762 HENRY G. BARBOUR 



not prevented either by Eck fistula or the reversed operation ; unilateral 

 splanchnicotoiny exercises some inhibiting influence, bilateral more. This 

 appears largely due to an influence upon the adrenals which become im- 

 plicated as In asphyxial glycosuria. Rouzaud found an average blood 

 sugar content of 0.12 per cent in surgical chloroform anesthesia, ether 

 giving a similar result. 



Fat Metabjlism. Rosenfeld(a) (6) and others described fatty infil- 

 tration of liver, heart and kidneys after chloroform. The fatty and other 

 changes of the liver have been extensively studied by Whipple and his 

 pupils. This investigator ascribes to the hepatic lesions: icterus, disap- 

 pearance of fibrinogen from the blood, diminution of liver lipase (with in- 

 crease of plasma, kidney and muscle lipase) and the occasional excretion of 

 leucin and tyrosin, as well as the other metabolic changes of chloroform 

 poisoning. These claims appear well supported by the analogy to phos- 

 phorus poisoning. 



That the blood fat is increased under ether more than any other anes- 

 thetic was maintained by Bloor(e), who found a rise of 40 to 100 per cent. 

 Its water-solubility was considered the factor which favors ether in this 

 regard. Berczeller gives 30 per cent as the maximum increase. Unless 

 animals had been stuffed previously with fat food, chloroform was found 

 ineffective until the second or third day when an "after rise" in blood 

 fat occurred, which Bloor -ascribed to the liver necrosis. 



On the other hand, a lowering of the percentage of blood fat is de- 

 scribed by Murlin and Riche ; the intensity of this effect was found pro- 

 portional to the degree of narcosis. Mann has found the cholesterol con- 

 tent of the blood unchanged under surgical ether. 



Etherizati<^i of dogs for from one to one and a half hours on succes- 

 sive days has been found by Ducceschi(a) (&) to produce a marked in- 

 crease in the cholesterol of the serum. This may persist for several days 

 after the treatment. No untoward effects were noted in a twenty-five day 

 experiment. Chloroform under similar conditions caused death within 

 eleven days; the cholesterol remained high two or three days only, assum- 

 ing a subnormal level thereafter. 



Acid-Alkali Metabolism. Marked increase in the titration acidity of 

 the urine after long chloroform narcosis was described by Kast and Mester 

 and others. Becker described acetonuria and pointed out the inadvis- 

 ability of administering chloroform to diabetics. Thomas maintained that 

 while the titration alkalinity of the blood was diminished the carbon 

 dioxid content remained unaltered. This was ascribed to "carbon dioxid 

 congestion," or insufficient ventilation. Abram described acetonuria after 

 both choloroform and ether. Aloi recently found beta-oxy butyric acid in 

 nine out of eleven cases of chloroform anesthesia. 



Ether, chloroform, or nitrous oxide may reduce the P h of the blood 

 to 7.0 (neutrality), according to Menten and Crile. 



