The Sitting-up Position. (_See_ Fig. 49.) The object of this position is to diminish venous engorgement and bleeding in operations requiring delicate dissection in the region of the neck. Prof. Alexis Thomson introduced the position into Edinburgh surgery: the author was at first rather nervous of it, but has found that with proper precautions the patients do uncommonly well. Beyond all doubt, the position is a great help to the work of the surgeon. Not every surgical table is capable of giving the full position without the use of many pillows and sandbags. The head-piece of the table is tilted up at an angle of about 75° or even 80°, and the patient pulled up so that the flexion of the body occurs in the lumbar, not the dorsal spine. A small sand-pillow is placed behind the neck so as to produce slight extension. Another heavier one is placed under the thighs to prevent the body slipping down. A slight tilt downwards towards the head end may be given to the table as a whole with the same object. [Illustration: FIG. 49.--Sitting-up posture for operations on the neck.] One should not in this position attempt to induce a deep chloroform anæsthesia. Weak C.E. mixture at most, but better simply open-ether is the method of choice. The induction is begun with the shoulders raised to a modified degree, and the full position assumed in a light third stage anæsthesia. Intratracheal ether combined with this position is an ideal anæsthesia for the removal of goitre or extensive dissections in the neck for enlarged glands. O’Malley’s Position for Nasal Surgery. (_See_ Fig. 50). The author became acquainted with this useful position while acting as Anæsthetist at the Royal Herbert Hospital, Woolwich, where the Nose and Throat Department was under the charge of Major O’Malley, F.R.C.S. Major O’Malley was kind enough in a recent letter written by request to refresh the author’s memory of the details. [Illustration: FIG. 50.--O’Malley’s posture for intra-nasal surgery.] With the patient lying as shewn in the photograph, every part of the interior of the nose can be easily inspected by the surgeon; the elevation of the head and shoulders prevents undue bleeding, and such hæmorrhage as does occur goes down the gullet, where it does no particular harm, instead of into the larynx. The degree of flexion of the head upon the neck is not so extreme as to interfere with respiration. The details of O’Malley’s procedure are as follows:--