A CONTRIBUTION TO THE SURGICAL LITERATURE OF THE COLORADO STATE MEDICAL SOCIETY; BEING TEN EXHIBITS, OR SOME BRIEF SUMMARIES OF SURGICAL WORK WITH RECORDED EVIDENCES OF SUCH.

BY W. R. WHITEHEAD, M. D., HONORARY MEMBER OF THE COLORADO STATE MEDICAL SOCIETY; FORMERLY

ONE OF ITS PRESIDENTS, ETC., ETC.

[NOW RETIRED FROM PRACTICE.]

With Numerous Illustrations.

Mr. President and Members of The Colorado State Medical Society:

One of the happiest reflections of my life, is that I am an honorary member of the Colorado State Medical Society; was formerly one of its presidents and have been thus, and otherwise much favored by you. In the young manhood and intellectual vigor of your membership I foresee a grand development of this society, far surpassing anything of which I have heretofore dreamed.

Moreover, your capacity and willingness for work is the surest presage of your development as a great medical organization to influence for good the future of this Commonwealth.

Says Thomas Carlyle in his little book called, "Past and Present,"* "The only happiness a brave man ever troubled him

*Book III, Chapter IV.

self with asking much about, was happiness enough to get his work done."-"Behold the day is passing swiftly over, our life is passing swiftly over; and the night cometh when no man can work;" and Carlyle asks these awful questions of us, all: "What hast thou done and how?" * "Where is thy work?"

* * * "Swift, out with it, let us see thy work!"

Sirs, in offering this contribution, probably my last, to this society as a part of its literature, I feel how far short of a proper exhibit of work it is now my honored privilege to proffer you, as compared with exhibits which in the future will illuminate the pages of your "Transactions" from the bright minds of your young and active members, urged to laudable efforts by new methods and new inspirations.

EXHIBIT ONE.

OPERATIONS FOR CLEFT OF THE HARD AND SOFT PALATE; SOME OF THEM FOLLOWED

BY THE GROWTH OF NEW BONE

IN THE PALATINE VAULT.

The operation for a cleft palate, which involves both the hard and soft palate, is a formidable, difficult and tedious one, and requires the use of ether and of a gag. Failures are not uncommon, nor are successes frequent. The beautiful anatomical principles of this operation were first published and conspicuously given to the world by Langenbeck of Berlin; but some important modifications in its operative details, and a number of more convenient and useful instruments for its performance, are the invention of the writer, whose operations for cleft of the hard and soft palate have not been numerous, yet the number of his recorded cases exceeds the number of successful cases on record of any surgeon in America.

It is very sincerely, with no boastful spirit whatever, that this statement is made, which can be easily verified, but truly with

a most regretful feeling that this beautiful, useful operation has not been generally understood, and has probably met with disfavor solely from the inconsiderate attempts to perform it without due study and preparation to master successfully its anatomical and surgical details; especially by dissections and studies of the palate muscles on the cadavre.*

My operations for cleft palate have been published in some of the prominent medical journals of this country, for a reference to which, see note below, giving some information concerning the bibliography of this subject, to whom it may interest and is put in very small type, so as not to be obtrusive.

NOTE. Bibliography: American Journal Med. Sciences, July, 1868: my first case of muco-periosteal uranoplasty: Ibid Oct., 1868, a long article

*NOTE. In the dissection of the prevertebral region the separated front part of the skull containing the face, larynx, pharynx and palate muscles, is usually put aside for the subsequent study of the palate region. This part I have several times secured to a block of wood with nails in a way convenient for dissection, and a few times have made, with knife and chisel, a sort of artificial cleft-palate on the cadaver, and thus pursued my studies of this region. See Heath's, or any other good, practical Anatomy for further details of the study of the palate muscles.

of about 28 pages on this subject, and following are references to authors given in that article: Of the German publications alluded to below, the writer was aided with the German text by Dr. Van Gieson of New York. In the American Journal Med. Sciences, July, 1843, p. 257, is reported the successful case of uranoplasty of the Boston surgeon, J. Mason Warren.

In the Medico-Chirurg. Trans., Vol. XXXIX, at page 71, allusion is made to Pollock's efforts.

For Baizeau's tentative operations, similar to those of Pollock in the restoration of acquired defects of the palatine vault, see Memoire sur les perforations et les divisions de la voute Palatine, Arch. Gen'l de Med. Decembre, 1861.

Arch. fur Klin. Chirurg. II Band Erstes und Zweites Heft, Berlin, 1861; translated into French in Arch. Gen'l de Med. 5 eme Serie, tome 19, pages 271, 567 and 709, refers to Langebeck's successful operations. This was the writer's first source of information concerning Langenbeck's operations. Some of the details by the French translator are not at all clear.

For reference to the reproduction of bone, I have referred in my article of Oct., 1868, to the following: "De l'Evidement sous-Perioste des Os," p. 52, Paris, 1867, by Sedillot, also to Ollier's work: "Traite Experimental et Clinique de la Regeneration des Os, et de la Production artificielle du Tissue Osseux," Vol. II, p. 474. Use was made of the two works last named in an account of my practical studies of the reproduction of bone in rabbits, as shown in my article read before the New York County Medical Society, March 21, 1870, published in the New York Medical Journal of the same year, entitled, "Remarks on the Reproduction of Bone," and copied in full in the Edinburgh Medical Journal a few months later. V. Band Arch. fur Klin. Chirurg: A second and more extended article by Langenbeck is contained in this publication.

Now follow references to my own cases which are to be found, at least some of those published, in the following medical periodicals: New York Medical Journal, April, 1869; Transactions of the American Medical Association, 1869: expensively illustrated by the association; Medical Gazette, June 25, 1870, tablular statement of five cases, upon to May 4, 1870; American Journal Med. Sciences, July, 1871; Ibid, January, 1872; Trans. Colorado State Med. Society, 1877; Ibid, 1887; Medical Record, August 7, 1886, etc.

It is well to add that the first attempt at a surgical operation for cleft palate reported, was in 1816 by Graefe of Berlin for a cleft of the soft palate only. He failed. The first successful attempt, also a small cleft of the soft palate only, was afterwards made by Roux of Paris on the person of a young Englishman, Dr. Stephenson, who read the report of his own case before the French Academy of Medicine. The remarks in this exhibit of cases concern cleft of both the hard and soft palate.