H. S. Stannus 
11 
(14) Li'ps, Mouth and Palate. Most natives shew a well-marked tubercle in 
the median line on the " red " margin of the upper lip ; in a few however this is 
replaced by a distinct groove which involves the red margin of the lip or only the 
subjacent fold of mucous membrane (see sketch Fig. 8 and photo, Plate V, (16)). 
Fig. 8. 
These cases resemble one of a Hindu (recoi'ded in the Lancet, Oct. 2, 1909, by 
Thurston), who besides having the median hare-lip was the subject of poly- 
dactylism. In one of my cases there was a considerable gap between the upper 
central incisors but no further abnormalities wei'e present. 
In a single case notching of the upper lip was found to the left of the middle 
line with a mark running up to the nostril which looked like a scar. There was 
no question of any operation having been performed, though the condition 
resembled exactly an artificial repair of a lateral hare-lip (Fig. 9). A similar 
Fig. 9. 
case has been shewn at the W. Lond. Med. Chir. Society in which there was, 
besides, a deformity of the nose and a family history of hare-lip. I have only seen 
one case of ordinary Hare-Lip, a Blantyre boy aged 10 years (1909), the affection 
being left-sided and unassociated with any cleft of the palate (Plate V, (17)). 
Among 30,000 natives examined in the northern districts of this country no 
case was seen. 
No case of typical Cleft Palate has come to my notice ; on the other hand I 
have seen three cases which owing to their non-association with defects in the 
upper lip are of great interest. All three cases, one a boy aged 10 years (1906), 
the other two adult males, presented complete Absence of the Pi-enuucilla and 
attached teeth. In the boy there was also a Median Perforation in the hard 
Palate. Congenital perforations of the palate apart from clefts are apparently 
rare in Europe. Dundas Grant (Roy. Soc. Med. April 1910) has recorded the case 
of a girl aged 16 years with a perforation above and to the right of the base of 
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