ATTACHMENT OF THE PALATE TO A DENTURE. 257

cate boundary wherever it comes in contact with movable. tissue.

Such a palate may be made in a mold by substantially the same process as hereafter described. (See page 301.) It may be secured to the plate by a variety of simple means. One which will give as little trouble to the patient as any other is to make a series of small holes along the edge of the plate, and stitch it on with silk, or fine platina, gold or silver wire may be used. It is desirable in such a case to have

the plate and palate present a uniform surface on the lingual side. In fitting the plate, therefore, it may be raised along the posterior edge from the sixteenth to the tenth of an inch, according to the thickness of the palate desired. The rubber will thus be placed on the palatine surface of the plate, and present uniformity on the lingual surface.

A little thought will show that in this case the patient must educate the muscles of the pharynx alone to do the work of shutting off the nares, which in the former case was performed by them in conjunction with the muscles of the palate. Perfect articulation will depend upon the suc

258 THE IMMEDIATE EFFECTS UPON ARTICULATION.

cess of the patient in this new use of these muscles. In cases of acquired lesions of the palate, such as are under consideration, this education of the muscles to a new work will not be difficult. The patient at some former time has had the power of distinct articulation; his ear has recognized in his own voice the contrast between his present and his former condition; the ear will therefore direct and criticise the practice until the result is attained. It is astonishing to what an extent muscles may be trained in this way to the successful performance of an unnatural function. In the case illustrated by Figs. 176 and 177 the defect had existed for twenty-eight years, the patient at the time of the introduction of the artificial palate being nearly fifty years of age. The effect upon the speech was instantaneous. Articulation was immediately almost as distinct as in youth; and this remarkable distinctness can only be accounted for upon the assumption that the pharyngeal muscles had undergone a thorough training in the vain effort to articulate without a palate.*

These two cases, chosen to illustrate the application of artificial palates in accidental lesions, required, as will have been perceived, entire upper sets of artificial teeth in connection with the palates. This selection was purposely made because the difficulties to be overcome are much greater. In cases where there are natural teeth remaining in the upper jaw, the palate and its connection with the plate would be substantially the same, and the plate could easily be secured to the teeth by clasps in the same manner as a partial denture.

* An account of this case appeared in the "Argus," of Bainbridge, Georgia, August 1, 1868, written by the patient himself, who was the editor of that paper.

CHAPTER XI.

HISTORY OF ARTIFICIAL VELA.

THE history of artificial vela begins with M. Delabarre. In the last chapter a distinction was made between obturators and artificial vela, which must be kept in mind. The definite history of obturators goes back more than three hundred years, and that of artificial vela scarcely more than fifty; due, possibly, to the fact that there was no suitable material known, prior to the discovery of caoutchouc, of which a substitute for the natural palate could be made.

M. Delabarre was, in all probability, the first one who conceived and put into practical use a soft, flexible, elastic valve, which would fulfill to any degree the functions of a natural velum. The case was one of syphilitic origin of extensive character. The entire roof of the mouth and soft palate had been carried away, together with nearly all the teeth, necessitating a formidable apparatus, which was a combination of denture, obturator, and velum. The denture was made of mineral teeth mounted on a platinum base, and sustained in situ by a spring connecting with a skeleton frame resting upon the lower teeth; restoring, to a certain degree, the form of the lost structures, and not unlike, in its general contour, to the full upper denture of the present day. To the posterior edge of this denture he attached a velum and uvula of "gomme élastique" (India-rubber).

In reading M. Delabarre's account of this apparatus, he seems to have been more anxious to conserve deglutition than to restore the articulation of the voice. To this end he

260

DELABARRE'S "MACHINE."

devised a valve in the anterior part of his denture, which, by a system of compound levers, was connected on the superior surface with the velum and uvula, and operated by pressure of the forward part of the tongue. Fig. 178, copied from Delabarre's treatise, illustrates the instrument. A shows the valve in the roof, which rose up on pressure from below and was returned by a light spring. B B indicate two levers hung in the middle upon axes; the anterior end of the first

attached to the valve, and the posterior end of the second attached to the velum and uvula, so arranged that the motion of lifting the valve would be communicated to the velum and elevate that also. This "machine," as Delabarre calls it (the term being singularly appropriate when transferred to English), could only be operated by the tongue in a certain position, and therefore the machinery could not have been of any advantage in articulation, although Delabarre claims that the whole apparatus was of great benefit to the patient in

THE FIRST ARTIFICIAL PALATE (1820).

261

mastication, in deglutition, and "for the articulation of words." In the light of modern science we can not regard the machinery as of any advantage; the velum would, in all probability, have contributed an equal benefit without it. Such a complicated apparatus would be likely to become easily disarranged, and not of a very permanent character; therefore it is not surprising that we find no record of any attempt to make an application of it to other cases.

The object of this detailed description is chiefly to give a clear understanding of the first attempt to make an artificial velum. Granting that this experiment of Delabarre's was a complete success, its importance must not be overrated. The case was one of accidental lesion; and later experience has shown that a very simple and often a very crude appliance will restore articulation to one who formerly possessed that function. Nevertheless, to him must be accorded the credit of the first conception and practical application of the only material which could be adapted to a velum; and, although the caoutchouc of that day was a very perishable material, compared with the same substance as improved by vulcanization, his experiment laid the foundation of successful artificial vela, and, in all probability, encouraged Mr. Snell, of London, in his experiments made shortly after, and for which he claims complete success.

Mr. Snell makes the date of his construction of an artificial velum about 1823, and this is the first record I have been able to find of any effort to remedy the evils of congenital fissure of the palate by mechanism. All appliances made prior to that time were for accidental lesions, and congenital cases were considered as hopeless except by surgery, and even at that date the era of staphyloraphy was just dawning.

His first case was that of a young lady with fissure of both hard and soft palate along the median line, which does not appear in the record to have been complicated with harelip. He "obtained a correct model of the defective parts,