6. Operation for Congenital Fissure of the Soft Palate. By SETH SHOVE, M. D., Westchester Co.

A report of the following cases is submitted, believing they possess some points of general interest:

In the month of August, 1852, Enoch Ambler, of Lewisboro', aged 22, of good health and habits, and a firm and resolute disposition, called to consult me respecting a complete congenital fissure of the soft palate, which occasioned very defective articulation, difficulty of swallowing, and all the usual attendants of this serious malformation. Finding no deficiency in the bony structure, and other circumstances being favorable for an operation, I advised staphylorraphy. After removing each half of the uvula nearly at the base, and allowing the patient sufficient time to acquire the habit of holding his mouth open, and to allay the natural excitability of the parts by frequent touching and handling, the operation was performed in the following manner :

The patient being seated in a good light, with his head supported by an assistant, and his mouth well open, I seized the left side of the velum at the most depending part, by a common polypus forcep, (the best I had at the time) and with a probe pointed bistory, pared off a little more than a line of its margin, beginning at the lower border and carrying the knife, with a sawing motion, upwards and forward to the angle of the fissure, which extended quite to the bony palate. The right margin was then passed in the same manner. After all hemorrhage had ceased three ligatures were inserted by means of a simple hook, with a movable needle point, passed from behind forward, and drawn through with a forcep. These ligatures were tied by the Bushe's knot-maker.

The patient was more restricted in regard to food and drinks than I should advise in future, and on that account, doubtless, suffered much from restlessness and fever.

On the fourth day a small slough appeared around the middle ligature, which was removed at once, and the two remaining ones on the fifth and sixth days, when the union was found to be complete throughout, with the parts in fine condition, except a

round hole about two lines in diameter, occasioned by the slough. This I was enabled to close entirely in the course of three or four weeks, by repeated touches of the concentrated tincture of cantharides, as recommended by Dieffenbach.

The success in this case was complete. The patient now, after the necessary practice, enjoying all the usual functions of the parts, with a voice nowise distinguishable from the best.

On the first of February, 1858, Eliza Robinson, of Lewisboro', aged 19 years, presented herself for an operation for a broad congenital fissure of the palate, involving the entire velum, and the bony structure to the extent of about four lines in length and three in breadth. After waiting a sufficient time for the training of the parts, and recovery from a recent attack of intermittent fever, the operation was commenced by careful myotomy of the levatores palati and palato-pharyngei muscles, as suggested by Mr. Ferguson; and hoping to succeed in closing that portion of the fissure which extended into the palatine bone. I made a free incision upon either side, opposite to this point, as proposed by Dieffenbach. In this, however, I was foiled by the thinness and density of the parts covering the bone; and I was obliged to content myself with bringing the sides of the velum, previously excised in the usual manner, into exact contact by three ligatures, which were introduced by short curved needles, held in the forcep and tied without difficulty by the fingers alone; the first knot being held with a long, slender, curved forcep, in the hand of an assistant, to prevent slipping till the second turn of the knot was completed, and so with each, beginning with the uppermost first. The patient was allowed to take broths at rather long intervals, and advised to rinse the mouth with cold water, avoiding all motion of the parts as much as possible.

For two or three days she had troublesome cough, for which she took anodynes. The stitches were removed at the usual time, when union of the velum was found to be complete, leaving an opening between the posterior deficient angles of the bone, about four lines in length, by two in breadth. This opening I hoped to close by the tincture of cantharides; but failing after persevering efforts, I have at length resolved upon palatoplasty, as soon as the parts shall have acquired sufficient firmness. It should be observed that the improvement of the voice in this last case was not as great as might have been expected, probably owing to the small remaining opening, resulting from defect of the bony structure.

7. Case of Hydrops Sacci Lachrymalis. By JOHN BALL, M. D., Brooklyn, N. Y.

I have been induced to make a record of the case I now present, from the fact that it is one of very rare occurrence, it being the only one of the kind that has come under my observation among many thousands of cases of opthalmic diseases that I have treated in the public institution under my care, and in pri vate practice. And further, in relating this case to many sur, geons of large experience, I have not met with one who had any practical knowledge of the disease. And, besides, without going further into antiquity than the last century, I have consulted many authors, beginning with Ware, and his cotemporaries, and coming down to Guthrie, Jeaffreson, Morgan, Howard, Middlemore, Wat son, Tyrrell, Lawrence, M'Kenzie and others, without finding any accurate description of the disease. The most of them do not mention the disease at all, while some of them, and among them M'Kenzie, confound this disease with that of mucocele, and describe that disease under the title of mucocele or hydrops sacci lachrymalis, the name given to it by Beer. Schmidt describes both of these affections under the common name of varix of the lacrymal sac.

Lawrence, after describing what I would call true mucocele, speaks of another condition of the lachrymal sac, as described by Beer, where the distension of the sac has reached the size of a pigeon's egg; that, as soon as the swelling has attained the size of a bean, the integuments become of a livid red, the color growing deeper as the swelling enlarges; that it is quite indolent, and resists pressure; that the cavity is filled with a secretion like thick glue. But such a state of the sac, in respect to size and contents, he says has not come under his observation.

Now this last condition is what I would denominate true hydrops sacci lachrymalis,—a disease sui generis, independent of and distinct from that of mucocele.

I will now proceed to relate the case, of which the accompany, ing cuts give a very good representation, both before the opera tions and about three months afterwards.

In August, 1857, Mrs. J. W., a German lady, 34 years of age, living in New York city, consulted me in reference to two tumors, one below the inner canthus of each eye.

The one on the left side was nearly oval, and about the size of