Observations on the operative measures necessary in the treatment of hare-lip / by Richard G.H. Butcher.

  • Butcher, Richard G. H., 1819-1891.
Date:
1856
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the operative measures necessary in the treatment of hare-lip / by Richard G.H. Butcher. Source: Wellcome Collection.

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    other functions; it would only be to add to the annals of the art, descriptions repeated a thousand times since Celsus trans¬ mitted to us a methodical description of this affection. Having retained the child in hospital, and supplied nutriment as much as could be taken, on the seventh morning after his admission, the 18th April, I proceeded to operate, after the following man¬ ner. The child was rolled up in a sheet, mummy-wise, and laid in the arms of a nurse, seated upon a high chair, the head being steadily supported against her left shoulder by an assis¬ tant behind. Standing in front of the patient, I first proceeded to deal with the central piece in the following wayA tenaculum being struck into its inferior part, and traction made upon it, all its attachments were carefully divided from below upwards, from the osseous projection behind, with a narrow-bladed bis¬ toury, to such a point as to permit the tip of the nose to be elevated to the position it ought to occupy; the posterior sur¬ face then of this pendant double tubercle was thinned from behind, and its sides cut directly downwards in its upper half, while half the remaining portion was reserved in a triangular shape, the apex inferiorly; thus the tenaculum with the lower bit were cut out, from the sides of the upper half, reserved to form the septum of the nose. The bleeding was smart at first, but after a few seconds it ceased to give any annoyance. The prominent little tubercle of bone was nipped off, to permit the septum to rest evenly. The next step in the operation was to rectify the vicious direction of the gums, implanted into the widely separated maxilla; by the assistance of a wire pincers, the blades of which were flat, and covered with a couple of folds of shamois leather, I was enabled not only to turn back the dense fibrous structure, but to snap across the bone where it was attached. This proceeding was effected on both sides. I then rapidly freed the lip and ala of the nose on either side from the bone beneath, so as to permit of their being brought fully forwards. The incisions, to effect this object, were ne¬ cessarily very extensive. The knife during the separation of these parts was kept very close to the bone, so as to guard against hemorrhage from injury to any of the vessels supplying the cheek. The cleft lip was next pared, a tenaculum being introduced where the red border was most prominent in either half. The instrument on the left side was let rest in the hand of an assistant, while, taking that on the right in my left hand, and making the necessary traction upon it, downwards and in¬ wards, marking well the commencement of the eversion of the mucous membrane, I cut off the red margin from a point com-