months old, and 15 of these had the canal obliterated, or nearly 50.00 per cent. The remaining 97 cases were of subjects between one day and two months old. Only one of these had the canal obliterated (an infant thirty days old) so that we may infer from this that the arterial canal is very seldom obliterated before the sixtieth day.

But as in 15 cases out of 33 of subjects over two months and under twelve years old, the canal was obliterated, we may conclude that that structure is usually entirely obliterated by the twelfth year, for only one of the cases was of a subject over four and a half years old; but here, again, the cases are too few in number for a satisfactory conclusion.

To sum up-can we fairly deduce from these results more than this?

1. That the foramen ovale never closes before two and a half months, and only very rarely indeed before the age of six months, and that it frequently is found open up to the twelfth year.

2. That the arterial canal is never obliterated before the thirtieth day, and very rarely before the sixtieth, and that it is usually closed before the end of the fifth year.

From the third set of tables containing comparisons of the relative times of closing of both these structures in the same individual, we draw the following conclusion :

1. That the arterial canal is usually obliterated before the foramen ovale is closed; for out of 130 cases, in 15 of which the canal was obliterated, only 5 had the foramen ovale closed. But in these 5 cases 2 had the arterial canal open, so that in 15 cases in which the canal was closed only 3 had both structures obliterated.

More, we think, we cannot justly conclude from the results noted down in these tables, especially on account of the small number of cases over six months old examined with regard to the state of the foramen ovale.

Much remains to be cleared up concerning the condition of the foramen ovale between that period and the twelfth year, before we can have any accurate knowledge of the time of closing of this

structure.

However, Dr. Alvarenga states that he is going to continue his investigations, and promises another pamphlet containing further results.

Surgery of the Mouth.1

We have classed these two pamphlets together because they both have reference to the mouth; the one to its deformities, the other to its injuries. Messrs. Ramsay and Coles have dealt with the congenital and accidental defects of the palate; while Mr. H. O. Thomas has given us a valuable suggestion as to the means of treating fractures of the jaw.

Dentistry has made great and encouraging progress of late years. We owe it no small thanks for the comfort we enjoy—indeed, some would tell us that it had done much to prolong human life, by enabling elderly people to masticate their food better than they could with such teeth, or stumps of teeth, as nature had left them. However this may be, there is no doubt that dental art has advanced rapidly, and that a happy combination of dentistry and surgery enables us to deal with cases which half a century ago were well nigh hopeless. This is true of the injuries of the jaws, and it is true also of the congenital deformities of the mouth. Let anyone turn to Mr. Christopher Heath's Jacksonian Prize Essay, and he will see how much may be done in the worst cases of fractures of the jaw when dentistry and surgery go hand in hand. And the little work before us by Messrs. Ramsay and Coles shows how much may be done in the severest cases of cleft palate when the surgeon avails himself of the skill of the dentist.

The authors of this thin volume do not discuss the operative treatment of cleft palate, except so far as it is necessary to their purpose to do so. That they leave to the surgeon. Their proper subject is the mechanical treatment of the deformities of the mouth; and in this department their success appears to have been so great that they are doing the profession a service by publishing their results.

Though the operations for cleft palate have been brought to a wonderful degree of perfection, the results are not so satisfactory as we could wish. We have rarely seen a case, however creditable it might be to the operator, in which the patient obtained anything like a full and perfect articulation. Perhaps this may be because surgeons have hitherto thought that it was undesirable to interfere before the age of puberty; and now that some are practising the operation at an earlier age we may see happier results. Whether this should be the case or not, there will always, we fear, be mal

11. The Mechanical Treatment of Deformities of the Mouth, Congenital and Accidental. By ROBERT RAMSAY and JAMES OAKLEY COLES, Members of the Odontological Society. London, 1868. Pp. 95.

2. Cases in Surgery Illustrative of the New Method in Applying the Wire Ligature in Compound Fractures of the Lower Jaw. By HUGH OWEN THOMAS, M.R.C.S.L. London, 1869. Pp. 15.

formations of the palate so severe that surgery will be unable to deal with them effectually, and in these instances we must seek the aid of mechanical appliances. It is to this class of cases that Messrs. Ramsay and Coles have paid special attention, and the present work contains an account of their method and a résumé of their experience.

For an explanation of their various modes of procedure, and of the materials they employ, we must refer our readers to the volume itself; but we may here quote, in an abbreviated form, one or two cases which show what can be done by the skilful and scientific application of a false palate :

"Mr. D., aged 19, cleft of hard and soft palate, extending also through the dental arch, a single harelip having been treated in a very satisfactory manner soon after birth. The left side of the

maxillary portion of the fissure at its border was continuous with the vomer, thus giving no overlap, except on one side and at the apex of the cleft. In these cases the incisors are generally but very imperfectly developed; we, therefore removed the centrals and considerably improved the mouth for the purposes of speech and mastication, by fitting artificial teeth in their place on the front piece of the velum. The artificial palate was then made. This was put in, November, 1865, and has been worn with great comfort ever since. In less than a twelvemonth the articulation of every word and sound was perfect; and those most difficult letters, K and R, were pronounced with the greatest ease and precision. The only thing that could not be overcome was the peculiar nasal tone that results always from the malformation that occurs in the nose after the operation for harelip. Before the patient was put under treatment, his speech was quite unintelligible, even to many of his friends; yet, after the mouth was restored to as symmetrical a form as, under the circumstances, was possible, this gentleman, by his own perseverance, unassisted by anyone's tuition, acquired such clearness of utterance as to elicit expressions of the greatest astonishment at both the Medical and Chirurgical and Odontological Societies, before whose members he very kindly went through the alphabet and several difficult sentences, and within a short time of this he was elected an officer in a volunteer rifle corps, as well as a volunteer fire brigade, thus affording the best evidence of the ability he possessed to make himself readily and perfectly understood" (p. 76).

Here is another case, of a somewhat similar kind, in which the successful result is attested by equally satisfactory evidence:

"Mr. R., æt. 22, cleft of the soft palate, extending just beyond the posterior margin of the hard palate, treated May, 1864. The voice in this case was very bad. The young gentleman was most anxious to have something done, as a public appointment was being kept for him, provided his speech could be rendered intelligible. A velum was made fitting into the cleft; but, unlike the others shown,

it had only one flap at the posterior part, the two sides of the cleft embracing it only to the commencement of the bulbous portion of the bifurcated uvula. Though this extremely simple form of instrument was used, the result was such that in two months he was able to enter upon the duties of the appointment that had been held open for him " (p. 82).

Let us now turn to the second of the two pamphlets which we have named at the head of this notice. In this essay Mr. H. O. Thomas explains the way in which he has tied together the fragments of the jaw in cases of compound fracture. His method consists in passing a wire through both fragments, and then coiling it upon itself at each extremity, so as to form a sort of button. This button at each end of the wire prevents it from slipping, and, if it requires to be tightened, it is a simple matter to make another turn on the coil at either end or at each end.

It is not easy to give a clear idea of the proposed plan in words; but a glance at the woodcuts with which the account is illustrated will explain it in a moment, and will show also the instruments which Mr. Thomas has devised to enable the surgeon to carry out his suggestion. Several cases are related in which the author has used this plan with success; and it is one which is worthy of the attention of surgeons, for it promises to be a valuable addition to our means of dealing with a very troublesome class of cases.

Life of Benjamin Bell.1

HOWEVER much the life of Benjamin Bell might have been worth writing when his name and fame were fresh in the memory of his professional countrymen, we fear that the biographer who now undertakes to record it, will arouse but limited interest among a generation living nearly a hundred years since Bell held a leading position as a surgeon and a writer on surgery;-a generation that has become the inheritor of the labours of a series of surgeons who have followed him, equally skilled in their art, and at least equally matched with him as teachers of that art. The complacency that must attend a sacrifice offered to the shades of a departed ancestor, and the attendant gratification diffused among the members of the family circle and kindred will, in our apprehension, constitute the only reward the worthy writer of the biography can obtain, not that we hold in light esteem the good work contributed towards the development of modern surgery by Benjamin Bell, primus; on the contrary, in a history of surgery his name must occupy no inconspicuous place. Nor again, is anything but com

The Life, Character, and Writings of Benjamin Bell, F.R.C.S.E., &c. By his grandson, BENJAMIN BELL, F.R.C.S. E., &c. Edinburgh, 1868. Pp. 170.

mendation to be written respecting the manner in which that eminent surgeon's living name-sake has performed his task. Yet withal this memoir comes upon us as a thing out of date, and the impression will obtrude itself that the sketches of the life of Bell in Kay's 'Edinburgh Portraits,' in Chambers' 'Lives of Distinguished Scotchmen,' and in Anderson's 'Scottish Nation,' alluded to by the writer, might be accepted as furnishing sufficient memorials of the man. The principal inducement to undertake the biography, as stated by the author, was the discovery of eighty-two letters addressed by Benjamin Bell to his father and mother, between the years 1767 and 1793. "They are mainly occupied with family concerns, and therefore do not admit of being largely quoted," and, therefore (if we desired to be critical, we should write) did not call for a memoir to reproduce them. But the author goes on to say that by them "our acquaintance with the character and dispositions of the writer is rendered full and satisfactory;" but here again we are compelled to remark that at this day the private character and dispositions of the old surgeon are of the smallest possible interest to the present race of medical men or to the public. His niche in the temple of fame was earned by his work for the advancement of surgical knowledge, and it is only the history of that work that will claim the attention of the present and future generations.

His life, moreover, was an uneventful one. He was born in 1749, and died in 1806; was a pupil at Edinburgh when the University was at the height of its greatness, enjoying the reputation of the Monros, of Black, Cullen, Rutherford, and the Gregorys; became a dresser, and soon a surgeon's clerk, and in his twenty-fourth year a surgeon of the Infirmary. From that time his talents and character secured him a prosperous professional career, marred indeed to a considerable extent by bad health and early infirmity. The system of surgery, which passed through seven editions under his own hands, and became the text-book of the day, constitutes his most enduring monument. His grandson and biographer wrote a review of his contributions to surgery in the Edinburgh Medical Journal,' for November, 1868, and has reprinted it as an appendix to the present volume. From an historical point of view this notice and estimate of Bell's professional writings will possess a value to the inquirer into the modes of practice pursued at a long-past period, and into the successive stages whereby modern surgery has been built up.