182 IMMEDIATE AND REMOTE 



is used frequently as the anaesthetic of choice. The 

 signs are incessant vomiting, drowsiness or uncon- 

 sciousness, and a sweet acetone odour in the breath. 

 Acetone and aceto-acetic acid are present in con- 

 siderable amount in the urine. A trace may often 

 be found after any ansesthetic. Death follows 

 within a few days. At the post-mortem examination 

 the liver, kidneys, and other organs show signs of 

 acute fatty degeneration. Whether this is the 

 cause or the consequence of the acidosis may be in 

 doubt, but the vomiting and drowsiness are almost 

 certainly due to the effect of the acid intoxication 

 on the brain. Most surgeons who are aware of the 

 condition can recall sad cases where an operation 

 promised well, but this fatal complication stepped 

 in and banished all hope of a favourable issue. 

 Recently it has been found possible to imitate the 

 condition in experimental animals. To draw the 

 practical lesson, we can at present hope only to 

 prevent, not to cure. Every patient to whom it 

 may be necessary to administer chloroform should 

 be guarded as far as possible against this compli- 

 cation. The urine should be tested with ferric 

 chloride. A prolonged starvation should be avoided. 

 Glucose and alkalies have been advocated as remedies 

 likely to prevent trouble, and the former would 

 appear to be the better. If possible, ether should be 

 given to patients who have been starved, to fat 

 children, and, especially, where the urine strikes a red 

 colour with ferric chloride. Diabetics require special 

 care. If prolonged vomiting follows recovery from 

 the anaesthetic, the poison should be diluted by a 



