LIST OF ILLUSTRATIONS.

[1.]Hare’s lip (Bland Sutton).
[2-6.]Different varieties of harelip (after Tillmanns).
[7, 8.]Double harelip with projection of os incisivum, seen from the front and in profile (Fergusson).
[9.]Complete cleft palate with double alveolar harelip (Mason).
[10.]Complete cleft palate without alveolar or labial deformity (Mason).
[11.]Complete unilateral cleft palate with vomer attached to one segment (Mason).
[12-14.]Incomplete fissures of the palate (Mason).
[15.]Cleft of lip, alveolus, and anterior part of palate only (Mason).
[16.]Median harelip with absence of intermaxillæ (Bland Sutton).
[17.]Median fissure of upper lip (Bernard Pitts).
[18.]Oblique facial cleft (Tillmanns, after Kraske).
[19.]Facial cleft in child (Tillmanns, after Hasellmann).
[20.]Double facial cleft with macrostoma (Tillmanns, after Guersant).
[21.]Puppy’s head with double alveolar harelip and double partial facial cleft (after Albrecht).
[22.]Lateral aspect of a severe case of macrostoma (Bland Sutton).
[23.]Double macrostoma with auricular appendages (Tillmanns).
[24.]Ditto ditto (Fergusson).
[25.]Mandibular cleft (Wölfler).
[26.]Intermaxillary sutures of a tetraprodontous child’s jaw (after Albrecht).
[27.]Intermaxillary sutures in a hexaprodontous jaw (after Albrecht).
[28.]Muscles of palate dissected (Fergusson).
[29.]Head of fœtus at 5 weeks (Sutton).
[30.]Head of fœtus at about 6-7 weeks (Sutton).
[31A.]Head of fœtus at about 8 weeks, from the front (Quain’s Anatomy).
[31B.]Head of fœtus seen from below (Quain’s Anatomy).
[32, 33.]Later stages of development of head (Quain’s Anatomy).
[34.]Diagram of development of palatal processes and ethmo-vomerine plate (after Gegenbaur).
[35.]Bony palate of a 6 months’ fœtus (after Gilis).
[36.]Diagram illustrating “Goethe” theory of alveolar harelip.
[37.]Diagram illustrating “Albrecht” theory of alveolar harelip in a tetraprodontous jaw.
[38.]Diagram illustrating “Albrecht” theory of alveolar harelip in a hexaprodontous jaw.
[39.]Adult upper jaw with right-sided alveolar harelip and cleft palate (after Albrecht).
[40.]Child’s jaw with cleft palate and double alveolar harelip, showing the sockets of the teeth (after Albrecht).
[41.]Os incisivum (Fergusson).
[42, 43.]Diagrams illustrating the effect of differing slopes of the palatal segments (Mason).
[44.]Teat of feeding bottles adapted for feeding infants with cleft palate (Mason).
[45.]Coles’s nipple shield for ditto (Coles).
[46A and B.]Author’s incisions for unilateral harelip, and position of sutures.
[47A and B.]Graefe’s operation for unilateral harelip.
[48A and B.]Nélaton’s ditto.
[49A and B.]Malgaigne’s ditto.
[50A and B.]Giraldés’ ditto, or the mortise operation.
[51A and B.]Mirault’s ditto.
[52.]Stokes’s ditto (Mason).
[53A and B.]Collis’s ditto (Mason).
[54A and B.]Author’s incisions for double harelip.
[55.]Sédillot’s operation for ditto (Mason).
[56.]T. Smith’s operation for ditto (Mason).
[57.]T. Smith’s gag with tongue plate (Messrs. Arnold and Son).
[58.]Mason’s gag (Matthews Bros.).
[59.]Rose’s gag (Matthews Bros.).
[60.]Various forms of raspatories (after Durham).
[61A.]Fine hook forceps.
[61B.]Smooth-nosed forceps.
[61C.]Knife for paring edges of cleft (Mason).
[62.]Angular long-handled catch forceps.
[63.]Various forms of needles.
[64, 65.]Diagrams to illustrate the effects of tightening the sutures on the needle-tracks.
[66.]Wire twister (Messrs. Maw, Son, and Thompson).
[67A.]Diagram to show extent and position of incisions in uranoplasty.
[67B.]Diagram of position of sutures and condition of palate after operation.
[68.]Double-curved raspatories.
[69.]Loop method of passing sutures (Mason).
[70.]Method of tying slip-knot (Fergusson).
[71.]T. Smith’s palate needle (Messrs. Arnold and Son).
[72-74.]Various form of artificial vela (Coles).
[75.]Appearance in profile after operation for double harelip, including removal of os incisivum (Coles).

ON HARELIP AND CLEFT PALATE.

CHAPTER I.
GENERAL INTRODUCTION.

Harelip—Cleft palate—Frequency—Occurrence in animals—Associated deformities—Median harelip—Facial clefts—Macrostoma—Mandibular clefts—Causes of these deformities.

The congenital fissures and deformities of the mouth and lips form a group which is considerably larger than might be imagined from the scanty notice given them in ordinary text-books; and although many are extremely rare, yet possibly if more attention were drawn to them, fresh cases would be noted and recorded, and the somewhat scanty materials from which we have to work out their development and characteristics would be increased. In order to facilitate subsequent description, I append a classified list of the deformities which we shall pass under notice, premising that the more practical part of this work will be occupied exclusively with two of them.

Six different classes may be described:—

(1) Median harelip (inter-intermaxillary).