312

BENEFITS OF AN ARTIFICIAL PALATE.

language in youth than in maturer years, and for that reason it is better that all cleft-palate cases come under treatment at the earliest age admissible. With an instrument scientifically adapted to the peculiarities of each case, and a training by some one who understands the mechanism of speech, there is no reason why every youthful person with such a defect may not overcome it entirely within a few months.

CHAPTER XV.

BUCCAL AND NASAL PROTHESES.

UNDER the above head will be described certain appliances for the replacement of lost portions of the buccal or nasal structures. All artificial teeth might with propriety be included under the general term of "buccal protheses "; but, as their application and uses are so well known, the illustrations which follow will not embrace the ordinary restoration of dental organs and their associated alveolar processes. The necessity for such apparatus arises from the accidents and diseases to which the buccal and nasal organs are subject, and consequently nearly every prosthetic effort must be in a measure an original and unique one.

In all apparatus designed for internal use in either buccal or nasal cavities, there will be but little difficulty in finding materials which are applicable to the purpose; any of the substances used as a base for artificial teeth are suitable, and the choice will depend upon the peculiarities of the case and the judgment of the operator. The difficulties will lie in the construction, for which there can be given no definite instruction other than a perusal of the following described

cases.

The attempt at the replacement of a nose may be regarded as exceptional, for the reason that it is so conspicuous an organ that the appearance is of more consequence than the utility. There is no organ of the entire economy the loss of which creates such a hideous deformity as the nose, nor is the successful prosthetic restoration of any organ so

difficult. Artificial teeth, eyes, legs, hands, arms, etc., are all made so skillfully as to escape detection, but artificial The best of them, however artistic or appropriate in form, are but a poor imitation of the adjacent living tissue.

noses never.

At the present time there is no permanently durable substance known which has the color and translucency of flesh; and furthermore, the frequent changes in the complexion from variations of temperature, excitement, climatic exposure, etc., make the contrast of an artificial nose all the more evident. Various devices have been resorted to in the effort to overcome these objections.

In many respects wax, properly colored, forms the best imitation of flesh, but its objections are manifest, although it is sometimes used by those who are willing to put up with the trouble of constant renewals.

Celluloid has the requisite translucency, and possesses an advantage over wax in being firmer and more durable, but it is open to the objection that it is very difficult to perfectly match with it the adjacent complexion, and furthermore, in the author's experience, the substance changes in appearance under prolonged exposure to the weather; this can be partly overcome, however, by touching up the surface with suitably colored chalk crayons, whereby a very good effect may be produced.

The least satisfaction has followed the use of vulcanite, and painting the surface in imitation of the flesh. This I have done, and, although the nose was colored by an accomplished portrait-painter, there was no life in the organ, and the result was an æsthetic failure.

I think the most satisfactory thing of the kind I ever did was made of "rose pearl," a substance similar to celluloid, but much more difficult to work and not now easily obtained. This case is described on page 341.

There is no more appropriate place than this to describe an experiment with

AN EAR MADE OF CELLULOID.

315

AN ARTIFICIAL EAR.

I was applied to by a young man who had no external ear on the left side of his head, save a little rudimentary portion of the lobe. It was a congenital defect, and the absence was so conspicuous as to make him very anxious for an artificial one. I did not encourage the experiment, but yielded to his urgency.

A cast was taken of that side of the head, and upon it I modeled out of wax an ear to match in size and shape his natural one. This wax model was copied in celluloid. The artificial ear was secured at its lower end by a bit of gold wire passing down through the rudimentary lobe, and upon the upper and concealed surface were two spring-clasps, such as wig-makers use, by which it was caught to the hair. I succeeded in getting an excellent imitation of the opposite ear both in color and form, so that, when in position and the hair thrown carelessly about it, the falsity of the ear was unobservable. The change, however, which afterward took place in the color of the celluloid, together with the instability of the attachment, would hardly justify a repetition of the experiment.

PROSTHETIC TREATMENT OF A CASE OF HEREDITARY SYPHILIS.-In 1872 a miss fourteen years of age was brought to me by her mother, who said that the child had been for two or three years under treatment for a catarrhal difficulty, and that she had lost nearly all her upper teeth. There was no remarkable change in the expression or appearance of the face, other than that associated with the loss of the upper teeth. The upper lip was a little sunken, but no other feature seemed to be changed. An examination of the oral cavity showed three teeth only remaining in the upper jaw, viz., the first and second molars of the right side, and the second molar of the left side, while all the roof of the mouth, between and anterior to these teeth, was gone. The

316

EFFECTS OF INHERITED SYPHILIS.

situation at that time is well illustrated in Fig. 210. represents the inner or oral surface of the lip as it was pulled out and forward in taking an impression. The semicircle B B marks the dividing line between the oral and nasal cavities. This semicircular rim was soft, flexible, and elastic, devoid of bone or cartilage in any part except at its junction with the alveolar process which surrounded the roots of the remaining teeth. The soft palate, marked C, had not lost its integrity; the uvula and the superior pharynx were also undisturbed.

Neither were the bones of the nasal cavity destroyed. DD represents the vomer and turbinated bones, covered with thickened and puffy tissue, completely filling the nasal cavity, and hanging quite level with the original roof of the mouth, as indicated by the anterior edge of the soft palate C and the rim B B.

So completely did these enlargements fill the cavity, and shut off escape by the nostrils, that the voice was not interfered with in distinctness of enunciation more than commonly arises from a cold in the head. Not being alto