A treatise on harelip and cleft palate

Abstract

Congenital clefts and Gsures are the result of arrested development. Fusion of the globular and maxillary, and the palatal processes in the embryo is completed about the end of the third month of fetal life, so that interference with development takes place prior to that time and continues. Many causes have been given for arrested development, but none have been found to sufficiently explain its occurrence in all cases. The most important causes are faulty nutrition, heredity, and maternal impression. The influence of faulty nutrition has not been clearly proveId in t,he human race, as women who received the most liberal and nourishing diet during the entire period of gestation have frequently given birth to children with clefts. On the contrary, women who existed on the most meager diet and on one or two varieties of food during the entire period of gestation have given birth to perfectly developed children. In animals, especially the lion, the influence of faulty nutrition has been repeatedly proved in the zoological gardens of London and Dublin. The process of growth and developlment depends upon the formation of loops of blood vessels in the embryonic tissue, which become organized tissue. In defective vascular supply may be found a probable cause of arrested development and this would explain its occurrence in early fetal life and at the terminal distribution of the vascular supply. The vascu1a.r supply to the right half of the head is greater than to the left. This probably accounts for the most frequent occurrence of the clefts of the lips and alveolar process on the left side. The frequent occurrence of clefts in the descendants of those who had clefts and in members of the same family points strongly to heredity. In many cases the occurrence of the affliction does not take place until the second, third, or fourth generation. At present the influence of maternal impressions cannot be absolutely denied, but the mother will state positively, that she had not the maternal impressions during gestation, and in many cases where strong maternal impressions existed, the offspring was perfectly developed. Many eminent obstetricians have admitted the possibility of maternal impression being the cause. Clefts may be the result of syphilis. Such clefts should rarely, i.f ever, be operated upon, as union seldom takes place and the operation frequently results in increased destruction of tissue.