DEFORMITIES.
HARE-LIP.—This is due to the fact that the flesh or bony parts do not quite properly unite. It may form a single or double hare-lip, or complicated, or it may involve the soft parts, or the hard (bony) and soft parts at the same time. It is always to one or the other side of the middle line. It is double hair-lip in about one-tenth of the cases, and when double it is frequently complicated with cleft palate.
Symptoms.—Upon examination you notice that there is a split in the lip, either partly through the lip or entirely, so that the bone is exposed; or the slit goes not only through the lip, but also through the bone.
Operation.—This is necessary, and it is quite successful. The best time is between the third and sixth month, especially when it is a simple case. In some cases of double hair-lip, when the child cannot take the breast and has to be fed, early operation should be done if the child is strong. The operation for a simple hare-lip is very easily and quickly done. For complicated cases it takes longer, and of course is not without some danger. It should be done, for a child is a pitiable sight with this deformity. When grown up it is a source of great annoyance and shame.
CLEFT PALATE.—The bones that form the hard palate do not unite in the median line and a longitudinal opening is left in the roof of the mouth. This is called Cleft Palate.
Symptoms.—Of course, upon examination this split is seen. It may involve not only the hard palate, but also the soft palate and uvula. It is then generally accompanied by single or double hare-lip. When the severe forms occur they cause great trouble. Fluids pass freely into the nose, and unless the child is carefully fed by hand it will soon die, as it is unable to suck. In the less severe forms the child soon learns to swallow properly, but when he learns to speak he cannot articulate properly and his voice is nasal.
Treatment.—For this reason an early operation is advisable, not so early as for hare-lip, but before the child has learned to speak, say between the age of three and four when faulty speech (articulation) may be overcome by successful closure of the palate. When the operation is done late, the patient will not be able to overcome the bad habits of articulation acquired in his childhood.
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Operation.—The anaesthetic is necessary. The end of one-half of the cleft palate is seized with an instrument and the edge freely pared with a thin bladed sharp knife; same with the other half. Then the stitches are put in of silk worm, gut or wire. The patient is fed on liquid food for three or four days, and afterwards on soft food until the stitches are removed. They are removed about the sixth or eighth day, and the wound should be completely healed.
CROOKED FEET. Talipes.—There are many varieties. The treatment should be begun, under the instructions of a physician, and continued from infancy and many a good foot can be obtained.
KNOCK KNEE. (Genu Valgum).—This is due to an overgrowth of the internal knuckle (condyle) on the knee joint, and curving inward of the shaft of the thigh-bone (femur) in its lower parts, with relaxation and lengthening of the ligaments of the knee joint.
It usually shows itself soon after the child begins to walk, but may not do so until puberty,—rarely later. It is due in the child to rickets; in the latter form, it is caused by an occupation that requires continued standing, by a person of feeble development of the muscles and ligaments. "Flat-foot" is often associated with it and, at times, may be the real cause. It may affect one or both knees, may be so slight as to escape detection, except upon a very careful examination, or so severe as to separate the feet very widely and render walking difficult and wobbling. In children other symptoms of rickets can generally be found. If not severe it may often get better spontaneously as the rickets condition improves and the general strength increases. This result is common in the cases occurring later, from standing if the general condition improves.
Treatment.—Should be begun early and both general and local treatment should be given. The quicker the treatment is begun, the quicker will be the recovery and the deformity will be less. The ordinary medical and hygienic treatment should be given for rickets.
Local Treatment.—This is mechanical, supplemented by baths, rubbing, friction, electricity and preceded, if necessary, by attending to the bones. If the rickets is still active, and the bones are soft and yielding, standing and walking should be forbidden, the limb should be straightened by manipulation and the correct position secured and maintained by an outside splint and bandage. Sometimes operative measures are needed.
BOW LEGS. (Genu Varum).—This is the opposite of knock knees, and the deformity usually affects both limbs, the knees being widely separated. The disease begins in early childhood; the cause is rickets, and the deformity is the direct result of the weight of the body and muscular action.
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Treatment.—Spontaneous recovery occurs; but if the case is at all severe, and the child is young enough that the bones have not become firmly set in the abnormal curves, mechanical treatment should be employed to bring the limbs to a better position. This may be done by plaster of paris or braces. This must be used intelligently and continuously. Children should not be allowed to walk so early, especially those of slow development.
CLUB FOOT (Talipes).—Varieties:
1. The heel may be drawn up and the foot extended (Talipes Equinus).
2. The foot may be flexed, bent up, (Talipes Calcaneus).
3. The foot may be drawn inward, adducted, (Talipes Varus).
4. The foot may be drawn outward, abducted, (Talipes Valgus); or, two may be combined, extended, and drawn inward (Equino Varus).
In the congenital (born with it) variety the displacement is almost always one of adduction, that is, drawn inward, with commonly some elevation of the heel. It generally affects both feet, but it may be confined to one and if only one is affected, the right is oftener affected than the left. The deformity varies. At the time of birth and for some months afterwards the deformity can usually be corrected by proper manipulation, but later, if left to itself, it becomes in greater or less measure fixed, because of the muscular contraction, and developed changes in the shape of the bones.
Cause—It is not known.
Treatment is successful if it is begun early. Each case should be treated as it needs. The treatment should be varied to suit each case. Bandaging or adhesive straps properly applied has been used with success. Sometimes the leg must be kept motionless by plaster of Paris or gutta-percha bandages. They must be frequently removed and reapplied. In older cases the tendons must be cut and braces applied. Parents are careless who neglect such a case for even one month.