[Illustration: FIG. 55.—Sédillot’s operation for double harelip. _a a._ Prolabial flaps to form red margin of lip by union in middle line. _b b._ Incisions below alæ nasi to permit approximation of the above. _b′ b′._ Incisions in sides of central tubercle. (_Mason._)] The latter operation (T. Smith’s, Fig. 56) is only adapted to those rare cases where the soft tissues of the central tubercle are abundant. He turns down marginal flaps from this central part and implants them on prepared surfaces of the outer segments. The apex of the philtrum thus forms the central part of the united lip; hence there must not only be a tendency to depression of the point of the nose, but also great probability of a decided notch subsequently manifesting itself in the median line, when cicatrisation is complete. [Illustration: FIG. 56.—T. Smith’s operation for double harelip. The outer segments are pared and the parings removed. Prolabial flaps are turned down from the sides of the central tubercle. Evidently it can only be of use where the soft tissues are abundant. (_Mason._)] CHAPTER VI. OPERATIVE TREATMENT OF CLEFT PALATE. _Period of operation.—Preparation of patient.—Anæsthesia.—Duties of the assistant.—Instruments.—Description of uranoplasty; of staphyloraphy.—After-treatment.—Complications.—Modifications of operation._ The period of life at which an operation can be safely undertaken for Cleft Palate is a matter which demands careful consideration. Before the introduction of anæsthesia the assent of the patient was required, and therefore the operation was seldom performed before the age of puberty. With the aid of chloroform this is obviated, and we can now operate at an earlier period; undoubtedly as regards the subsequent power of articulation the earlier the operation is performed the better. On the other hand, the palatal tissue in infant life is so delicate, and the cavity of the mouth so small that a plastic operation is attended with more than usual difficulty. Further it is almost impossible to keep an infant sufficiently quiet to allow of primary union, as it is constantly interfering with the stitches by pushing the tongue against the wound, and sucking the edges apart. Statistics of results, moreover, tend to prove that such operations conducted on young infants are not only directly dangerous to life, but also indirectly, by depressing the general vitality and increasing the liability to subsequent disease. Thus Ehrmann[86] records ten cases operated on under two years of age with two deaths, two failures, and six cures, which latter he considers due to the fact that the children were fed after the operation by œsophageal tubes passed through a protective plate of hardened rubber so as to prevent interference with the sutures. Of these six cases cured, only one was living after four years had elapsed, and in this the soft palate only had been closed. He considers that the loss of blood, and the shock