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Irregularities of Form in the Newly-Born

bone, middle, head, upper, till, jaw and operation

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An irregularly shaped head is not infre quent as the result of severe labour, or the use of instruments, &c. It is frequently extremely elongated, perhaps badly flattened or pressed in at one side. No fear is to be entertained on this account. Within a few days the head will gradually return to the normal shape.

Tumours or swellings may exist on the back of the head or at other parts of the head. Spina Bifida is the name given to a tumour occurring at the lower end of the backbone, due to an arrest of the growth of the bone, alid protrusion of the membranes and other parts of the spinal cord in the shape of a bag. It is in many cases amenable to skilled treatment. Such swellings must not be interfered with by the mother or nurse. They are carefully to be guarded from injury or pressure. Spina bifida, is much less serious than the similar condition of the head, and children born with it may be otherwise well-formed and healthy. A pad should be carefully adjusted and fixed over the swelling so as to maintain all over it a moderate degree of pressure.

Defects in the Opening of the Bowel or Urinary Passages sometimes exist. They should at once be brought under the notice of the medical attendant.

or split-lip occurs on the upper lip, the split being on one side or other of the middle line, or on both sides. It is due to an arrest of development. For the upper jaw is formed by parts from each side growing inwards towards the middle line. They do not meet in the middle, but, in the gap left, growth takes place of an intermediate part which in time unites completely with the parts on each side, and thus the complete upper jaw is formed. This intermediate part it is which in the developed condition carries the four front teeth. Now hare-lip is an arrest of the growth at one period or another, the result of which is that ISmplete union is not effected at one or other side or at both. The split may involve the soft parts only, or it may extend through to the bone. In the most extreme cases the central part of the upper jaw, including the bone and soft parts con nected with it, is quite unnnited with the rest of the upper jaw at each side. Often this

central portion is projected forwards and up wards, standing straight out from the face, and sometimes it is so much twisted to one side as to block one nostril, out of which it seems to be sticking. In such cases the palate is cleft also, that is, the roof of the mouth is deficient in the middle line, owing to an arrest in the development of the bone, which should have grown forward till junction and complete union was effected in the middle line.

in slight cases only involves the soft parts at the back of the mouth, the uvula, &e. (Fig. 101, p. 195). As it extends forward it involves the bone, till in extreme cases the cleft passes from back to front. There is thus no separation between the cavities of the mouth and nostrils.

When hare-lip exists alone, bone union being •complete, the deformity is the only thing, and it can easily be remedied by an operation, which will leave little or no hint of the original con dition. But when it is associated with non union of the bone it interferes with suckling. This may sometimes be remedied by the mother using a nipple shield with a large nipple. When, however, the split is large and cleft palate also exists, suckling is impossible, and even feeding is very difficult. Cleft-palate may exist alone to a greater or less extent. In many cases it is not noticeable till the child begins to speak, and then it is recognized by the peculiar nasal "twang". Both conditions can be remedied by operations. For hare-lip the operation should be performed before teething. It is not attended by danger, and its results in improving the appearance are remarkable. For cleft-palate there is no haste, but it should not be delayed till the child has learned to speak and has acquired the "twang". It is not nearly so simple an operation as the former. In extreme cases the separation may be too great to permit of closure by operation, but a plate may be made to cover the opening.

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