954 



TERATOLOGY. 



lary bones are largely separated from each 

 other posteriorly, so as to form a fissure, more 

 or less extensive, of the bony and of the soft 

 palate. Sometimes there is only a fissure of 

 the uvula (Von Ammon). The nearest ap- 

 proach to the natural state is, when the planes 

 of the palatine bones' form with each other an 

 acute angle rising high upwards in the nasal 

 cavity (Himly, W. Vrolik). In some cases, 

 the palate is fissured at its anterior part, close 

 to the foramen palatinum anticum (hiatus fora- 

 minis palatini antici, Von Ammon). En re- 

 sume, it appears that fissure of the palate and 

 hare-lip are independent of each other. But 

 it may happen that, originally, the fissure of 

 the palate coexists with the hare-lip and closes 

 itself later. The indentation which is ob- 

 served in hare-lip without fissure of the palate, 

 between the external incisive and the canine 

 tooth, makes it probable that nature proceeds 

 in this manner. It is also not improbable that 

 hare-lip may sometimes be cured spontane- 

 ously in the womb. The gradual transition of 

 the various forms of this malformation into each 

 other, shows that its cause is not external and 

 accidental, and that it is produced, neither by 

 blows which the child inflicts upon itself with 

 its fists (Jourdain), nor by a mechanical im- 

 pediment preventing the union of the palatine 

 lamina? (Pinnder). Complete fissure of the 

 face and the palate is rather to be considered 

 .as an arrest of developement at an early 

 period of formation. Hare-lip conforms with 

 the foetal condition in that period of develope- 

 ment which I have called the third. If the 

 original intermediate protuberance does not 

 unite itself with the lateral parts, double hare- 

 lip is formed. The protuberance obvious in 

 it is formed by the intermaxillary bone either 

 in its totality, or only by a part of it. If 

 it unites itself with only one lateral part, 

 single hare-lip is formed. The intermaxillary 

 bone is composed of four separate parts, of 

 which each contains an alveolus. The result 

 of this is, that each of these parts may be 

 united, separately, with the supermaxillary 

 bones ; which fact explains clearly why only 

 three or two incisive teeth are sometimes to 

 be found in the protuberance. The fissure 

 of the upper lip sometimes occupies the mesial 

 line, passing through the middle of the inter- 

 maxillary bone. This is also the case when the 

 intermaxillary bone is wanting. 



In this way, all the various forms of fis- 

 sure of the face can be reduced to an arrest 

 of developement, which explains in the mean- 

 time the constant tendency of the fissure to 

 close itself, as may be observed in children 

 .having this malformation. Fissure of the palate 

 and lip does not endanger the life of children, 

 and union of the separated parts in hare-lip 

 and cleft palate can be obtained by a surgical 

 operation. 



e. Fissure of the under lip. The under lip 

 .is very seldom cleft (J. F. Meckel, Von 

 Ammon, Nicati, Bonisson). It is equally 

 rare for the under jaw to remain after birth 

 separated into two parts. 



II. Fissure of the Skull (Acrania). 



Many forms of this monstrosity are known, 

 to which different names have been given, as 

 acephalia spuria, microcephalia t anencephalia, 

 hemicephalia. But, for its shortness and ety- 

 mological sense, I prefer the name of acrania, 

 which was introduced by J. F. Meckel. Un- 

 der this name I comprehend all the different 

 forms in which this malformation occurs, and 

 also, with Himly, the hernia cerebri. Accord- 

 ing to my opinion, the division into different 

 families and genera, and the nomenclature of 

 J. Geoffrey St. Hilaire, ought to be rejected. 

 I, for my part, am always inclined to simplify 

 science as much as possible, and to be succinct 

 in its exposition; and I propose, therefore, the 

 following types. 



First Type. Want of the brain, and ex- 

 posure of the whole basis of the skull. The 

 superior surface of the cranium is flat, and not 

 formed by the bones of the skull, but only by 

 a membrane, of which the margin is very un- 

 equal, hard, and formed by bones. The 

 external integuments extend over this margin, 

 and terminate there in an unequal line, 

 which is distinctly circumscribed by the thick 

 hair of the head. With this cutaneous border 

 is connected the slightly vaulted membrane, of 

 a red, somewhat bloody colour, which imme- 

 diately covers the periosteum that invests the 

 more or less convex surface of the basis of the 

 skull. The brain is wanting, but the central 

 terminations of the cerebral nerves are in most 

 cases present, yet sometimes these also are 

 wanting (J. F. Meckel). The forehead is flat, 

 and directed forwards in an oblique direction. 

 The eyes protrude on its anterior or orbital 

 margin, covered with swollen superior eyelids, 

 and directed more or less upwards. The face 

 is flat, and nearly horizontal ; the upper, and 

 still more so the under jaw are comparatively 

 longer than those of a well-formed subject ; 

 the tongue is in general prominent, because 

 the mouth cannot be shut on account of the 



Fig. 606. 



