Observations on cleft palate : with cases illustrating the new operation of staphyloraphy / by William Fergusson.

  • Fergusson, William.
Date:
[1849]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on cleft palate : with cases illustrating the new operation of staphyloraphy / by William Fergusson. Source: Wellcome Collection.

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    in the ordinary operation, as the chances of spasm and consequent dragging in the stitches are greatly arrested. Well made gruel is what I chiefly recommend, and it may be seasoned with salt, sugar, or a little wine, as the patient may choose. Usually, in eight or ten days the union of parts is so firm that solid food may he permitted, and it is seldom that any surgical interference is requisite after that time. Patients and their friends are generally most anxious regarding the change of voice and improvement in articulation as soon as speech is permitted. If the whole cleft has been closed by the operation, the improvement in tone is at once perceptible ; but if there be any aper¬ ture left, as is often the case, little change can be perceived. If, however, the opening be closed by any piece of mechanism, the result as regards the voice will appear much the same as in the other instance. In some the change is much more apparent than in others; but in all, considerable after-training is required to improve the voice and speech. The original defect has permitted the air to pass as readily through the nostrils as by the mouth; hence the nasal sound so characteristic of such cases, and hence, too, the impossibility of articulating such sounds and words as get their modulation in the front part of the mouth in the natural state of the palate. I have found some of those on whom I have operated so very indolent and regardless of improvement, that they have not taken any pains to learn the use of the parts as altered by the operation; but in others there has been such satisfactory pro¬ gress as to astonish and delight the friends. One of my patients, whose articulation was so bad before the operation that I could scarcely understand a word he said, afterwards set himself industriously to study elocution, and in less than twelve months acquired such mastery, that his speech was in reality more correct than is usually heard in ordinary society. The power of speech is acquired so slowly and imper¬ ceptibly in early life, that we hardly appreciate the needful efforts; and under the circumstances referred to, we are all perhaps too sanguine as to the expected improvement,—forgetting, in our zeal, the many years that passed in early life ere an ordinary command was obtained over the organs of speech. In most instances I believe that considerable effort is required on the part of the patient to reap the full benefit of a successful operation. I have attempted on several occasions to close the fissure in the hard palate, in accordance with the directions of my friend Dr. J. M. Warren1, but as yet without much success. The plan of dissecting the soft tissues from the bones, as recommended by this ingenious surgeon, seems in his hands to have been very successful. My own failures must, I suppose, be attributed to want of skill on my part, or to the circumstance, that the cases in which I have hitherto tried the practice have not been favourable for its application. Sometimes, whilst dealing with the soft palate, I have also dissected the tissues from the bone between the margins of the gap and the alveolar ridges, and so 1 New England Quarterly Journal of Med. and Surg. April, 1843.