Mr. Salter goes somewhat farther and believes that all the former will yield upon careful examination the cells which are characteristic of, and have given name to the latter. Without venturing to dispute the fact that many, perhaps most of the fibrous form of epulis, may give origin to brood-cells, yet we think there are some which will not be found to do so. These would have a distinctly periosteal origin, whilst the others would have a mixed origin, i. e. endosteal and periosteal. Some, again, probably have a purely endosteal origin; in such the fibrous element may be said to be entirely absent, a loose connective tissue supporting the vessels, cells, and osteoblasts. Ossification of some portions of each of the varieties do occur, but, as we should expect, it is found more commonly in the latter variety.

Free excision of these growths is the treatment laid down by all surgeons who have had experience in the matter. Yet this treatment cannot be known amongst the profession at large, for of those who present themselves at hospitals for relief most, we find, have had their removal attempted by astringent lotions or escharotics. When their removal by the knife has been attempted, this too has been done too sparingly in many cases, and the result has been a return of the disease, always alarming to a patient, and rendering a second operation more difficult and more severe. The rules laid down by Mr. Heath cannot be improved upon. Free excision of the growth, with careful scraping of the subjacent bone, or, at all events, destruction of its surface by the actual cautery or the strongest escharotics, is the proper treatment. Should the growth be of the myeloid variety. We would recommend dealing with it still more freely, as having probably a deeper origin of growth, and the bone forceps, seldom necessary in the fibrous variety, may be here employed with advantage. We have reason to believe that some of the myeloid tumours classed as malignant have owed their return to an imperfectly performed operation in the first instance. Mr. Salter thinks that when teeth are in close proximity to the tumour attempts may be made to preserve them; but as he admits the great prospect of the growth returning, we think that, under the circumstances, the general rule of removing them had best be carried out in the first instance.

Tumours of the jaw proper, in contradistinction to those we have already noticed, occupy a very considerable portion of Mr. Heath's work, and as they are described separately in each jaw unnecessary space has, as we have before hinted, been sacrificed. A large number of very interesting cases occurring in the practice of this writer together with many copied from the works of others are introduced, but we think the one hundred pages thus occupied might have been reduced, without any detriment

to the work, to nearly half that number, as but little fresh light is thrown either upon the origin of their growth, their nature, or their treatment. A useful table, showing the relative frequency of these diseases, collected by O. Webber, is introduced, in which, as pointed out by Mr. Heath, the number of carcinomatous tumours enumerated are probably in excess of what they ought to be; an opinion we believe and trust is correct, as they occupy more than one third of the whole.

In speaking of fibrous tumours of the upper jaw Mr. Heath introduces the views of M. Broca, contained in his Traité des Tumeurs,' viz. that many of the cases of fibrous and fibrocellular tumour depend upon the growth of a tooth-germ. Such are his-Broca's-odontómes embro-plastiques, which resemble in every respect ordinary fibrous tumours, but are always encysted, and occur only in young subjects and before the last tooth is formed. Mr. Heath mentions a case which he thinks bears upon the subject, but with the exception of the tumour being readily enucleated the facts mentioned cannot be said to support the views of M. Broca. Mr. Heath's patient was a young married lady, and must have been a very young married one if the last of her teeth had not been formed.

In treating upon the same subject Mr. Pollock points out that, whilst in the lower jaw the diagnosis of the origin of fibrous tumour is very easy, the tumour being usually a globular mass and circumscribed, this is not so in the upper, owing to a more lobulated form and tendency of the morbid growth to insinuate itself into the various cavities at the base of the skull. He recommends early removal, but points out that in some cases a return will occur.

Cancerous diseases of the jaws, more common in the upper than in the lower, are by far most frequently of the medullary form. In looking through the information and cases given by Mr. Heath we find little to encourage us to hope that we are at present at all nearer to the solution of the question as to whether such diseases will ever be treated successfully. Moreever there is little to support the views recently brought under our notice by Mr. De Morgan, that carcinoma is less of a constitutional disease than has hitherto been supposed, and that very early operation may be attended with permanent success. In the lower jaw, from its isolated position, we might have hoped for some encouragement for such views, and here, perhaps, we do meet with a little, as operations appear to have been attended with rather more success in this region than in many other parts of the body. Mr. Heath seems in favour of operating generally in cases of malignant disease of the jaw. Mr. Pollock, speaking very doubtfully upon the subject, says—

"After all, it will be found that much discrimination is required on the part of the surgeon who has to decide upon the removal of a cancerous growth of the jaws, and so much depends upon the individual features of each case that it would be entirely out of the question to attempt a strict code of directions relative to treatment. At best, however, interference by operation is, in the large number of cases, most unsatisfactory; in the few we hope some benefit is conferred."

Closure of the jaw from cicatrices is commonly the result of exanthematous disease, which also produces the necrosis to which Mr. Salter believes he first directed attention. In some cases it is caused by a simple binding of the cheek to the jaw, mucous membrane to mucous membrane, caused by ulceration resulting from a fang of a temporary tooth projecting into the cheek; such cases are slight and never call for operative interference. Ulcerative stomatitis produces a more severe form, not only binding the cheek to the jaw, but often uniting the two jaws by a band of unyielding fibrous tissue; but even these cases do not often call for surgical interference. After the exanthemata and especially when the patient has survived that severe disease, cancrum oris, when exfoliation of bone has taken place, the jaws and cheeks often become bound together either by strong cicatrices of a cartilaginous firmness or by actual ridges of bone. The operations for their relief are difficult and not often very satisfactory; simple removal of the cicatrix gives but temporary relief, its place being supplied by another equally unyielding. When bony union occurs it is often impossible to remove it, and here Esmarck's operation, i. e. section of the lower jaw in front of the bony union and formation of a false joint, has proved of service. When the union is not osseous and the cicatrices can be freely divided from their attachments to the upper and lower jaws, the most promising method consists in adapting to the jaws thus freed metal plates, as first attempted by Mr. Clendon, which cap the teeth and have shields covering the gum to an extent to prevent union between the gum and cheeks taking place. Between the capped surface of the plates wedges of wood or vulcanized rubber can be introduced to separate the jaws. The process is a very painful one to the patient, but, perhaps, is not much more severe than in cases we have frequently seen, where the sharp edge of a plate carrying artificial teeth has cut into the mucous membrane to the depth of a quarter or even the third of an inch, and which has eventually formed a sulcus of mucous membrane. A practical dentist such as the late Mr. Clendon, was no doubt led from a consideration of such cases to devise the useful appliances he introduced in Mr. Holt's case.

III.-Handbook of Law and Lunacy.1

REGARDING the legal aspects of insanity, and the laws and regulations laid down to guide medical men in their relations with lunatics and receptacles for lunatics, there has certainly been, in past time, much deficient information; and in consequence thereof pains and penalties, abuse and satire, have been, ever and anon, launched against the members of our profession, and not without indications of much concurrence on the part of the public. However, within a very recent period several authors have been stirred up to write on the subject of the laws relating to medicine and medical men, amongst which the lunacy laws and the regulations of public boards relative to lunatics have had their place.

In recent numbers of this Review we have had occasion to call attention to the appearance of two very complete manuals of the laws affecting medical men, by Mr. Weightman and Mr. Glenn, both barristers of experience, well versed in law. In each of these works the lunacy laws received a very large share of attention, and in Mr. Weightman's book the text of the several Acts of Parliament was duly set forth. Moreover, in our number for April last we reviewed a treatise on the 'Jurisprudence of Insanity,' by Mr. Balfour Browne, one of the joint authors of the volume now before us, in which some of the same topics were treated as enter in the subject-matter of this new production.

With this amount of recent literature within their reach, it may be presumed that medical men are now thoroughly furnished against all the embarrassing contingencies which may befall them in any dealings they may have with lunatics, lunatic asylums, or lunacy trials and commissions.

We have said that, with regard to the present treatise, Mr. Browne is a joint author, being associated with Dr. Sabben, who is one of the craft of the now euphoniously (?) called psychiatrists, the mad-doctors of olden time. This association of law and physic bodes well in the production of a 'Handbook of Law and Lunacy,' for the lawyer must be supposed to be learned in the law, and the doctor cognisant of the sort of legal and other information wanted by medical men. We particularly look for such a qualification from Dr. Sabben, since he is connected with the management of an asylum, and conversant with the circumstances surrounding lunatics in all their legal and medicolegal relations.

1 Handbook of Law and Lunacy; or, the Medical Practitioner's Complete Guide in all Matters relating to Lunacy Practice. By J. T. SABBEN, M.D., and J. H. BALFOUR BROWNE, Barrister-at-Law. London, 1872, pp. 138,

The result of the joint labours of these two gentlemen is a book of no great dimensions, but well filled with most useful instructions and advice. We cannot, indeed, say that it comes up to the standard we might expect, nor can we commend all its teachings in all points, or its writing in matter of style. With reference to the last, there is too much of what the Americans call" tall" writing and an affectation of learning. Chapter II contains much of this sort of thing in the description of the course to be taken in examining an alleged lunatic. The directions about testing the memory, to note its "conservative faculty," its "reproductive energy," and its "elaborative faculty," will to many a plain practitioner read very elaborate, but unnecessarily magniloquent. Nor to such a one will the phrases" appetite for muscular activity," "appetite for light and heat," "denudification," "prescient and prophetic dreams," "æsthetical imaginations," &c., be felt to convey more clear notions than the commonplace English phrases and words that could well replace them.

The chapter on the "Removal of Insane Persons to Asylums" is replete with useful hints and directions, which, if attended to, will save the reader many annoyances, particularly in giving certificates of lunacy, a matter in which there is too often an immense amount of bungling. Examples are given of certificates filled up, and illustrative of the sort of statements required for each leading variety of insanity. It may be noted that in every case it is assumed that the alleged lunatic is communicative, and replies to questions addressed to him. This, however, is not the case, for now and then a patient remains doggedly silent, and it is impossible to convict him out of his own mouth of harbouring delusions. In such instances the obstinate taciturnity is rightly adjudged as evidence of unsound mind, to be confirmed by the testimony of others as to facts observed or remarks heard.

In the course of the next chapter, on "Commissions in Lunacy," when commenting on the differences obtaining between an affidavit and a certificate of lunacy, it is laid down as the law of the case that the information sworn to in the former document may have been "obtained at any number of previous interviews or gathered from an intercourse extending over years, . . . while all the facts that are stated in a certificate must have been observed, and all information quoted must have been obtained, upon the same day upon which the certificate is signed." This rigid ruling is new to us, and seems to strain unnecessarily the intent of the law. For, surely, the history of a case from personal observation, the narration of facts known to the individual certifying occurring at a period more or less