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parts. All of these symptoms, however, disappear when the cause is removed, either by operation or mechanical treatment, though the latter, by checking to a greater extent the passage through the nares, is probably the more efficient of the two

for this purpose.

CHAPTER IV.

SOME ACCOUNT OF THE APPLIANCES USED FOR REME

DYING CLEFT PALATE (WHETHER CONGENITAL OR
ACCIDENTAL) FROM A.D. 1552 TO THE PRESENT
TIME.

An account of the progressive stages by which we have arrived at the present comparative perfection of artificial palates may not be uninteresting to our readers, or out of place in a work of the present kind.

Our principal authority on this subject is Snell, who took great pains to collect all that it was possible to glean as to the contrivances used by our forefathers for remedying this deformity.

Little is known or said on the matter till the fifteenth century, though Isaac Guillemeau, in his work published in 1649, mentions the name by which the Greeks called the appliances for filling up the cleft; thus leading us to infer that they were acquainted with some method of treatment for perforation or cleft of the palate.

In order that we may more easily see the time that was occupied in passing, stage by stage, from one improvement to another, we propose

to

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arrange the names of those surgeons, dentists, and others who have paid any attention to this matter, in chronological order.

1552.-Hollerius, in his “ Obsery. ad Calcem de Morbis Internis,” proposes to stop the apertures with wax or sponge.

1565.-Alexander Petronius, in his “ De Margo Gallico," proposes, when there is but one opening in the palate, to stop it with wax, cotton, or a gold plate, taking care to give to the instruments the same concave form as the roof of the mouth. Though this is the first mention of a gold plate being used for this purpose, still, from the fact of Petronius not being more explicit as to its mode of fitting and retention in the mouth, we are, as Snell very justly observes, led to the conclusion that the remedy was one with which his readers were not altogether unacquainted; and we must not therefore give Petronius the credit of being the inventor of this mode of treatment.

1579.-Ambrose Paré, in his book on surgery, published in Paris, and in the

1649 translated into English by Thomas Johnson, proposes that the cavity should be covered over by a gold or silver plate, “made like unto a dish in figure, and on the upper side, which shall be towards the brain, a little sponge must be fastened, which when it is moistened with the moisture distilling from the brain will become swollen and puffed, so that it will fill the concavity of the palate, that the

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artificial palate cannot fall down, but stand fast and firm as if it stood of itself."

1649.- Isaac Guillemeau, in his “ De Ouvres,' gave a drawing of an instrument similar in form to Ambrose Paré's instrument; but suggested that, as it was not always possible to adapt the plate perfectly to the roof of the mouth, a lining of sponge or lint should be applied, in order to render the closure more complete. 1653.-Amatus Lusitanus, in his “ Curat.

6 Medic. Centur.," mentions a boy with diseased cranium and perforated palate, whose voice was restored by means of the gold plate and sponge.

1685.-Nic. Tulpius, in his “ Observat. Medici," mentions the same mode of treatment.

1715.-Garangeot, in his “ Treatise on Instruments," is the first that we find making any step in advance of his predecessors with regard to the construction of obturators. Describing one, he says :-“This instrument has a stem in the form of a screw, upon which runs a nut. To make use of it, take a piece of sponge, cut in the shape of a hemisphere, with a flat surface ; pass the stem of the obturateur through the sponge, and fix it by means of the nut. Dip the sponge

in water, squeeze it dry, and introduce it through the aperture.”

1723.–Fabricii Hieronimi, in his “ Chirurgicis Operationibus," recommends sponge, lint, or

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silver plate; not suggesting any new form of instrument. He is the first, so far, that is, as we have been able to examine these old works, who makes specific mention of congenital cleft palate in contradistinction to accidental cleft or perforation.

1734.-R. Wiseman, Sergeant-Surgeon to King Charles II., in his Chirurgical Treatises gives evidence of having bestowed much thought upon the treatment of the defects of the palate, though he cannot be said to have made much real and practical progress. His novelty in treatment consisted in filling up the cleft with a paste composed of myrrh, sandarac, and a number of other ingredients.

His idea was certainly in advance of his time; for by this means a most important end was gained,—that of perfect exclusion of air by its complete adaptation to the margins of the cleft. We are unfortunately not informed how this “paste palate was kept in position.

1739.-Heister, in his “ Institutions of Surgery,” suggests the use of “a gold or silver plate adapted to the perforation, and furnished with a handle or small tube, which, being armed at the top with a sponge, he may thereby exactly close the perforation.”

1754.- Astruc, in his “ Treatise on Syphilis," makes the first mention that we have of a silver button to the metallic obturator, in place of the

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