1620 REVIEWS AND NOTICES OF BOOKS.

whole having escaped into the dressing. The stump was notagain disturbed for ten daya, when the wound was found tohave healed by primary union and the sutures were con-

sequently removed. subsequently to operation the patientwas perfectly comfortable and free from pain. The tempera-ture remained at or about normal throughout, except on oneocca,sion, when he complained of sore-throat and the eveningtemperature reached 100’2° l’B Three weeks after the opera-tion the patient was sent to the Convalescent Hospital atCheadle, where he remained ten days and was then senthome. He has recently written that he has remained in goodhealth.The following is the description of the specimen by

Mr. H. W. Pomfret :-Naked-eye appearalwes,-Upon cutting into the swelling

on the inner side of the knee-joint a dark grumous fluid

gushed out from the midst of a venous-coloured, very soft, andfriable tissue. This tissue presented a granular structure

approaching that of a fi5h’s roe and was apparently confinedwithin a thin membranous wall. This swelling was in factcircumscribed and formed a large cyst. Intervening betweenthis cyst and the articular line was a cluster of white, pulta-ceous, but individually distinct bodies bearing the exactappearance of boiled haricot beans. Attached to thetendons of the inner hamstrings and extending up theham at distances of about an inch apart were foundthree venous-coloured cysts about the size of walnuts.These cysts were definitely encapsuled and connectedwith the tendons like ganglia, The capsule of each ofthese smaller cysts was lined with the same friable tissue asthat found in the larger cyst at the inner side of the knee,the central contents being also similar grumous fluid.The articular cartilages were for the most part perfectlynormal, but at points round the head of the tibia the edgeof the cartilage was slightly ercded by the altered synovialtissue. This same condition prevailed round the margins ofthe posterior ends of the femoral condyles, whilst at one

point on the internal condyle was a larger erosion, caused bytissue spreading from the inter-condyloid fossa. This largererosion presented much the appearance of tuberculous ulcera-tion ; the synovial membrane, however, presented littleresemblance to tuberculous disease. The thickening of themembrane was, in most parts, not more than in simplechronic synovitis. Its surface glistened, was of a brightclaret red, and appeared flocculent. Round the margins ofthe articular cartilages, especially posteriorly about thecrucial ligaments, the membrane became much thicker,studded with small, round, bright red elevations, and mergedin the inter-condyloid notch into a soft tissue resembling thatof the cysts. Lower down, behind the crucial ligaments andlargely replacing the ligamentum posticum, was another col-lection of the white bean-like bodies. The patellar cartilage,the superior tibio-fibular articulation, and the bones were allperfectly normal.

Miorosoopioal appearances.-The friable roe-like tissue ofthe cysts and the tissue from the inter-condyloid notch hadthe microscopical appearances of spindle-celled sarcoma

undergoing mucoid degeneration--that is to say, looselyarranged spindle cells with here and there branched cellsand clear spaces between them. Closely packed spindlecells without degeneration were the only elements to befound composing the structure of the white bean-like bodies.Remarks by Mr. SAL’rER.-The foregoing is a fairly com-

plete history of the case, which is undoubtedly one of primarysarcoma of the synovial membrane, the rarity of which con-dition is such that I have been able to find no record of anyprevious case in the English journals, and Mr. Hardie informsme that he has only once previously met with a case of thekind. This occurred in a middle-aged woman in private prac-tice. Amputation through the thigh was performed, and thepatient succumbed to the effects of secondary growths in thebones of the face and skull about eighteen months afterwards.

FOREIGN UNIVERSITY INTELLIGENCE.-St. Petersburg (Mtlitary Medíoal Academy) A new Professorship ofInfectious Diseases and Bacteriology is about to be estab-lished, and in connexion with it a special clinic for infectiousdiseases, with about fifty beds, is to be built.-Berlin : Dr.Langaard, for many years Professor Liebreich’s assistant,and one of the editors of the 2’Jrerapeutische Monatskefte, hasbeen raised to the rank of Professor.-Leipsic: ProfessorSoltmann of Breslau has been appointed to the ExtraordinaryProfessorship of Children’s Diseases vacated by the migrationof Professor Heubner to Berlin.

Reviews and Notices of Books.1’7te P7t!lsiolog?l f!/ the Carbohydrates, their Applieation as:

1’ood and Relation to Diabetes. By 1’. W. PAVY, M.D.London : J. & A. Churchill. 1894. Pp. 280.No more able exponent of the physiology of the carbo-

hydrates than Dr. Pavy could be found. A large part of his,life has been spent in studying their properties, in examiningtheir composition, and in endeavouring to trace their historyin the animal body from the moment of their ingestion in the-solid state to that of their elimination in the form of waterand carbonic acid gas ; whilst in his practice he has been,largely occupied in the endeavour to divine the causes and toprevent the consequences of that excessive discharge from thebody in diabetes and allied affections. It is therefore withmuch interest that we have read the results of his mature

judgment in the pages of this work. That starch, one of the-most typical examples of the carbohydrates, is formed by thechlorophyll of plants, under the influence of the sun’s rays,from the carbonic acid gas and water of the atmosphere is.

undoubted, but the exact steps of the process by whichCO2 and H2O yield this substance has not been clearly demon-strated, and Dr. Pavy points out that two hypotheses maybe advanced: in one, the formic aldehyde hypothesis,formic aldehyde, CH2O, may first be produced, and then,by polymerisation (or the union of several molecules toform one larger molecule), six such molecules may uniteto form a carbohydrate of the composition CüH1206; or

"instead of the carbohydrate being directly or by inter-mediate steps synthesised from its elements, it may happenthat these become appropriated by the living protaplasm and’worked up into the proteid matter of which protoplasm isconstituted, and from which the carbohydrate by a furtheraction is afterwards split off." A considerable section ofDr. Pavy’s work is devoted to argument in support of thishypothesis.The general formula for the carbohydrate group is repre-

sented as [C6(HO)n]n’. They are therefore six carbon-

atom compounds. A fermentable sugar named a-acrose,.

resembling dextrose and having the same composition(CÙH120()), but optically inactive, has been syntheticallyformed by Emil Fischer, and has become the starting-pointof the synthesis of several fermentable sugars of the glucosegroup, and other sugars have been formed possessing seven,eight, and nine carbon atoms in the molecule.

Dr. Pavy divides the carbohydrates which fall under hisconsideration into the amyloses with the formula (06H1005) n,including cellulose, starch, glycogen, and dextrin ; the

saccharoses, C12H22Ol1’ including maltose, lactose, and canesugar; and the glucoses, CüH1206’ including dextrose, loavulose,and galactose, and each of these he describes in detail. Thebehaviour of sugars with phenyl-hydrazine is briefly given,and it is shown that combinations of this substance with the

sugars exist, the product being formed in two stages, onemolecule of the sugar becoming united in the first instancewith one molecule of phenyl-hydrazine giving rise to hydra-zone, which then takes up oxygen and combines with anothermolecule of phenyl-hydrazine to produce osazone, and thedifferent osazones can be recognised by well-marked chemicaland physical characteristics. A long chapter is devoted to,the "glucoside constitution of proteid matter, " in which theauthor inserts some part of the paper he read last year beforethe Royal Society. Dr. Pavy next proceeds to consider thedestiny of starch after its ingestion into the alimentary tract.The action of ptyalin is shown to be that of converting starchinto maltose by augmenting its hydration, and correspond-ingly increasing its reducing power on cupric oxide. In the

stomach, as is well known, starch undergoes little change,though the action of the saliva may be continued in it. The

1621REVIEWS AND NOTICES OF BOOKS,

tpancreatic ferment and those of the Lieberkuhnian and

Brunnerian glands exert a powerful action, and maltose

and probably glucose and other forms of sugar are produced.Cane sugar when ingested is to a large extent transformed’into glucose, and this substance glucose is fitted for absorp-tion and is readily recognisable in the portal blood.

Dr. Pavy finds the average quantity of sugar in the blood ofthe general circulation to vary from 0’6 to 1 part in 1000.Portal blood, especially after the ingestion of carbohydrates,contains a larger quantity of sugar than that of the general,circulation-2, 3, 4, or more parts per 1000 being present ;,but he endeavours to show that it is not true that the

’liver is, as has been alleged, in a more saccharine state thanother parts of the system. It contains sugar, but so do all

the other tissues, and the sugar in both liver and tissues isthe same in kind, a form of sugar having somewhat lessreducing power on cupric oxide than glucose. The salient

points in the glycogen controversy, which were so warmly,propounded and contested thirty years ago, are given, andmany references to observations then or since made are

appended.The general conclusions at which Dr. Pavy arrives are that

there is no evidence of the disappearance of sugar in thesystemic capillaries or of the transport of sugar, consequenton the functional activity of the liver, from that organto the systemic capillaries. The liver instead of throwingsugar into the general circulation, in reality checks theprogress of ingested carbohydrate matter. It prevents thefluctuating proportion of the absorbed sugar dissolved inthe portal blood from influencing the sugar in the general.circulation. The sugar thus arrested and stored up no doubtafterwards slowly enters the blood of the general circulationto a certain extent ; but practically the liver constitutes abarrier to the entrance of too much sugar. When, from anycircumstance or combination of circumstances, the barrieris weak or is overcome, sugar in quantity may enter thegeneral circulation, and diabetes is the result. The authorconcludes his work with some very sensible observations onthe principles which should regulate the diet and regimen indiabetes, to which we refer those of our readers who desireto acquire the most recent views of the pathology of thisdisease.

Analyses of Twelve Thousand Prescriptions. Compiled byW. MARTINDALE, F.C.S. London : H. K. Lewis. 1894.W. MARTINDALE, F.C.S. London : H. K. Lewis. 1894.

MR. MARTINDALE is distinctly to be congratulated uponhaving successfully carried through a labour of great interest.It was certainly a happy thought to collect a large numberof prescriptions drawn from different important medicalcentres, and, by careful comparison, to estimate the numericaldegree of employment of the various official and unofficial

preparations. The idea was especially happy in view of therumours in the air of a new edition of the British Pharmaco-

poeia. The collection may prove to be a little misleadingsince, in spite of the numbers-which might be thought tobe convincing-it is obvious that the drugs employed, andthe frequency of their employment, must vary somewhat withthe time of year from which the examples are drawn, as wellas with the question of local epidemics. Further, as Mr.Martindale himself points out, the list furnishes no clue tothe different antiseptics and anaesthetics in favour, nor

--an it possibly gauge the use of drugs by those medicalpractitioners who dispense their own medicines. Still,with all these limitations the compilation was well worththe trouble involved and will no doubt furnish manyvaluable hints to those to whom the task of revisionof the British Pharmacopoeia is entrusted. The ques-tion here answered is not, "Should a certain drug bexetained ? " or, "should it be used ? " but merely "has itbeen used?" And where the answer is given in the

negative it does not imply that the drug has no physiologicalor therapeutic value, but merely that its virtues are

possessed to a greater degree by other drugs which mayalso be free from the charge of producing certain un-

desirable effects. To say that Mr. Martindale’s compila-tion is in its entirety a surprise would be to insult the

intelligence of the reader, who has doubtless frequentlywondered at the present bulk of the Pharmacopoeia. Hewill be accordingly gratified to find that many drugswhich have excited his questioning interest fall into the

category of official drugs which are not once mentioned in the12, 000 instances examined. On the other hand, when regardedsomewhat in the light of a prize competition for determiningthe most popular drugs, the results are scarcely, perhaps,what might have been anticipated. The first place is easilyawarded to spiritus chloroformi, though, in sporting phrase-ology, tincture of nux vomica is a good second. The positionof glycerine in front of bicarbonate of soda will probably bea surprise, as will also be the fact that in this Plebiscitesyrup of orange and sal volatile stand in advance of quinine,which was only to be found 598 times in the 12,000 prescrip-tions. Bromide and iodide of potassium, with liquor arsenicalis,come somewhat lower down the list. The first mercurial

preparation is pilula hydrargyri, which stands in the twenty-ninth place with 273 votes, while liq. hydrargyri perchloridionly gains 66, the perchloride itself only gaining 58. Rela-

tively few unofficial preparations are to be found in the firstlist of the highest scores, but there are enough to show thatthe unofficial formulary of the British Pharmaceutical Con-ference has secured the attention of the medical profession.The list of official preparations which have not once beenprescribed among the 12,000 examples includes several whichwill cause some surprise-e.g., the hypodermic injections ofapomorphine and of ergotin, and the lamellæ of cocaine,though doubtless the explanation is that these are kept instock by practitioners and used by them when necessary;but, on the other hand, many of their companions in the liststand almost inevitably self-condemned, such as cerevisiasfermentum, cupri nitras, and several of the extracts, infusions,and ointments. If employed judiciously, making all allow-ances for possible sources of error, this compilation shouldbe of inestimable service, both as a guide in revising thePharmacopoeia and as an index of uniformity in practice.

LIBRARY TABLE.

A Manual of Diseases of the Ear. By GEORGE P. FIELD,M.R.C S. Fifth Edition. London : Bailliere, Tindall, & Cox.1894. -The fact that the fourth edition of this work sold outin eight months is sufficient evidence of its popularity. The

present edition is enlarged by an appendix containing theauthor’s Harveian Lectures for 1893 on the Pathology andTreatment of Chronic Suppurative AfEections of the MiddleEar. The increase in size of the book will be justified bythe interest with which readers will study the appendix. Thelectures contain much that is of importance to the physicianas well as to those especially interested in aural surgery.

The Use of Anaesthetias in Dental Surgery. By ALBERTMAURICE, L.D.S., L.C.S. Edin., Honorary Dental Surgeon,Montgomeryshire Infirmary.-The subject of anaesthetics foruse in dental surgery has been so frequently discussed fromevery point of view-the anaesthetist’s, practically and

theoretically, the operator’s, and the patient’s-that it is

hardly surprising that this brochure contains nothing new.However, it is evidently the work of a practical, experienceddental surgeon. Chloroform, ether, nitrous oxide gas, pental,and the local anaesthetics, such as cocaine and ethyl chloride,are passed briefly in review. He makes a vigorous protest againstthe use of chloroform where it is desirable to extract manyteeth at one operation, especially where it is administered in