Observations on cleft palate and on staphyloraphy / by W. Fergusson.

  • Fergusson, William
Date:
[1845]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on cleft palate and on staphyloraphy / by W. Fergusson. Source: Wellcome Collection.

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    bed. The latter part of the treatment has been acted on before ; and, in my estimation, the generous method of the distinguished Surgeon- General is worthy of consideration, especially as it has been followed by success, and also that the starving system, besides being occasionally followed by evil results, is that part of the treatment most distressing to the generality of patients. It will be observed, that the large vessels and nerves passing through the base of the cranium in this vicinity are all behind and above the incisions which I recommend. In meddling with the pillars of the fauces there cannot be the smallest danger; and if the knife be properly placed above the palate, there is nothing between it and the pterygoid plates of bone but the levator and the tensor palati. I have traced, after a good injection, the ascending pharyngeal artery passing forwards between these two muscles,—doubtless the same branch as that which has been already referred to in the dissection of the cleft palate, —but have not experienced any annoyance from bleeding from this quarter in the living body. It is well known that incisions in the mucous mem¬ brane will bleed more freely in some persons than in others; but all authorities agree that vexatious haemorrhage has never yet happened in any case of staphyloraphy, nor should I apprehend any from the pro¬ ceedings above described. The variety of wounds may seem objectionable, but I doubt if they equal in extent such incisions as have been advised by others. These, in whatever manner they are made, must doubtless increase the inflam¬ mation that ensues. In the first example where I put my own method into execution, a small slough formed on the posterior margin of one of the flaps, and the gap opened again throughout more than one half its extent. The result here might have been possibly occasioned in the manner alluded to, but it is more probable that it was in consequence of the patient being in an indifferent state of health at the time. Three months afterwards the part which had opened was again operated on : the edges of the fissure were alone meddled with, for notwithstanding the double paring, they could be approximated with the utmost facility. The immediate union was complete, with the exception of a very small chink in front, which has since contracted so much, that the point of a common probe can scarcely be passed through it. Entertaining, as I do, a strong feeling that the results of an operation are more valuable tests of its efficiency than any reasoning, however plausible, I shall for the present be satisfied to leave the estimate of these proposals to the consideration of my professional brethren who may feel interested in the subject.
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