It is particularly important that, at least as regards the first of the three--Inflammation-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. Incomplete

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.

The

We

We have reviewed this essay with great interest. 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. 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, Department 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.

Haines, who are also amongst the contributors; and, so far as the present volume is concerned, the editors may reasonably claim to have succeeded in the object aimed at, namely, "to give to the medical and legal professions a fairly comprehensive survey of forensic medicine and toxicology in moderate compass." It is too discursive a work to be suitable for students preparing for examination, its rôle being rather that of a book of reference; though even in this direction its usefulness is lessened for British practitioners by the constant, and, indeed, unavoidable, reference to American laws and institutions. But for precisely the same reason the work gains in interest for an English reader what it loses in value as a practical guide in this country. The introduction is a terse and thoughtful chapter by the editors, who discuss the sources of error in evidence relating to obvious or ascertainable matters of fact; it is interesting to note, in view of the recent discussion of this subject by the British Medical Association, that they advise a conference with the experts of the other side for the purpose of interchanging views. The chapter on the "Technic of Medico-Legal Post Mortem Examination," by Professor L. Hektoen, of Chicago, is very thorough and satisfactory, and finely illustrated by photographs. Wounds, death from unnatural causes, and cognate subjects are adequately treated. In the article on Identity, it is startling to read the following:-" It has repeatedly been -"It observed that the hair may grow after death. In the New York Medical Record, August 18, 1877, Dr. Caldwell reported that in 1862 he was present at the exhumation of a body that had been buried for four years. The coffin had become loosened at the joints, and the hair of the corpse appeared at these openings. There was reliable evidence (sic) that the head had been shaved before burial, yet the hair of the head measured eighteen inches in length, the beard eight inches, and the hair of the chest four to six inches." That such grotesque stuff should be gravely adopted without comment by a writer in a scientific medical treatise is much to be regretted; it is a blot on the book which ought to be removed at the first opportunity. The chapters on Railway

Injuries, Injuries and Disorders of the Nervous System following railway and allied accidents, the Medical Jurisprudence of Life Assurance, and the Medico-Legal Aspects of Vision and Audition, are valuable monographs which will repay perusal. The concluding chapter on Mental Perversions of the Sexual Instinct contains much that is unsavoury, and is evidently not written pueris virginibusque. This is, of course, due to the necessities of the case, but the balance of the entire book would have been more proportionate if the thirty-three pages of the last chapter had been reduced, and the section on Finger-prints, which is extremely meagre, had been considerably amplified. We welcome the issue of this work, and await with interest the second volume, which is to deal with several practical branches of forensic medicine.