last 

 feed and the anaesthetic. A prolonged administration 

 is more dangerous than a brief one. The train of 

 symptoms is referred to as delayed chloroform 

 poisoning. A hospital of 200 beds may perhaps 

 furnish one or two such cases annually, if chloroform 



