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Manual of Surgery. By THOMPSON and Miles. Vol. II.

Young J. Pentland. Vol. I., pages 763; Vol. II., pages

723; illustrations, 418. It was our pleasure some few months ago to speak very favourably of the first volume of this work. We are equally impressed by the second volume, which is now before us, and which makes a fitting companion to the first.

Much of the unpleasant grind of reading may be saved by the student who takes a work such as this for his text-book, for the easy fluency with which it is written will cause its rapid absorption by the brain of even the dullest.

Vol. II. deals with regional surgery, general surgery having been disposed of in Vol. I. Though the two together are by no means ponderous, it will be found on careful persual that the authors have not omitted anything important. On the contrary, the work is brought well up to date, and careful note appears to have been taken of all the more important recent literature of surgery. Each chapter commences with a short synopsis of the matter to be dealt with, and a brief and clear description of the anatomy and methods of examination by which the clinical signs and diagrams are elucidated. As before stated, both letterpress and illustrations are exceedingly good.

BOOKS RECEIVED.

From Young J. Pentland

Edinburgh Medical Journal. Vol. XV. From John Wright and Co.

Diseases of Metabolism and Nutrition. VAN NORDEN. From Félix AlcanLe Ventre; Etude Anatomique et Clinique de la Cavité

Abdominal. No. 1. LE REIN par M. BOURCART. From The Scientific Press Limited

How to become a Certified Midwife. DR. APPEL. From Baillière, Tindall and Co. Cleft Palate and Hare Lip. EDMUND OWEN, F.R.C.S.

(Medical Monograph Library.)
Adenoids. WYATT WINGRAVE, M.D. (Medical Monograph

Series.)
From Smith, Elder and Co.-

Index of Symptoms, R. W. LEFTWICH, M.D.
From J. and A. Churchill-
The Development and Anatomy of the Prostate Gland.

W. G. RICHARDSON, F.R.C.S.

COMPETITIVE EXAMINATION FOR THE

ROYAL ARMY MEDICAL CORPS.

The undermentioned gentlemen were successful at the recent examination in London for Commissions in the R.A.M.C., and for which 49 candidates entered :

William Byam, M.R.C.S.Eng., L.R.C.P.London; Charles Ryley, M.R.C.S.Eng., L.R.C.P.London, D.P.H.London; Harry Theodore Wilson, M.R.C.S.Eng., L.R.C.P.London; Lionel Victor Thurston, M.R.C.S.Eng., L.R.C.P.London; Walter Hyde Hills, M.B., B.C., and B.A.Cantab.; Patrick Dwyer, M.B., B.Ch., R.U.Ireland; Philip Claude Tresilian Davy, M.R.C.S.Eng., L.R.C.P.London, M.B.London; John Forbes Cook Mackenzie, M.B., B.S. Melbourne; Arthur William Gater, M.R.C.S.Eng., L.R.C.P.London; George Alfred Duncan Harvey, L.R.C.P. and S.Ireland; Harold Charles Winckworth, M.R.C.S.Eng., L.R.C.P.London, L.D.S.Eng.; James Campbell, M.B., B.Ch, R.U.Ireland; Richard Collis Hallowes, M.B., B.Ch., B.A.O.Dublin, B.A.Dublin: Harry William Russell, M.B. B.Ch. Victoria; George Richard Painton, M.R.C.S.Eng., L.R.C P. London; Meurice Sinclair, M.B., B.Ch. Edin; Evelyn John Hanaler Luxmore, M.R.C.S.Eng.; L.R.C.P.London; Kenneth Alan Crawford Doig, M.R.C.S.Eng., L.R.C.P.London; Herbert Owen Marsh Beadnell, M.R.C.S.Eng., L.R.C.P.London; Herbert St. Maur Carter, M.D., M.B., B.Ch.Dublin, B.A. Dublin; Robert Harry Lucas Cordner, M.R.C.S.Eng., L.R.C.P. London; John Patrick Lynch, L.R.C.P. and S. Ireland; Alastair Norman Fraser, M.B., B.Ch.Edin.; Nelson Low, M.R.C.S. Eng., L.R.C.P.London; Percy Arnold Jones, M.R.C.S.Eng., L.R.C.P.London, B.A.Cantab.; Cecil Roy Millar, L.R.C.P. and S.Ireland; Augustine Thomas Frost, M.B., B.Ch., R.U.I.; George Herbert Richard, M.R.C.S.Eng., L.R.C.P.London; Harry Christopher Sidgwick, M.R.C.S.Eng., L.R.C.P.London, M.B., and B.A.Cantab. ; John St. Aubyn Maughan, L.R.C.P. and S.Edin., L.F.P. and S. Glasgow.

REPORT ON URINARY AND RENAL

DISEASES.

By PROF. SAUNDBY, M.D., M.Sc., LL.D., F.R.C.P.

I.-DIABETES.

DR. LEO SCHWARZ. “Untersuchungen Ueber Diabetes.”

Deutschen Archiv. fur Klinische Medicin. Bd. LXXVI.

Heft. 1-3

1. On the Relation of Acetone to Fat.Formerly acetone was regarded as being due to the destruction of albumen, but later researches have attributed it to the breaking up of fat, and Grube showed that certain articles of fatty food caused more acetonuria than others; butter being one of the worst in this respect, while bacon fat was the best. The author finds that in healthy, well-nourished men the addition of fat to the diet causes only a very slight increase of acetone excretion, and even then occurs only exceptionally and after the ingestion of very large quantities of fat. It is possible that in some conditions, such as hunger, phosphorous poisoning, narcosis, carcinoma, and other diseases, acetonuria may be due to the breaking up of the body fat; yet all wasting diseases not associated with acetonuria.

In severe diabetes acetonuria may result from fat taken as food, but it is probable that it also results from the breaking up of the body fat when carbohydrates are withheld; the intestinal canal does not seem to be of special significance for the origin of acetone bodies. The total excretion of acetone by the urine and breath does not undergo important variations with constant diet. The proportion of beta-oxybutyric acid to the total excretion of acetone bodies is in certain cases very great, and may reach as much as 70 or more per cent. The higher members of the normal fatty acid series, palmitic and stearic acids, increase the excretion of acetone bodies less than butyric

are

and valerianic and caproic acids, while still less is the influence of the members of the oily series, oleic and erucic acids (C22, H42, 02.) These relations of the fatty acids are explained by the observations that butter causes a greater increase of acetone bodies than the fats formed from the higher fatty acids such as pork, beef fat, etc. No close quantitative dependence of acetone bodies upon the quantity of fat ingested can be determined.

Oils appear chiefly to act through the volatile fatty acid which they contain. It is desirable therefore in the dietetic treatment of diabetes to forbid unlimited fat, and in accordance with the amount of acetone excretion to regulate the quantity of fat which each patient may be permitted to take.

2. The Action of Gluconic Acid.-Further observations have verified the statement that the excretion of acetone is diminished by the administration of gluconic acid.

3. Observations on Caramel.--Actual experiments show that caramel, which is formed by prolonged heating of sugar, may be administered to diabetics without increasing the glycosuria or diminishing acetone excretion.

4. The Effect of a Fasting Day.-In the treatment of diabetes it has been recommended by several authorities to order a fasting day from time to time, and the author's experiments show that such a day causes a great diminution in the amount of acetone, as well as in the quantity of sugar, and that it may usefully precede a change to a diet in which the carbohydrates are greatly restricted.

5. On the Changes of Acetone Bodies introduced into the Diabetic Organism.-Beta-oxybutyric acid is more incompletely destroyed by healthy persons abstaining from carbohydrates or by severe cases of diabetes than by fully nourished persons, while acetone undergoes little change either in diabetics or in normal individuals. Acetone, therefore, is not an intermediate product of physiological tissuechange, whereas for beta-oxybutyric acid this possibility cannot be excluded.

6. On Lipemia in Diabetes.—The amount of fat in the blood appears to be somewhat higher in severe

cases of diabetes than in non-diabetic persons. Lipæmia occurs in severe diabetes on a fat-free diet and apart from coma, and may exist for a long time without giving rise to symptoms. Its presence appears to be connected with the excretion of large quantities of acetone bodies. The absorption of large quantities of fat causes, as a rule, alimentary lipæmia in severe cases of diabetes. The blood can be lipæmic without containing an abnormal quantity of fat, so that it is probable that diabetic blood is deficient in lipolytic power.

7. On Lævulose.—Lævulose has been shown to be present in a relatively large number of diabetic urines. In two cases this was dependent upon the use of carbohydrates, but in others no such relation was observed. It does not appear to be always more easily assimilable than grape sugar, as has been hitherto believed. In a non-diabetic patient spontaneous lævulosuria has been observed without being accompanied by glycosuria.

Note.--The author frequently refers to the Seliwanoff's reaction as a test for lævulose. It is given in Cohn's “Tests and Re-agents” as follows:-“An aqueous solution of resorcin and fructose (lævulose) becomes red on being heated with HCl., and furnishes a precipitate which dissolves in alcohol with a red colour. Cane

Cane sugar, invert sugar, and mellitose behave similarly.

F. W. PAVY and B. L. SIAU. “The Influence of Ablation of

the Liver on the Sugar Contents of the Blood.” The Journal of Physiology. Vol. XXIX. Nos. 4 and 5, June 15, 1903.

The much-quoted statement of Bock and Hoffmann, that on shutting off the liver from the circulation the sugar quickly falls and disappears altogether within three-quarters of an hour, stands at variance with later observation.

The authors' results agree with those of recent observers in showing that even after the lapse of some hours the lowest point reached by the sugar is about 0.5 per cent. They also

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