HARE-LIP.--This is due to the fact that the flesh or bony parts do not
quite properly unite. It may form a single or double hare-lip, or
complicated, or it may involve the soft parts, or the hard (bony) and soft
parts at the same time. It is always to one or the other side of the
middle line. It is double hair-lip in about one-tenth of the cases, and
when double it is frequently complicated with cleft palate.
Symptoms.--Upon examination you notice that there is a split in the lip,
either partly through the lip or entirely, so that the bone is exposed; or
the slit goes not only through the lip, but also through the bone.
Operation.--This is necessary, and it is quite successful. The best time
is between the third and sixth month, especially when it is a simple case.
In some cases of double hair-lip, when the child cannot take the breast
and has to be fed, early operation should be done if the child is strong.
The operation for a simple hare-lip is very easily and quickly done. For
complicated cases it takes longer, and of course is not without some
danger. It should be done, for a child is a pitiable sight with this
deformity. When grown up it is a source of great annoyance and shame.
CLEFT PALATE.--The bones that form the hard palate do not unite in the
median line and a longitudinal opening is left in the roof of the mouth.
This is called Cleft Palate.
Symptoms.--Of course, upon examination this split is seen. It may involve
not only the hard palate, but also the soft palate and uvula. It is then
generally accompanied by single or double hare-lip. When the severe forms
occur they cause great trouble. Fluids pass freely into the nose, and
unless the child is carefully fed by hand it will soon die, as it is
unable to suck. In the less severe forms the child soon learns to swallow
properly, but when he learns to speak he cannot articulate properly and
his voice is nasal.
Treatment.--For this reason an early operation is advisable, not so early
as for hare-lip, but before the child has learned to speak, say between
the age of three and four when faulty speech (articulation) may be
overcome by successful closure of the palate. When the operation is done
late, the patient will not be able to overcome the bad habits of
articulation acquired in his childhood.
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Operation.--The anaesthetic is necessary. The end of one-half of the cleft
palate is seized with an instrument and the edge freely pared with a thin
bladed sharp knife; same with the other half. Then the stitches are put in
of silk worm, gut or wire. The patient is fed on liquid food for three or
four days, and afterwards on soft food until the stitches are removed.
They are removed about the sixth or eighth day, and the wound should be
completely healed.
CROOKED FEET. Talipes.--There are many varieties. The treatment should be
begun, under the instructions of a physician, and continued from infancy
and many a good foot can be obtained.
KNOCK KNEE. (Genu Valgum).--This is due to an overgrowth of the internal
knuckle (condyle) on the knee joint, and curving inward of the shaft of
the thigh-bone (femur) in its lower parts, with relaxation and lengthening
of the ligaments of the knee joint.
It usually shows itself soon after the child begins to walk, but may not
do so until puberty,--rarely later. It is due in the child to rickets; in
the latter form, it is caused by an occupation that requires continued
standing, by a person of feeble development of the muscles and ligaments.
"Flat-foot" is often associated with it and, at times, may be the real
cause. It may affect one or both knees, may be so slight as to escape
detection, except upon a very careful examination, or so severe as to
separate the feet very widely and render walking difficult and wobbling.
In children other symptoms of rickets can generally be found. If not
severe it may often get better spontaneously as the rickets condition
improves and the general strength increases. This result is common in the
cases occurring later, from standing if the general condition improves.
Treatment.--Should be begun early and both general and local treatment
should be given. The quicker the treatment is begun, the quicker will be
the recovery and the deformity will be less. The ordinary medical and
hygienic treatment should be given for rickets.
Local Treatment.--This is mechanical, supplemented by baths, rubbing,
friction, electricity and preceded, if necessary, by attending to the
bones. If the rickets is still active, and the bones are soft and
yielding, standing and walking should be forbidden, the limb should be
straightened by manipulation and the correct position secured and
maintained by an outside splint and bandage. Sometimes operative measures
are needed.
BOW LEGS. (Genu Varum).--This is the opposite of knock knees, and the
deformity usually affects both limbs, the knees being widely separated.
The disease begins in early childhood; the cause is rickets, and the
deformity is the direct result of the weight of the body and muscular
action.
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Treatment.--Spontaneous recovery occurs; but if the case is at all severe,
and the child is young enough that the bones have not become firmly set in
the abnormal curves, mechanical treatment should be employed to bring the
limbs to a better position. This may be done by plaster of paris or
braces. This must be used intelligently and continuously. Children should
not be allowed to walk so early, especially those of slow development.
CLUB FOOT (Talipes).--Varieties: