In the severer cases it must not be forgotten that it is quite possible that some other factor is engaged in the production of the rapid wasting which in spite of every precaution may ensue, such as mesenteric tuberculosis, or some congenital intestinal or vascular defect. Whether such exist or not, the child quickly emaciates, the face becomes pinched and old-looking; the skin has an earthy appearance and hangs in wrinkles, lax and inelastic; and death, practically from starvation, soon ends the chapter. When our patient survives the dangers of infancy and arrives at boyhood or girlhood, the regurgitation of food through the nostrils ceases, except under occasional circumstances or in very severe cases; and although the difficulties of infant nutrition are often manifested in a much retarded growth, yet there is no reason why the physical constitution of the patient should ultimately suffer. Again, the knowledge of such visible and audible defects before operative treatment has been undertaken has a decidedly depressing influence upon the mind. The subjects of this deformity, from evident consciousness of their repulsive aspect, shun the observance of others as they grow older; and so strong is the sentiment which prevails as to maternal impressions that they are studiously avoided by women in the earlier stages of pregnancy. I have often noticed a distressed or hunted expression on the face of those who had attained to adult life before surgical treatment had been undertaken; and its disappearance after a successful operation has been equally marked.