2. Forcible repression of the incisive bone by seizing the projecting tubercle at its extremity and violently forcing it back, fracturing the bony processes which support it. This proceeding, which was introduced by Gensoul of Lyons, rests on the theoretical hope of simply fracturing its pedicle at its narrowest part without giving rise to much hæmorrhage, or to laceration of the mucous membrane. But anatomical facts are opposed to such a probability. The vomer, we know, is usually thick and hypertrophied in these cases, and the line of fracture will probably be far back, and may very possibly extend to the cribriform plate of the ethmoid and base of the skull. The mucous membrane, moreover, is liable to be severely lacerated and the hæmorrhage considerable; Sédillot[80] sums up the proceeding as “peu sûre, difficile toujours, et impossible souvent.” But few cases of success are recorded, and from its uncertainty one may dismiss it as unscientific and unjustifiable. 3. Repression after excision of a wedge-shaped piece of the vomerine plate immediately behind the os incisivum (Blandin’s method).[81] This only applies to cases of complete double cleft where the vomer is unattached to either palatal segment. Using strong scissors, M. Blandin cut out a 𝖵-shaped portion of the vomer, the anterior incision being vertical and the posterior oblique. The median tubercle could then be easily replaced. The great objection to this method, however, is the severe hæmorrhage which is liable to ensue from the divided anterior palatine arteries, and, in fact, M. Richet reported three cases in the ‘Société de Chirurgerie,’ in 1856, in which he had performed this operation, and all with fatal results. A much better plan is that which was suggested, in order to avoid such mishaps, by Bardeleben.[82] He incises the mucous membrane along the lower border of the nasal septum behind the os incisivum, and then strips up the mucous membrane and periosteum by means of a narrow-bladed raspatory. The septum may be either divided with cutting pliers and the projection thus reduced, or being grasped by a pair of sequestrum forceps, the blades of which are protected by gutta percha, may be diminished in length by being forcibly twisted upon itself. The effect of either of these proceedings will be to cause the two portions of the vomer to overlap, a matter of little consequence, whilst the operation being subperiosteal, but slight hæmorrhage occurs. The results of this method of treatment seem to have been fairly satisfactory. The late Mr. Butcher[83] designed certain ingenious instruments for “cutting through the projecting pieces in complicated harelip without dividing the soft parts,” or interfering with the vascular supply from behind previous to bending them back.