shape of the palate (a, a,) and at the same time shows the manner in which it was restored, by means of a hard rubber plate b.) Within three

weeks the speech was much clearer, and the voice more agreeable in sound. At the present time, while the palate is worn, both voice and speech are almost perfect.

The construction of an instrument for this purpose is so simple that it is not necessary to say more, than that the impression having been taken in plaster of Paris, the palate was restored with wax to the proper shape, and the model put in the flask and packed with rubber in the usual way. After vulcanizing, it was finished off very carefully, so as to give a thin edge to the borders, and not offer any obstruction to the action of the tongue. The portion coming in contact with the palate should be left unpolished, and, in fact,

G

untouched, beyond washing off the plaster, in order that better suction may be obtained when it is fitted into the mouth.

These cases are very numerous, and with ordinary pains-taking, very successful and satisfactory in their results.

Case IX.-Miss M. R. ; Aet. 12.-Brought to me June, 1869, with elongated palate and projecting incisor teeth. The history of the case showed most unmistakeably that the deformity arose from sucking the thumb during infancy and childhood; and the evidence of the mother—a lady of great intelligence-confirmed this view. She said, when she had severe pain herself, she was in the habit of sucking her thumb as a diversion from the suffering, and her three female children had got into a similar custom, without any occasion but that of imitation. The deformity was not, hereditary, as both father and mother had well-formed dental arches, and rather flat than deep palates. I extracted the first bicuspid on each side of the upper jaw, and made a vulcanite plate capping the side teeth, and having a broad band of elastic rubber, vulcanized with it, and passing in front of the incisors and canines, these teeth having been first reduced in the front, in order that sufficient pressure might be brought to bear upon them. In two months the teeth were brought into a fair position, considering the

severity of the case. The projection of the lip was entirely reduced, but the teeth had an appearance that is not uncommon in these cases-of being too long. The child will probably, however, grow out of this in a few years, as the whole of the face increases in size.

CHAPTER VIII.

DEFECTS OF THE PALATE ARISING FROM SYPHILIS.

Without entering into the medical treatment of syphilitic ulceration, it may not be an unsuitable introduction to give some of the leading features of this affection in the mouth.

Secondary syphilis seldom comes in the way of the dental surgeon, except when the teeth are affected either as a result of treatment or from the disease itself.

In the cases that come under the dental practitioner's notice it is generally observed that either the tongue, fauces, or soft palate are affected. The ulceration is almost invariably symmetrical, and in this differs from tertiary syphilis, as it does also in the manner in which the ulceration takes place.

In secondary syphilis, ulceration proper is rarely present except on the tonsils, but on the tongue there will be observed small symmetrical patches denuded of epithelium along the sides and tip. Occasionally, if neglected, these patches deepen into ulcers, with soft irregular edges-mucous tubercles. Secondary patches, whether mucous

tubercles or condylomata, are always symmetrical as to position. In the tonsils, the disease will sometimes extend into the glandular structure. In secondary syphilis the hard palate is seldom affected beyond the ulceration of the mucous membrane, necrosis of the bone seldom taking place at this stage of the disease.

The ulceration of tertiary syphilis is of a deep spreading character, with irregular and thickened edges, commencing at the mucous membrane, eating through submucous membrane and periosteum, and leading to necrosis of the bone.

In one case, under the care of my friend Dr. Morell-Mackenzie, the second cervical vertebra was laid bare, and considerable hæmorrhage ensued, apparently from the vertebral artery.

The salivation connected with this disease I need not enlarge upon at the present time. When there is any appearance of puffiness in the palate, an examination with the rhinoscope will generally show whether there is any ulceration of the posterior nares going on, and if there is the slightest appearance of this, the patient must at once be referred to the surgeon for treatment. The use of any gargle, inhalation, or local application with the brush, for the purpose of arresting the disease, is quite beyond the domain of even a dental

himself specially to the

surgeon who devotes treatment of defects