114 



if a day or two can be secured first, it should be 

 possible with our present knowledge to banish this 

 bugbear from surgery. It will be much safer to give 

 ether than chloroform, on account of the danger of 

 delayed chloroform poisoning. If the urine con- 

 tains no diacetic acid this precaution will be sufficient. 

 Should the red coloration with ferric chloride be 

 present, however, the patient ought to be put on the 

 oatmeal diet, and alkalies introduced by mouth, 

 rectum, or intravenously, until the acid reaction of 

 the urine disappears. These measures must be kept 

 up for a day or two after the operation, until the 

 danger has passed. 



Perhaps we are scarcely yet entitled to speak of the 

 treatment of diabetic coma. It is true that after 

 intravenous injection of two or three pints of a 

 solution of sodium carbonate (3iv to the pint), 

 patients have made a marvellous rally, and, as in 

 one case in the writer's experience, may be so far 

 recovered as to sit up in bed, eat an orange (without 

 leave), and talk to friends. But the symptoms soon 

 recur, and proceed to a fatal termination. The 

 alkaline injection must not be given subcutaneously, 

 but intravenously ; the former method will often 

 cause gangrene. 



REFERENCES. 



L. HILL. " Recent Advances in Physiology and Bio- 

 chemistry," Arnold & Co., London, 1906, p. 312. 



VON NOORDEN. " Metabolism and Practical Medicine," 

 Heinemann & Co., London, 1907. Edited by I. 

 Walker Hall. Vol. i., p. 169 (Acetone Bodies) ; vol. iii., 

 (Diabetes Mellitus). 



VON NOORDEN. " Diabetes Mellitus," J. Wright & Sons Ltd., 

 Bristol, 1906 ; " Acid Auto-intoxications," J. Wright 

 & Sons Ltd., Bristol, 1904. 



