1835 The Lancet  
PARISON OF M. ROUX'S AND M. DIEF-FENBACH'S METHODS. CHARLOTTE ANNETTE, twenty-one years of age, was admitted into the hospital on the 12th of January, 1835, to undergo an operation for the removal of the above-mentioned deformity, which had existed from birth, and was accompanied with great difficulty of speech, imperfect articulation of sound, &c. On examining the patient, who in other respects enjoyed perfect health, M. Roux recognised a vertical division of the soft palate to the extent of
more » ... to the extent of an inch, and reaching nearly to the uvula. The patient consented willingly to the operation proposed to her by M. Roux, which he performed on the 17th in the following manner :-Having arranged the necessary instruments, which consisted of a porte-aiguille (something similar to a porte-crayon), used for seizing and inserting the ligature needles, a common dressing forceps, several curved needles, all armed with sutures of three or four waxed threads each, a narrow probe-pointed bistoury, a pair of curved scissars, &c., the operator placed the girl in a low chair, and took himself a seat opposite to her; the patient's head was held slightly backwards by an assistant ; one of the curved needles, seized in the porte-aiguille, was then passed with its ligature through the aperture in the palate, and introduced from within outwards into the lower end of the right flap of the fissure, at about a quarter of an inch from its edge; the needle having been made to pierce this portion of the palate, the operator seized it with a common forceps, and drew it out, together with its ligature ; a similar proceeding was adopted for passing the other end of the ligature through the corresponding part of the opposite flap ; a second ligature was now passed on the right side, a little above the first; but on piercing the opposite side of the fiss1J.re, the curved needle snapped in two (an accident which is likely to occur in this operation) ; M. Roux immediately withdrew the ligature with one portion of the needle attached to it, and having discovered the other end at its insertion, withdrew it also; he then introduced another armed needle, which was carried through both flaps without any difficulty. The third ligature was applied at the superior extremity of the fissure ; the first stage of the operation was thus gone through, and the patient allow. ed to rest for a few minutes. In the second stage the operator commenced by paring the edge of each flap, in order to form a wound calculated to heal by the first intention ; for this purpose, having seized the lower end of the right flap with a dissecting forceps, he cut a small portion with the curved scissars, and then pared off the edge as far as the upper extremity of the fissure; the edge of the opposite flap was resected in the same manner; the patient was again allowed to rest for a few minutes, and after she had rinsed her mouth once or twice with cold water, M. Roux proceeded to terminate the operation by tying the ligatures. Commencing with the lowest one on the right side, he drew the ends of the thread gently together, and having formed half the knot, directed an assistant to hold it tightly with a forceps until the complete knot was finished ; the other two ligatures were tightened in a similar manner. The ends were now cut off ouiteclose. and on examining the patient's mouth the fissure was nearly quite closed; the patient herself seemed composed, and a change had already taken place in her voice, which was now distinct. She was directed to observe strict silence, and an absolute abstinence from all kind of food and liquid was enjoined ; she was even desired not to swallow her saliva. Nourishment was administered in the form of lavements composed of soup and yolk of egg. 18. The patient is tolerably well, although she had not slept during the night; the edges of the wound are in perfect apposition ; abstinence and lavements, as commanded yesterday. 19. Going on well; slept some hours during the night; the wound in a favourable state; same treatment to be continued. No unfavourable symptom. 21. This morning the patient, who was going on well, was allowed for the first time a small cup of soup, to be swallowed slowly, and a teaspoonful at a time ; nothing else to be taken by the mouth during the rest of the day. 22. The ligatures were cut off with a pair of scissars, when the lips of the fissure were found in perfect apposition; previous to their removal a small cup of soup was given to the patient with the same precautions as yesterday. 23. It appears that after the visit of yesterday the patient experienced considerable nausea, and vomited some viscid secretion, mixed with blood. This morning, however, she feels tolerably well, and the wound is in a satisfactory state, though it had given way to a trifling extent at the
doi:10.1016/s0140-6736(02)96771-1 fatcat:izmhhqa5jbb2xijfyiaznljw6q