736

of them altered in shape. The blood-vessels were for the mostpart not clearly defined, or were defined by rows of spindle-cells. A correct description of the cell elements of ovariantumours is of extreme value from many considerations which.cannot be entered into here. The normal structure containsmany cells of a very elementary type, which makes itconceivable almost for any kind of tumour to be developed,and also renders it possible for great metaplasia to occur inany one growth. Some parts one could classify as beingfibro-sarcomatous, others as small round-celled sarcoma, andothers as lympho sarcoma. Oval cells did occur, but wereisolated and few in number.The following were some of the commoner cell elements :

(1) extremely small, darkly-stained, round cells, about two-thirds the size of a red blood corpuscle, which may have beennuclei of broken-down cells (?) ; (2) cells a little larger thana red blood corpuscle, staining poorly with a small nucleus-or nucleolus ; (3) still larger cells staining deeply and con-taining many granules ; (4) cells similar to No. 3 but oval ;5) cells like large leucocytes with two or three nucleipresent ; (6) large flat cells, oval or irregular, sometimescontaining a nucleus; (7) small branching cells; and (8)Ted blood corpuscles, some showing a degree of poikilo-- cytosis (?).

Remarks.-Pathologically, malignant ovarian tumours are- of interest because of the obscurity which surroundsthe actual tissue from which they develop, particularlywhen they occur after the climacteric period. In thenormal ovary the cell elements are mainly of two kinds :’() the germ epithelium of Waldeyer with the variouscells forming a Graafian follicle; and (b) connectivetissue elements, condensed in the cortex but every-where of an elementary type. The rapid growth andextensive infiltration in this case point to sarcoma. The

age, however, is somewhat over the time at which the com-moner forms of sarcomata commonly develop. According toCohnheim, tumours grow from unutilised embryonic tissue,and it is extremely probable that in this case the growthtook its origin in the elementary form of connectivetissue mentioned. A malignant growth having its originin the epithelial coverings of the ovary was possible.The age of the patient was one at which there is a

.proneness to malignant disease, and the most likely partof the ovary to take on this character was this elementaryform of connective tissue. The growth was rapid, a littleover two months being taken to produce a tumour ofgreat size. A noticeable clinical feature was the absenceof ascites, the presence of which is so usual in ovarian

growths.

PRUSSIC ACID IN SWEET CASSAVA.

BY PROFESSOR CARMODY, F.I.C., F.C.S.

FRANCIS, one of my predecessors in the Trinidad Govern-ment Laboratory, was the firstl to point out that prussicacid was present in sweet cassava to a considerable extent.

Francis’s results have not received the attention which theydeserved, probably because they were a direct but unconfirmed-denial of statements repeatedly made by recognised autho-rities. There are very few recent editions of toxicological’handbooks that make any reference to the results publishedby Francis. Even in standard reference works like that ofDr. Thorpe’s "Dictionary of Applied Chemistry " it is statedthat "the milky juice in the sweet variety is innocuous,whilst that in the bitter is highly poisonous."The question is of importance from a toxicological point of

view in those places in the tropics where cassava is used- extensively as a food. For poisonous symptoms are notinfrequently reported after a meal of sweet cassava ; and asthe two kinds of cassava-the sweet and the bitter-are somuch alike as to be almost indistinguishable, the conclusion- usually arrived at is that the bitter variety has been cooked’in error.

My results fully confirm those of Francis as to the pre-sence of hydrocyanic acid, although his average figures aresomewhat higher than mine. This year has been an un-

usually dry one for Trinidad and a diminished supply of raindoes affect the character of plant juices.

1 Analyst, April, 1877.

The method of analysis adopted by me differs somewhatfrom that of Francis. He grated 500 grammes of cassava into500 cubic centimetres of water which was left for two hoursin a well-closed vessel. It was next strained through a linencloth into a flask which was then corked and allowed tostand until the starch subsided. 200 cubic centimetres ofthe clear liquid were decanted and distilled and the resultsobtained were multiplied by four for the total in 500 grammes.This calculation was based on the assumption that the

original 500 grammes contributed 300 cubic centimetres ofwater-an assumption which is not far from the truth if thecassava is quite fresh. Francis also remarks that a slightloss occurred during the process of grating, and in a tropicallaboratory this loss might be appreciable. I endeavoured toavoid this loss on the one hand, and the possibility of errorthrough assuming that all cassavas contained 60 per cent, ofwater on the other, by taking the whole root, slicing it

quickly, and allowing it to stand in water all night in awell-corked flask. The liquid was decanted in the morningand the whole distilled. The extraction with water wasrepeated a second and a third time. The slices effectuallyprevented the great disadvantages arising from the starchfinding its way into the distilling flask, which Francis pre-vented by subsidence but which necessitated his distilling analiquot part, this aliquot part being a definite volume of200 cubic centimetres taken from an approaeimate totalvolume of 800 cubic centimetres.

Francis does not appear to have made more than oneextraction with water. I have made three in all cases andin some as many as five. I have found that with slices thesecond extraction yields as much, and sometimes more, thanthe first. I have repeated Francis’s method of grating andfind that a second extraction yields about half as muchprussic acid as the first. It would appear from this, there-fore, that Francis’s results are not as high as they wouldhave been had he made a second extraction. The figuresobtained by Francis and myself are :-

It will be seen from this that while my " lowest"percentage is much below that of Francis my "highest isnearly the same as his. This establishes the truth of thestatement made by Francis, "that the so-called sweet orharmless cassava not only yielded prussic acid, but the

quantity obtained from it so nearly equalled that from thebitter that no line of distinction could be drawn betweenthem," so far as it relates to the amount of prussic acid inthe cassava ; but I have discovered an analytical differencebetween the two kinds by means of which they can be satis-factorily distinguished.

This discovery arose in trying to avoid the difficultiescaused by the presence of starch in the distilling flask. Atfirst I placed the slices in the distilling flask, added water inone set of experiments, and passed steam through in anotherand collected the distillates. This failed in each case

through the gelatinising action of the boiling water or steamon the starch. This starch being chiefly confined to theinner portions, in my next experiments I soaked the innerslices in water at ordinary temperature, decanted and dis-tilled. The quantity of starch thus admitted into the flaskwas so small as not to interfere with the distillation. Theskin and outer cortical layer, which together constitute aboutone-fifth of the total weight of the sweet cassava, could beplaced direct in the distilling flask, and the distillationcarried on satisfactorily. It was this separation of the partsfor convenience in distillation that led to the discovery thatin sweet cassava the prussic acid is located chiefly in theskin and outer cortical layer.The following are some of the results obtained from fairly

representative samples of sweet cassava.

737

With bitter cassava the following results were obtainedfrom representative samples :-

Inner part. Skin and outer Inner part. Skin an<t outer

HCN. cortical layer. Inner part. cortical layer.HCN. HCN HCN. HCNper cent, per cent, per cent. per cent.0-031 ............ 0024 0-017 ............ 0-019

0-034 ............ 0-012* 0019 ............ 0-020

0-021 ............ 0-025 0-016 ............ 0-0240-037 ............ 0-014’’- 0-017 ............ 0-020

0-030 ............ 0-025 0-013 ............ 0-0160-014 ............ 0-013 0032 ............ 0-035

* Exceptional. ’

The general conclusions to be drawn from these resultsare: (1) that in sweet cassava the prussic acid is notuniformly distributed throughout the tuber and that inbitter cassava it is uniformly distributed, or nearly so ; and(2) that this affords an analytical means of distinguishingbetween srveet and bitter cassava.An important observation in connexion with local methods

of eating cassava is that the skin of the sweet kind isremoved before boiling, the inner portion alone being cookedand eaten. This custom is no doubt the result of experienceand accords with what science would now teach as a wise

precaution. But notwithstanding this removal of the skinill.effects are said to follow from the use of the inner portionif water is drunk some time after a meal. This may now beaccounted for in this way. It is shown in my experimentsthat whilst a first boiling removes a certain amount of

hydrocyanic acid-all, in fact, that exists ready formed in thetuber-that a second addition of water and subsequentboiling removes a further portion. It would appear fromthis that cassava in a person’s stomach would also developan amount of prussic acid equivalent to that obtained in asecond distillation and that the drinking of water woulddissolve this and cause it to act more readily on the system.The total quantity would, however, be far below theminimum fatal dose and would only be expected to producethose unpleasant results occasionally reported. The questionnext arises-Is this second portion of hydrocyanic acidproduced by fermentative changes, as is known to happenin the case of bitter almonds ; or is it part of that

originally existing in the tuber and in some way protectedfrom the solvent action of the first treatment with boilingwater? It is possible that, with slices, the water wouldpenetrate slowly to their interior, and thus produce asecond yield of prussic acid ; and that if the cassava hadbeen grated, as was done by Francis, the water would.within Francis’s limit, dissolve the whole of the acid. Ihave not found this to be the case, as the following experi-ment shows :-

8meet Cassava.

. Half (4C8 grammes) Half (427 gramme’i)Duration. sliced. n/10 AgNO3. I grated. n/10 AgN03’

First extract 2 hours... I :

3 0 c.c. I i

2-2 c.c.

Second 2 ... l3 " ’ 1-4

Third 20 " ... 3-5 1-4 "

Fourth 2 " ... 1’0 " C-7 "

Fifth " 2 " ...

,

1-0 " 09 "

Sixth 17 " ... I 1-1 " -5 ..

Seventh " 2 " ... 0-4 " 0-7 "

Eighth " 2 " ... : 0-5 " 09 "

Ninth " 2 "

" ... 0-2 " -

I 1-3

,,- Total ............ 120 c.c. 10 0 c.c.

It would appear from this and similar experiments thatthe whole of the hydrocyanic acid cannot be removed fromgrated cassava by a two hours’ extraction with water andthat there is apparently a loss of acid even when the gratingis done under water. And, notwithstanding that my yieldfrom slices is the higher of the two, Francis’s results froma two hours’ extraction are appreciably above mine. Asalready stated, this may be due to the exceptionally dryseason. Next year I shall continue the experiments in orderto clear up this difficulty. At present I am inclined tobelieve that part of the acid may be formed by fermentativechange. If this be so cassava starch on keeping would belikely to be more poisonous than when freshly prepared.

Fermentation beyond a certain limit entirely decomposesthe hydrocyanic acid. Cassava is also cooked by roastingthe entire tuber. This removes all the HCN.There appear to be no grounds for the common belief that

sweet cassava contains more HCN the older it is. In all thesamples examined during a period of nine months from thetime cassava was first brought to market the proportionof HCN showed no increase that could be traced to age.Nor is there any ground for the belief that the locally grownsweet cassava is but a degenerate growth resulting frommany years’ association with the bitter variety. A selected

sample imported from Jamaica and grown at the LocalGovernment gardens contained the same amount, and thesame relative proportions in skin and inner part, of HCN asthe ordinary product of Trinidad.The subject is not yet ;exhausted, and I hope to be in a

position to publish further results next year.Trinidad.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

YORK COUNTY HOSPITAL.FOUR SURGICAL CASES.

(Under the care of Mr. W. H. JALLAND.)

Nulla autem est alia pro certo noseendi via, nisi qusmplurimssmorborum et dissectionum historias, tum aliorum tum propriasoollectas habere, et inter se comparare.&mdash;MORGAGNI De Sed. et Cau8.Morb., lib. iv. Prooemium.

-

THE first of the following series of cases is an illustrationof the occasional beneficial effects of an operation, even

though no lesion is discovered. This result is probably mostfrequently seen in operations for suspected renal calculi,when although no stone can be found relief of all the

symptoms follows. Various explanations have been offered,that some slight adhesion has been broken down, that somelocal congestion has been relieved, that some nerve has beendivided, and lastly, that the result is entirely the effect ofthe operation on the patient’s mind. Whichever explana-tion may be true-and probably each is true in some cases-there can be no doubt as to the reality of the improvementwhich follows. The third case shows the benefit of earlyoperation in intussusception, especially in very youngchildren.CASE 1. Exploratory laparotomy for S6vere abdominal

pain; no disease detected; recovery.-A married woman,aged 39 years, was admitted into the York County Hospitalon August 3rd, 1898, under the care of Mr. W. H. Jalland.For some time previously to her admission she had beensuffering from severe gastric pain which it was thoughtmight possibly be due to passing gall-stones, though thiswas doubtful. She never was jaundiced. She had violentsickness and the pain was so severe that she had had

frequent injections of morphia. On admission she was

somewhat wasted in appearance, with an anxious expression,and was evidently suffering at times considerable pain,although the region of the pain was somewhat in-definite, being described as above the abdomen. Herweight on admission was 5 st. 7 lb. She was putupon small quantities of peptonised milk and beef-tea, with drachm doses of bromidia when the pain wasvery severe. As she was not much better on the 26ththe stomach was washed out and this was repeated on the29th. As she was somewhat relieved after this food wasgradually increased. There was no necessity to give herany more sedative. She had been kept in bed previouslyto this, but got up on Sept. 15th and left the hospital con-siderably relieved on the 24th. She was admitted again onFeb. 16th, 1899, all her symptoms having returned. Thesame plan of treatment was adopted ; the stomach waswashed out frequently, small quantities of food graduallyincreased were given, and she left the hospital much relievedon March 23rd. She was admitted again on July 13th, 1899, thesymptoms having returned in a much aggravated form. She