J. Fayrer
1874 The Lancet  
580 1 have operated at various ages, and although I am far from believing that it is necessary to wait until the age of fifteen or sixteen, yet I cannot but think that at the present day we are apt to go to the other extreme, by operating too early in life. Take this child as an instance. Through ignorance solely he did not carry out the necessary instructions to give the palate the best chance of uniting. He was constantly craving for food, and at times was very troublesome. You must have
more » ... You must have observed how cautiously he was fed, yet, notwithstanding the solicitous care that the attendants lavished on him, the parts suddenly gave way, from no other reason, I believe, than his failing, from extreme youth, to appreciate the importance of perfect rest and quiet. Every case must of course be judged on its own merits, but I venture to think the age of six or seven will, as a rule, be found to be as early as is compatible with the successful issue of the operation. Finally, there is one more case to which I should like briefly to refer. It is that of a strumous, unhealthy-looking girl aged about ten, who was in Alexandra ward. She had suffered some few years back from, probably, necrosis of the maxillary, palate, and nasal bones. At all events the disease is now quite cured, but she is left in a deplorable condition, for her nose is much flattened, and there is a large gap in place of the hard palate. The soft palate is perfectly normal, but the absence of the hard portion necessarily makes her articulate indistinctly. We frequently see cases of this kind, only in a minor degree, among the out-patients, and sufferers generally adopt the absurd practice of introducing a piece of rag, or other material, into the aperture, the effect of which is to cause by absorption the gradual enlargement of the opening. The voice is at once restored by this simple means, but it is restored at the expense of the bony palate. As a rule, these cases are not benefited by surgical interference. You can understand the reason of this if you renect that there must be a considerable difference in the chance of repair between a part which has been in a diseased condition, and whose vitality is thereby lowered, and a part which, although deformed, is yet in every other respect perfectly healthy. The case was not a favourable one for an operation, so I recommended her to have an artificial palate, and with this she will go through life without her neighbours being in the least aware of her condition. Time will not permit me to enlarge on other cases, but I hope to have the opportunity of speaking of them on a future occasion.
doi:10.1016/s0140-6736(02)42282-9 fatcat:5ibd7duvwvgh3czg6wlsr7fkma