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of estimating the integrity of the renal function. Methylene blue, as suggested by Achard, the formation of hippuric acid, and renal glycosuria, are instances of the system employed by the writers. To describe the methods of determining the secretory power would take up too much space, and therefore we must refer the reader directly to the work. There is much that is of practical value in the book, and many questions of importance and interest are opened up. That some of the matter is redundant there is no doubt, but the pith of the book is sound.

The Sterilisation of the Hands : A Bacteriological Enquiry

into the Relative Value of Various Agents used in the Disinfection of the Hands. By C. LEEDHAM-GREEN,

F.R.C.S. Birmingham : Cornish Brothers. 1904. So various have been the results obtained by the numerous bacteriologists who have investigated the subject of the sterilisation of the hands that it has been perfectly clear that there must in many of the investigations have been some source or sources of error. In all probability it has been in the actual testing of the cleansed hand that an error has crept in. Thus Kümmel was satisfied with dipping the fingertips into fluid or solid media. This is manifestly not so severe a test as the hand is subjected to in a prolonged surgical operation. Mr. Leedham-Green has adopted the plan of scraping the skin with a sterilised ivory strip : he has performed the necessary control experiments, and has taken the precaution of neutralising any of the antiseptic agents that may be present. So far as we can judge from reading his book, his technique is open to no objection whatever, and so we can accept his results as being quite reliable.

Looking at the question from the point of view of the surgeon, we notice that the author makes one remark which is of the greatest importance, viz. :-“ Any method which causes the hands of an individual to become rough and cracked stands at once condemned for habitual use by him, no matter how efficient the method may have proved to be on the bands

of other persons.

This is an all-important point, which makes it necessary that every operator should find out what method suits his own hands best. Mr. Leedham-Green has laboriously tested every one of the well-known methods of cleansing the hands, and has come to the conclusion that the alcohol-and-sublimate method is by far the most reliable, though he clearly shows that, even by the use of this method, it is quite impossible to be at all sure of sterilising the hands. The reader of this book must be careful not to think that, because no method of cleansing the hands is perfectly reliable, therefore the elaborate precautions generally taken are useless. It is true that absolute sterility is difficult to obtain, but it is not therefore to be taken that any one of our precautions are to be relaxed. Rather are they to be redoubled, for it is quite clear, from the results detailed in this book, that, if the hands cannot be rendered perfectly sterile, yet the number of micro-organisms on them can be reduced to a minimum.

Mr. Leedham-Green's work has been done so carefully, so thoroughly, and with such an obvious absence of preconceived ideas, that his book, which is a concise and readable record of his work, must be taken to embody the opinions of an authority on the subject. It is a book which should be read by everyone engaged in the practice of operative surgery or of midwifery.

The General Pathology of Inflammation, Infection, and

Fever. By E. W. AINLEY WALKER, M.A., M.D. Oxon.

London : H. K. Lewis. 1904. This little book, which consists of a series of twelve papers, constituting the first series of Gordon Lectures delivered at Guy's Hospital, and which were originally published in the Clinical Journal, meets a distinct want. The ordinary textbook of pathology usually has not the space to devote to a full discussion of the above subjects, and yet they are questions of fundamental importance both in relation to the science of pathology and in its application to medicine and surgery.

It is particularly important that, at least as regards the first of the threeInflammation—the student of medicine should be familiar not only with the phenomena exhibited during the process, but with the history of discovery within its domain, and with the names associated with important advances in knowledge. In this respect the book, although admittedly not an exhaustive treatise, leaves little to be desired. The question of the cells chiefly concerned in the process is, perhaps, not treated of as fully as one might wish, and some recent advances in knowledge have not received the attention they deserve, but that is probably due to the fact of the publication in book form occurring two years after the delivery of the course of lectures. For example, the work of Councilman, Beattie, and Maximow, in showing that the mononuclear leucocytes are important factors in the process of inflammation both in the earlier and later stages, is not mentioned. That these cells are of importance during the earlier stages, particularly in removing polymorphonuclear cells which have been killed, is now admitted by all, and that they may possess the capability of functioning in a manner similar to the so-called fibroblasts is held by many.

In dealing with the question of Infection, the author is treating of a subject with regard to which our ideas are undergoing vast changes. So rapid have these changes been, and so enormous is the amount of work which has been done on the question, that it would tax the powers of the most lucid writer to set the results before student readers in a clear and comprehensive manner. Considering the scope of the work, we must congratulate the author on the degree in which this result has been attained.

Cleft-Palate and Hare-Hip : The Earlier Operation on the

Palate. By EDMUND OWEN, M.B., F.R.C.S., Consulting Surgeon, St. Mary's Hospital ; Hospital for Children, Great Ormond Street, etc. Medical Monograph Series.

Pp. 111; 39 illustrations. 2s. 6d. net. This little book is written with the object of “ bringing into more general notice the original and excellent work which has

been accomplished in the treatment of Cleft-Palate by Dr. Truman Brophy, President of the Chicago College of Dental Surgery," and is dedicated to him.

The principle involved in Brophy's operation consists in the thrusting together of the maxillary arches so as to bring the palatine processes—the borders of the cleft-nearer to each others, and allow of closure of the gap by simple suture after paving the edges. The operation is carried out at as early an age as possible, as the bones are soft and can be bent and moved more easily and with less injury than when at a later age they are more fully ossified : and also because the sooner the soft palate is brought under control by fixing its muscles in the median line, the earlier will its movements be trained to take part in vocalisation, and to become perfect in their action. The period between the age of two weeks and three months is recommended as the most favourable time for this operation. At this very early age it might be urged that infants can hardly be expected to bear the shock of a severe operation. Experience proves, however, that they bear it so well that anxiety on this account should not outweigh the obvious advantages of the early operation.

Dr. Brophy contends that the roof of the mouth, in cases of cleft-palate, is wider than it should be by the width of the cleft; and that if the maxillæ are thrust bodily together, the transverse arch becomes of normal size, so that when the teeth appear they will properly “bite” with those of the lower jaw.

This book begins with a useful account of the development of the palate and lip : the material used at the operation, and the duties of the assistants, are described, and the treatment of cases preparatory to operation is carefully outlined. Since failure of the cleft-palate operation is due to sepsis in the wound, Mr. Owen lays stress on the importance of attention to the general health, the aspect, digestion, etc., of the child—and in those of later age, to the condition of the teeth, tonsils, and pharynx. The early operation, and that performed after infancy, are carefully described, and a very helpful chapter on After-Treatment follows.


success or failure are due to sepsis of the area operated upon : this can be prevented generally, but seldom checked. The wound becomes unhealthy, the stitches give way, and the cleft gapes : some part of the cleft is generally bridged over, however, and supplementary operations may be undertaken hopefully, if granulation tissue does not of itself occlude the gap. Mr. Owen thinks that a second operation can often be done with advantage within three weeks (after failure through sepsis) of the first operation.

A terse description of the operation for Hare-Lip contains all that is necessary, and the book concludes with an appendix containing illustrations of the instruments used in the early operation for Cleft-Palate.

We have reviewed this essay with great interest. The principle involved in Dr. Brophy's method marks a distinct advance in the treatment of cleft-palate, and appeals at once to the practical surgeon as being a radical means of cure. We know by experience that it is difficult, but it is not more so than any other method. Mr. Edmund Owen has done a valuable service in presenting the method with the added authority of his own experience, and we recommend the present number of the Medical Monograph Series as the best practical description of the subject to the general practitioner and operating surgeon alike.

A Text-book of Legal Medicine and Toxicology. Edited by

FREDERICK PETERSON, M.D., President of the New York
State Commission in Lunacy, Chief of Clinic, Depart-
ment for Nervous Diseases, Columbia University, etc.;
and WALTER S. HAINES, M.D., Professor of Chemistry,
Pharmacy, and Toxicology in Rush Medical College,
Chicago, Professorial Lecturer on Toxicology in the
University of Chicago. In two volumes, fully illustrated.
Volume I. W. B. Saunders and Co., Philadelphia and

London. 1903. This book contains a great deal of informing and suggestive matter. It is a collation of articles by sixteen American writers under the joint editorship of Dr. Peterson and Dr.

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