. The diseases of children : medical and surgical. arently been lost in the cleft. Rotation of PrcBmaxilla.—Very frequently there is some rotation ofthe prsemaxilla upon a vertical axis, especially in unilateral cleft ; in suchcases the teeth are also rotated and may be so directed that the outer border,or in some instances the cutting edge, looks directly forwards. This positionof the teeth requires to be remedied after their complete eruption. As, how-ever, hare-lip is now usually operated upon before the teeth are cut, theirexact position is in such cases of little importance at the time. F
. The diseases of children : medical and surgical. arently been lost in the cleft. Rotation of PrcBmaxilla.—Very frequently there is some rotation ofthe prsemaxilla upon a vertical axis, especially in unilateral cleft ; in suchcases the teeth are also rotated and may be so directed that the outer border,or in some instances the cutting edge, looks directly forwards. This positionof the teeth requires to be remedied after their complete eruption. As, how-ever, hare-lip is now usually operated upon before the teeth are cut, theirexact position is in such cases of little importance at the time. Feeble Vitality.—The deformity of simple hare-lip unaccompanied bymalformation of the palate is important almost solely on account of thedisfigurement, though it must be borne in mind that many of these childrenhave other deformities or are weakly, and, though without any actual malforma-tion, do not seem to have sufficient vitality to make it possible to rear them. When, however, the failure of the union affects the palate as well as the Fig 24.—Severe Double Hare-lip. Showing the projectingpraemaxilla. 168 Diseases of the Digestive System other ill results follow; the child is unable to suck from inability to producea vacuum in the mouth ; its nasal passages and pharynx are exposed to theair and become affected with chronic catarrh, its tongue is dry and the airentering its lungs is imperfectly warmed. Even when fed with a spoon thefood often regurgitates through the nose. Hence to the already weakly con-dition of the child are added the dangers of insufficient nutrition and catarrhof the respiratory tract. It is not, therefore, to be wondered at that only asmall proportion of children so affected survive ; should they do so, they aresubject to the further drawback of imperfect and indistinct speech. It isalleged that many of these children die from starvation, which might beprevented by operation ; we do not think this is true ; we believe they woulddie in any cas
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