of ammonia solution to a pint of water, or of rose water if the patient prefer it, is always advantageous, and may be used two or three times a day with great advantage. Even in cases where the saliva is not acid, but where there are carious teeth, the cavities of which are coated with an acid fluid, the same wash may be used, not only to prevent the rapid continuance of the carious attack, but in alleviation of that chronic irritation and pain which is so common an accompaniment of the condition described. Care should also be taken that the mouth is rinsed well after food, and especially after food of an acid or a saccharine description.

At the same time excessive friction with a hard brush should be avoided, as well as all dentifrices that mechanically injure. The carious tooth, in short, requires cleaning, but not polishing.

In medicinal treatment one is guided by the special signs of stomachic disorder. These are not capable of being described in detail in one lecture, and certainly not in a lecture which has, I fear, been too tedious throughout. But, in a general sense, the remedies required are of the alterative and tonic class. An occasional aperient if there is constipation; steel, in one or other of its forms, if there is anæmia; quinine if there is neuralgiac tendency. These are the remedies. They may be combined with the mineral acids in many cases with immense benefit, care being taken that, in the act of administration, the acid is not brought into contact with the tooth; or the quinine and iron may be given together without break in therapeutical laws, should the indications for the combination present themselves.

I have now, Mr President, a painful but a grateful duty to perform; I have to announce that this course of lectures is completed, and that our pleasant meetings are, for a period at least, at an end. Called suddenly to the performance of the lecturer's duty, and called to the exposition of subjects to which I had given no more special study than to any other branch of medical knowledge, I felt the labour embarrassing at first, and the result seriously deficient throughout. But as I have been supported by your patient attention, and even encouraged by your friendly receptions, I take the hope with me, that the effort has not been considered as altogether in vain. If to you these labours have been useful, to me not the less have they been valuable. Teaching little, I have acquired much, and amongst all present there is not one who has been more decidedly a learner.

PROFESSOR ERICHSEN'S LECTURES ON THE

SURGERY OF THE MOUTH AND JAWS.

ON Tuesday, November 8, Mr Erichsen gave his second lecture at the College of Dentists, on "The Surgery of the Mouth and Jaws," the attendance of members being unusually large.

The subject of the lecture particularly considered was the treatment of Cleft Palate, and the lecturer commenced by remarking that before entering upon it he wished to refer back for a moment to a point which he had omitted for want of time, in his pervious lecture on "Hare-Lip." He alluded to the questionWhat is the best age to perform the operation for hare-lip? There was great diversity of opinion amongst surgeons on this point, but all were agreed that the operation ought never to be performed during dentition. although all were not agreed as to whether it was better to operate before or after cutting the incisor teeth. On the one hand it is argued the child can go through the operation more safely after the appearance of the teeth, because it is older, and consequently stronger. On the other hand, however, the child becomes more intractable as it grows older, and the idea of danger (from convulsions, &c.) in the younger child is purely chimerical,-as is proved by the fact that far more serious operations are constantly being performed on infants, and therefore a very young child ought to be able to bear he operation for hare-lip. In his opinion the best time to operate was at about the age of six weeks, or rather from six weeks to three months, i.e, before the incisor teeth are ordinarily cut. Sometimes the entreaties of parents oblige the surgeon to operate earlier, and a child is indeed capable of bearing the operation during the first day or two of existence-he had himself performed it thus early. The objections were-1st, loss of blood; 2nd, laceration of tissue (which is almost unavoidable), and, as the vitality of a very young infant is generally low, loss of blood tends to render the operation less successful than at the age he had mentioned, namely, from six weeks to three months.

Passing to the operation for Cleft Palate, Mr Erichsen proceeded to explain that the malformation termed cleft palate was closely allied to hare-lip; it originated in a want of fusion between the maxillary bones on either side, and also of the intermaxillary bones. The fissures were shown to be variable in length as well as in width. Firstly, in regard to length of fissure (a point necessary to be noted in operating). It might be confined to the uvula, which would constitute a minor degree of malformation. It might extend to the velum pendulum (or soft palate.) It may extend to the line of union between

the superior maxillary bone, but not so far as the alveolar process; or it may extend further and implicate the alveolar process. This last is the most extensive degree of fissure, is generally accompanied with malformed incisors, and always with double hare-lip. In width the fissures likewise vary. In one case a fissure will only be linear, in another it will be so extended by the absence of the septum nasi as to render apparent a very large cleft. These clefts were described by Mr Erichsen as giving rise to considerable functional disturbance, as, for instance, to the infant in the act of sucking, the vacuum necessary to this act could not be produced with the roof of the mouth wanting. Then deglutition could not take place properly, because in deglutition the function of the tongue is to carry the food backwards against the palate to the back of the mouth, when the soft palate is inclined backwards so as to direct it into the pharynx. Persons affected with cleft palate were alike inconvenienced in taking solids and liquids; speech was also seriously interfered with through this defect, which rendered the pronunciation of many words impossible, or at least very imperfect. The letters c, s, z, for instance, could scarcely be articulated. Persons suffering from cleft palate were extremely liable to become breathless and to pant on the smallest exertion; this could not be readily accounted for, although an undoubted fact. The above inconveniences arising from cleft palate, Mr Erichsen continued, were those which the surgeon and the scientific dentist were called upon to remedy as far as possible.

In early life a spring compress (similar in principle to the truss), exerting pressure outside the cheeks from the posterior part of the head may be made available to gradually press the divided parts nearly together, but not entirely so. In many cases the scientific dentist may construct obturators so as to entirely block up the cleft. The best material of which such obturators are constructed were shown to be gold fitted to the palate so as to cover the orifice, and to have a piece of sponge affixed to the upper part of the palate, which piece of sponge should be shaped to the cleft. This kind of apparatus was shown to be perfectly efficient in preventing communication between the mouth and nose, forming, in fact, an excellent artificial palate.

Other metals besides gold were sometimes used in constructing obturators, as were also bone, gutta percha, and vulcanite, but gold surpassed them all in utility. With regard to artificial substitutes for the soft palate, ingenious attempts had been made to form them, but these could scarcely be regarded as having proved successful, although vulcanized india rubber had been employed with good effect in a limited degree.

Mr Erichsen then went on to explain the surgical operation for division in the soft palate, entering clearly and minutely into the anatomy of the parts, which, he said, should be well under

stood by the practitioner before attempting to operate. The soft palate was described as a curtain dividing the mouth from the pharynx, the position and functions of the muscles being particularly dwelt upon, especially those of the levator palati. Staphylarophy (as the operation is termed), had never apparently been thought of by the ancients, and it was only within a comparatively recent period that it had been practised, although this seemed a thing somewhat extraordinary.

The first operation for cleft palate ever performed was undertaken by a French dentist, M. Le Mounier, in the year 1764, who succeeded in paring the edges of the cleft, and uniting the parts by second intention. Little is recorded of Le Mounier, except that he is described by Robert as " un tres habile dentiste."

In 1817 Græfe, the German surgeon, attempted the operation, but unsuccessfully; two years afterwards, however, Roux, of Paris, practised it with such success upon an English medical student named Stevenson, that the latter read a paper on his own case before the Academy of Science. Since that time the operation has gradually come into general use.

The present mode of operating was to divide the levator palati, which paralyzed the velum, so that the edges having been pared can be brought together and kept so by sutures, without the ill effects of muscular tension. The stitches should be removed at the end of four or five days.

The operation ought not generally to be undertaken before the age of sixteen, as patients were seldom tractable enough to bear it earlier, and success depended in no small degree on tractability in the patient, as everything tending to disturb the parts had to be avoided. M. Roux had a very large number of cases on which he operated, but he was only successful in half of them, failures occurring principally from ulceration at the entrance of stitches and like casualties, before complete union had been established. The names of various distinguished surgeons who have, since Roux's time, given their attention to the subject were mentioned, and the improvements in practice introduced by them stated; these had reference principally to means adopted with the view of reducing, by longitudinal sections, the traction. Warren's efforts in this direction were prominently noticed, as were those of Mr Fergusson described to be the first surgeon who had reduced these incisions to a systemized plan—a plan founded on myotomy, instead of proceeding on the previous uncertain method of making irregular incisions. Mr Fergusson might certainly in some respects have been forestalled in practice, but he had as certainly not been forestalled in principle.

Mason

The remedy for clefts of the hard palate by surgical operation was then described by Mr Erichsen in lucid terms. He said that the operation was scarcely to be recommended to the affluent, who could afford to pay for efficient obturators, but to the poor the operation was undoubtedly valuable. There were

no muscular structures to interfere with the operation in the hard palate, the fibrous tissues and mucous membrane alone covering the bony arch. Mason Warren was the first to perform the operation for cleft hard palate, twenty years ago. With suitable instruments he pared the edges of the cleft, and then scraped down very carefully the tissues from either side until they united in the mesial line, and thus closed the cleft. The late Mr Avery devoted much attention to this subject, and in. vented many ingenious knives and other instruments suitable for the operation. More recently Mr Pollock has directed: professional attention to and has simplified the performance of Warren's operation.

The lecturer explained that his observations had reference only to congenital defects. The loss of bony palate by disease or accident could not be treated surgically with success; in such cases the only remedy being to have the apertures blocked up; a cicatricial tissue is not favourable to the operation, so that the patient must remain content with the use of an obturator. The same remark applied to a soft palate injured by disease-it could not be treated surgically.

When staphyloraphy has been successfully performed, the patient should carefully attend to the education of the voice. Correct enunciation must not be expected at once; a professor of elocution is generally found to give valuable assistance in training the voice. The soft and hard palates alike required a course of education after the operation. Mr Erichsen concluded by briefly alluding to the impossibility of speaking at so late an hour on the malformations of the lower jaw, which he purposed doing in his next lecture.

COLLEGE OF DENTISTS OF ENGLAND.

ELECTION OF MEMBERS.-Since our last announcement the following gentlemen have been elected by the Council, Members, and Associates of the College:

Members-Messrs. F. Bullen, Chester; F. Gibbs, London; W. Nightengale, Newcastle-on-Tyne; W. Penny, Lincoln; J. Shiels, Cork, Ireland; J. Shortt, M.D., Madras, India; J. Skerdon, Melbourne, Australia; and A. B. Verrier, St. Petersburg.

Associates-J. Driscoll, London; J. Greenfield, London; R. Halsey, London; and W. R. Wood, Brighton.