ITS SURGICAL AND MECHANICAL TREATMENT. 99 



may be urged as another objection. Beyond the 

 very serious results already referred to, the operation 

 may fail from extensive sloughing. Up to the 

 present time, the number of successful cases recorded 

 is small. What proportion they bear to the un- 

 successful I am quite unable to learn, as of these 

 there is no very accurate account kept. I have 

 examined the surgical registers of three of the 

 London hospitals, and if I may judge from these, I 

 fear it is very small. 



Finally, the necessity of repeated operations where 

 the fissure is extensive, at each of which the above 

 enumerated and other conditions necessary to suc- 

 cess must exist, may be urged as another objection 

 to the surgical treatment. 



But, on the other hand, it may with truth be 

 said that when the surgical treatment is successful, 

 the patient is saved all further inconvenience and 

 expense ; that a natural palate must always be 

 more useful and comfortable than an artificial one ; 

 and that, should it fail through sloughing of the 

 soft parts, the patient is not in a worse condition 

 for mechanical treatment than before. 



AU that is to be said for and against the mecha- 

 nical treatment of cleft palate may be summed up 

 in one word, viz., that all classes of cases may and 

 often have been successfully relieved by it ; the cases 

 most difficult to the surgeon — fissures of the hard 

 palate — are the easiest to the dentist ; and when 

 the fissure involves the velum alone, or the hard and 



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