years of age; the operation for hare lip having been performed during infancy.

The dental arch instead of having the breadth (in comparison with the size of the rest of the head,) of the normal jaw is found to be exceedingly contracted, the two margins of the fissure in the alveolar ridge being very near together, if not in actual contact with each other.

By this time the portion of the palate, that in childhood produced the appearance of a double cleft will have changed its position, and the patient will have that form of palate, which is found in most of these severe cases.

All this is produced, I think, by the contraction of the lip after the operation has been performed on it. The steady pressure which, as the wound heals, is exerted on the two portions of the jaw, gradually approximates the anterior margins of the cleft, and at the same time compels the central portion of the palate to which I have drawn attention, to assume a vertical instead of an horizontal position, as at birth. A careful examination of the drawings in reference to this matter, will I think bear out this view.

For the anatomy of cleft palate I am largely indebted to Sir William Fergusson, who some years back had the rare good fortune to come across a case in the dissecting-room, an account of which he gave in a paper read before the

Medical and Chirurgical Society on the 10th December, 1844. On the conclusions which he came to as to the physiology of the parts, he based his method of treatment for this condition of the palate, and put forward the plan of dividing the levator palati muscle, in order to obtain perfect control over the palate during the operation.

The value of this account of the anatomy and physiology of cleft palate cannot be overestimated, since, in addition to the light it threw upon the surgeon's work, it has of late years become the basis of treatment by mechanical

means.

Under these circumstances I feel I cannot do better than give to my readers an extract from the Society's Transactions (for 1845), in Sir William Fergusson's own words :

"Few have had the opportunity of dissecting a cleft palate, and some notice of a specimen in my possession will form an appropriate introduction to the views developed in this paper. The fissure in this instance implicates a portion of the hard as well as the whole soft palate, and is such as the surgeon frequently meets with in practice. The specimen was procured in the dissecting-room from the mouth of an aged female subject.

"In the examination of this preparation there

are several marked differences between it and the parts in a more natural state. The superior constrictor muscle is more fully developed than under ordinary circumstances, and its upper margin, extending between the basilar process of the occipital bone and the internal pterygoid plate is particularly distinct. This part of the muscle forms a sort of semicircular loop, in which the levator palati muscle seems to be suspended.

"The pharynx has been laid open by a perpendicular incision through the constrictors in the mesial line, and the moveable portion of the palate has been dissected on one side. The circumflexus, or tensor palati, differs little from the natural condition, and the levator palati is much as it is usually met with, its lower end spreading out in all directions on the soft palate. The palato-pharyngeus consists of two distinct bundles of fibres; one, the smaller of the two, running between the tensor and levator palati; the other, a mass equal in size to a goose-quill, seems to form the principal part of the free portion of the palate; and posteriorly its fibres, previous to joining those of the other bundle, form the whole muscular portion of the posterior pillar of the fauces. This muscle arises by tendinous and fleshy fibres from the posterior margin of the osseous palate and the inner surface of the in

B

DESCRIPTION OF PLATE 3.

Showing a Dissection of a Cleft Palate; copied from the work on Practical Surgery, by the kind permission of Sir William Fergusson, Bart.

The plate represents the posterior nares and upper surface of the soft palate.

a. The levator palati; the dark line shows where it should be cut across.

b. The inner bundle of fibres of the palato-pharynegus forming the posterior pillar of the fauces; the black line indicates the place for division.

c. The palato-glossus, with the mark for incision, if one should be deemed necessary.

The tonsil lies between these two muscles.

d. The tensor palati, the cartilaginous extremity of the Eustachian tube is in front of this letter.

e. The posterior extremity of the inferior turbinated bone.

f. The septum.

g, g. The uvula on each side stretched apart.