405

FOREIGN DEPARTMENT.

SURGERY.

Case of Perfect Union of a Congenital Divisionof the Soft Palate.

b- the November Number of Hecker’s

.Litterariaclae Annalen der gesammten Heil-

kunde, which we have just received, a caseof successful operation for the removal ofthe above named deformity is related byDr. Dieffenbach, of Berlin. An interestingaccount of the comparative anatomy of thevelum palati from the same pen, will befound in the 160th Number of THE LAXCET.

A description of Dr. Dieffenbach’s methodof operating was intended to have been

given in the succeeding week, but by someaccident it was omitted ; and as a referenceis made in the present case to that descrip-tion, it will be necessary briefly to mention

it in order to make the present operationintelligible.

The principal difference in piefi’enbach’smode of procedure from those recom-

mended by Graefe, Roux, Souchet, Jousse-lin, and Alcock, consists in the substitutionof a finely drawn lecid wire for the ordinaryligatures. It is necessary that the leadshould be as pure as possible; the wireneeds only be a little larger than a stout pin;and if used when recently drawn, it will befound just as yielding as a waxed thread.After the edges of the divided palate havebeen removed, which may be easily effectedby taking hold of each with a forceps andtransfixing it with a small cataract knife,as near the bony palate as possible, theknife is then carried onwards with a gentlesawing motion to the extremity of the uvula.The lead ligatures are to be introduced in thefollowing manner: the one extremity of apiece of the wire is screwed into the end of asmall needle about seven lines long, curveda little from its point to the middle, havingthree cutting edges, the concave surface

being plain : from the middle to the end it be-comes cylindrical and hollow, of the same sizeas the lead wire which is screwed firmly intoit by means of another screw in its cylin-drical portion. Being thus secured, theneedle is taken hold of with a pair of for-ceps, the blades of which, bent at rightangles, are just long enough to-embrace the

needle firmly, and to reach over the edge ofthe palate. The handles of the forceps aresufficiently long to reach to the deepestpart of the mouth. The needle thus held ismade to transfix the right side of the dividedvelum about two lines from its edge, and isthen taken hold of by a common straightforceps, and pulled gently out of the mouth.The other end of the lead wire, armed witha similar needle, is then introduced in likemanner on the opposite side. The gneedleshaving been unscrewed or cut off, the ex-tremities of the ligature are then twistedonce or twice slightly round, and put on oneside of the mouth until the other ligaturesare introduced. It is then recommended tocommence the closing of the edges of thevelum by twisting with a forceps the ends ofthe anterior ligature carefully around eachother, until the edges of the wound are

brought into contact. The twisted wiresare to be cut off within about a quarter ofan inch of the palate, and turned forwardupon the roof of the mouth. The second

ligature is to be managed in the same man-ner, and so the third, or as many as theremay be. Should the inflammation be so vio-lent as to cause great tumefaction of theparts, the ligatures may be untwisted tothe necessary extent to relieve the tension,without altogether setting the edges free ;and the wire may be again twisted tighterwhen the inflammation subsides. To re-

move these ligatures it is onlv necessary tocut the wire on either side above the twistedpart, when the whole ligature may be easilybrought away by a little lateral motion.The history of the present case is as fol-

lows :—The patient was a maiden lady,about 30 years of age, of a delicate consti-tution, who had from her birth a fissure ordivision of the soft palate. The operationhad been attempted by Graefe and othersthree times without success; but nothingintimidated, the patient applied to Dr. Dief-fenbach. The operation was performed inthe presence of Drs. Barez and Andresse,junior, in the manner before described, be-ginning on the right side. The hæmorrhagewas slight, and soon stopped by garglingthe mouth with cold water ; four ligatureswere then introduced at equal distances inthe way mentioned, and the edges of thefissure were brought into accurate contact.The patient was forbidden to speak or toswallow any thing for twenty-four hours ;during which time the mouth was orderedto be frequently washed out with elderflower tea, to clear it of its saliva.

For three days, the success of the opera-tion appeared doubtful ; the inflammationand fever were very considerable, but therewas no necessity to loosen the ligatures.On the fourth day the patient became veryweak, and was ordered nourishing enemata.

406

The mouth was washed out frequently withelder tea and honey of roses. On the sixthday, the inflammation had considerably sub-sided, and it was ascertained that union hadtaken place. The ligatures were cut throughclose to the palate, and easily withdrawn.After the ligatures had been removed, andthe mouth washed out, a little opening ofabout the size of a small pea was discoveredbetween the first and second ligatures ; butas there was no appearance of matter on

the edges, it was supposed that it wouldgradually diminish. After a few days thepatient was allowed to take her ordinaryfood, and soon acquired her usual goodhealth. The little opening just named,healed, however, very slowly ; four monthselapsed before it entirely closed, duringwhich time it was necessary occasionally totouch the edges with a strong tincture ofcantharides and other stimulants.

Since her recovery, the patient has beenseen by llust and Hcim, two of the princi-pal practitioners in the Prussian capital.

NOUVELLE BIBLIOTHEQUE MEDICALE,

OCTOBER, 1826.

Researches on the Immediate Seat of Inflamma-tion. By M. CRUVEILHIER, Professor ofAnatomy, Paris.

EvER since the doctrines of Brown and hisfollowers ceased to exert their iniluence onmen’s minds, or, in other words, from thetime that hypothesis and speculation havebegun to give way to observation, we findthat physicians have very generally adoptedthe opinion that the greater number of dis-eases are either directly inflammatory intheir character, or the consequences of in-flammation, instead of being, according tothe dogma of the Brownists, indices of de-bility in the system, or produced by debili-tating causes. Innammation, then, has longengaged the attention of inquirers, and manyhave discussed, at length, questions tendingto elucidate its seat and nature, the con-dition of the vessels of the part, whe-ther the blood Bowed faster or slower thanusual, &c. &c.

Whatever difference of opinion mighthave existed on these topics, still all were

agreed in considering the capillary arteriesas the immediate seat of the derangement,be that what it may. M. Cruveilhier, how-ever,is decidedly of opinion that the imme-diate seat of inflammation is in the capillaryveins, and this position he proceeds to

establish by proving : ist, That in every in-liamniation it is the venous radicles thatare esyeciatly affected. 2d. That the inflam-mation of these radicles constantly givesrise to all the phenomena attendant on in-flammation.

In order to be assured of the truth of thefirst position, it is only necessary to examinewith attention any inflamed texture, whe-ther cellular, adipose, serous, or mucous,and it will (says the Professor) be at oncemanifest, that in all cases the inflammatoryredness is seated in the minute veins,Moreover, when inflammation seizes any ofthe accidental textures,* such as cancer ormelanosis, the veins become enlarged, aswe see particularly in soft cancer or en-

cephaloid.If acute ophthalmia be examined at its

commencement, during its increase or at itsheight, we shall see the veins gorged withblood, and their capillary branches (whichare imperceptible in the natural conditionof the part) injected and distended; if theinflammation becomes chronic, or if it re-curs frequently, the veins, no longer able toreturn to their original condition, remain asit were varicose, and so become a mechani-cal impediment to the movement of the

eye-ball, and to a certain extent an excitingcause of inflammation by the irritationwhich they keep up in the part. The dila-tation of the veins has been usually at-tributed to an increased activity in the arte-rial circulation, which produces a passivedistension of the veins ; but in this case theeffect has been mistaken for the cause.

This permanent dilatation of the veins re-maining after inflammation, is not connnedto the membranes of the eye ; it occurs alsoin other inflamed textures ; and this per-sistence of their dilatation affords a readyexplanation of that circumstance so longknown, so generally acknowledged, viz. thatparts once inflamed are exceedingly liableto take on that condition again. The tex-tures most abundantly supplied with veinsare the mucous membranes ; they are there-fore, according to M. Cruveilhier, particu-larly prone to take on inflammatory action.When the lining membrane of the tracheaand bronchi is inflamed, the veins are ob-served disposed in meshes, enclosed one

within another ; from these, small branchespass off, which terminate in larger veinsplaced in the interstices between the ringsof the trachea.When inflammation occurs in the mucous

membrane of the intestines, this con-

dition of the veins is strikingly manifest;and if ulceration takes place, it is the

* These are called by M. Cruveilhier" tissus degénérés," thereby evidently con-sidering them to arise from a degenerationof the part in which they occur, and not anew formation : this opinion he long sinceadvanced in his work on Pathology ; we

thought it was not likely to be again re-vived.