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HOPITAL DE LA CHARITE.

CONGENITAL FISSURE OF THE SOFT PA- ‘LATE.-STAPHYLORAPHE, BY M. ROUX;FAILURE OF THE OPERATION.-COM-

PARISON OF M. ROUX’S AND M. DIEF-FENBACH’S METHODS.

CHARLOTTE ANNETTE, twenty-one years ofage, was admitted into the hospital on the12th of January, 1835, to undergo an ope-ration for the removal of the above-men-tioned deformity, which had existed frombirth, and was accompanied with greatdifficulty of speech, imperfect articula-tion of sound, &c. On examining the pa-tient, who in other respects enjoyed per-fect health, M. Roux recognised a ver-tical division of the soft palate to the ex-tent of an inch, and reaching nearly tothe uvula. The patient consented will-

ingly to the operation proposed to her byM. Roux, which he performed on the 17thin the following manner :-Having arranged the necessary instru-

ments, which consisted of a porte-aiguille(something similar to a porte-crayon),used for seizing and inserting the ligatureneedles, a common dressing forceps, seve-ral curved needles, all armed with suturesof three or four waxed threads each, anarrow probe-pointed bistoury, a pair ofcurved scissars, &c., the operator placedthe girl in a low chair, and took himself aseat opposite to her; the patient’s headwas held slightly backwards by an assist-ant ; one of the curved needles, seized inthe porte-aiguille, was then passed with itsligature through the aperture in the pa-late, and introduced from within out-wards into the lower end of the right flapof the fissure, at about a quarter of an inchfrom its edge; the needle having beenmade to pierce this portion of the palate,the operator seized it with a common for-ceps, and drew it out, together with itsligature ; a similar proceeding was adopt-ed for passing the other end of the liga-ture through the corresponding part ofthe opposite flap ; a second ligature wasnow passed on the right side, a little abovethe first; but on piercing the oppositeside of the fiss1J.re, the curved needlesnapped in two (an accident which islikely to occur in this operation) ; M.Roux immediately withdrew the ligaturewith one portion of the needle attached toit, and having discovered the other end atits insertion, withdrew it also; he thenintroduced another armed needle, whichwas carried through both flaps withoutany difficulty. The third ligature was ap-plied at the superior extremity of the fis-sure ; the first stage of the operation was

thus gone through, and the patient allow.ed to rest for a few minutes. In the secondstage the operator commenced by paringthe edge of each flap, in order to form awound calculated to heal by the first in-

tention ; for this purpose, having seizedthe lower end of the right flap with a dis-secting forceps, he cut a small portionwith the curved scissars, and then paredoff the edge as far as the upper extremityof the fissure; the edge of the oppositeflap was resected in the same manner;the patient was again allowed to rest for afew minutes, and after she had rinsed hermouth once or twice with cold water, M.Roux proceeded to terminate the opera-

tion by tying the ligatures. Commencingwith the lowest one on the right side, hedrew the ends of the thread gently toge-ther, and having formed half the knot,directed an assistant to hold it tightlywith a forceps until the complete knotwas finished ; the other two ligatures weretightened in a similar manner. The endswere now cut off ouiteclose. and on ex-

amining the patient’s mouth the fissure wasnearly quite closed; the patient herselfseemed composed, and a change had al-

ready taken place in her voice, which wasnow distinct. She was directed to observestrict silence, and an absolute abstinencefrom all kind of food and liquid was en-joined ; she was even desired not to swal-low her saliva. Nourishment was admi-nistered in the form of lavements composedof soup and yolk of egg.

18. The patient is tolerably well, al-

though she had not slept during the night;the edges of the wound are in perfect ap-position ; abstinence and lavements, as

commanded yesterday.19. Going on well; slept some hours

during the night; the wound in a favour-able state; same treatment to be con-

tinued.20. No unfavourable symptom.21. This morning the patient, who was

going on well, was allowed for the firsttime a small cup of soup, to be swallowedslowly, and a teaspoonful at a time ; no-

thing else to be taken by the mouth duringthe rest of the day.

22. The ligatures were cut off with apair of scissars, when the lips of the fissurewere found in perfect apposition; previousto their removal a small cup of soup was

given to the patient with the same pre-cautions as yesterday.

23. It appears that after the visit ofyesterday the patient experienced consi-derable nausea, and vomited some viscidsecretion, mixed with blood. This morn-

ing, however, she feels tolerably well, andthe wound is in a satisfactory state, though

it had given way to a trifling extent at the

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upper part. M. Roux observed, that this fwas one of the bad effects of strict absti- I

nence in an -individual previously enjoy-ing good health, and accustomed to takeregular nourishment. However, it was Ian indispensable part of the treatment, forthe mere act of swallowing the saliva Iduring the first four days, would be suffi-cient to disturb the ligatures, and frustratethe hopes of both patient and operator.

24. Since yesterday the edges of thewound have been gradually separating,and to-day the fissure appears to be com- Ipletely re-established. M. Roux proposesto operate again in a few weeks.From the account given of the pre-

ceding operation, it may be seen that M.Roux divides it into three parts; in thefirst he introduces the needles and liga-tures ; in the second he pares the edges ofthe fissure ; and in the third he tightens Ithe ligatures. The process of M. DIEF- lFENBACH equally comprehends three pe- iriods, but as it differs considerably from ithe one employed by M. Roux, and is,moreover, incorrectly described in mostworks on operative surgery, we shall takethis opportunity of comparing it with theforegoing one, at the same time giving atrue account of the method as describedby M. DIFFFEN)3AcH himself during hisvisit to Paris.We may commence by remarking, that

Roux first introduces his needles, andthen pares the edges of the fissure, whichhe does by seizing the posterior edge ofthe velum with a forceps, clipping a bitwith the curved scissars, and then con-tinuing to refresh the edge with his bis-toury. DIEFFENBACH, on the contrary,does not place the ligatures until he haspared the edges of the fissure; and ob-serves, very justly, that the operation, ac- Icording to M. Roux’s method, is more,

long and laborious, because when the ve-lum is pierced for the first time by theneedles, it becomes very irritable, retracts,and gives rise to an effusion of mucus andsaliva, mixed with blood, which embar-rasses the operator in his attempt at paringthe edges of the wound, a most essentialpart of the operation. Instead of the

forceps which M. Roux employs to seizethe velum palati, the Berlin surgeon fixesa hook in the posterior edge of that part,and then passes a small-pointed bistourythrough the middle velum, with which hecuts at first backward towards the hook,and then turns the edge of his knife for-wards, and cuts to the hard part. Thesame is done for the opposite side of thefissure, and the result gives a V-shapedwound, which is afterwards brought to-

gether by the sutures. From the more

steady manner in which M. DiEFFt; zij3.-cu

fixes the velum palati, he is enabled toperform this part of the operation muchmore accurately and quicker than M.Roux.The two surgeons also differ consider-

ably in their choice of needles and liga-tures. The needles of M. Roux are

curved, armed with a thread ligature, andintroduced with a straight porte-aiguille.Here again we conceive the process ofM. DIEFFENBACH has the advantage overthat recommended by his rival; the Berlinsurgeon employs ligatures composed ofleaden wire; these are mounted by asmall sharp lance-head of steel, and arethus passed through the edges of thewound by means of a porte-aiguillecurved near its extremity. By this mo-dification M. DIEFFENBACH avoids therisk of breaking his needle (an accidentwhich occurred in the operation we havereported) ; he also conceives that the

straight is more easily passed through theflesh than the curved one; and, finally, heobtains the positive advantage of being ableto tighten his ligatures, by the simplemanoeuvre of twisting the two ends, andof again tightening them at a future periodshould one point become loose, as it oftendoes.

j But the most remarkable difference be-tween the two processes remains to benoticed; after the leaden ligatures havebeen placed, twisted, and the ends cut off,M. DIEFFENBACH plunges his bistouryinto the velum palati on one side of thesuture, and makes an incision, of a fewlines in length, parallel to it; he does thesame on the opposite side, and the two inci-sions are immediately converted into twooval holes by the dragging power of the su-tures. The object of these lateral incisionsmay.be readily conceived; they relieve thetension of the parts, permit the edges ofthe wound to remain in more perfect con-tact, and allow the passage of the salivaor even nutrient fluids. The forced ab-stinence of the patient in M. Roux’s lastcase was probably the cause of the opera,-tion having failed.

CORRESPONDENTS.

Several communications among thosewe have received shall be inserted as soonas we can find space far them.

i The " testimonial" of Mr. H. Y. isof no use. He will find himself compelled,however reluctantly, to institute proceed-ings in the Court of King’s Bench.

Complaints continue to reach us rela-tive to the non-publication, by Messrs.