In the _tertiary_ stage the disease usually commences as a gummatous infiltration of the periosteum of the hard palate, resulting in an inflammatory swelling which softens and breaks down, the mucous membrane over it giving way; portions of the bony palate are thrown off at a later date with the discharge, in the form usually of “crumbly” spongy sequestra of variable size. This process often extends beyond the palate to the bones of the nose, to the walls of the antrum, and to the alveolar border of the superior maxilla. After cicatrisation has taken place, apertures of varying extent are left bounded by dense fibro-cicatricial tissue, which in some measure tends by its contraction to diminish the size of the opening. Clear articulation is impossible under these circumstances. Similar conditions occur in _inherited_ syphilis, leading to destruction of the bony palate, but in these cases the disease usually extends downwards from the nose. The _treatment_ of these affections need not here be discussed in detail so far as regards the general means to be adopted. What we are chiefly concerned with is the question as to the possibility of surgical interference with a view to closing the apertures, so as to improve the speech and increase the patient’s comfort by preventing the regurgitation of fluids from mouth to nose, and the descent of nasal mucus on to the tongue. The result, however, of the experience of all surgeons tends to prove that in the majority of cases any operative interference is worse than useless, and is likely to increase existing mischief. The chief reasons for the want of success are (1) that so much loss of substance has already occurred; (2) that the tissue dealt with is cicatricial, and consequently of low vitality; and (3) that the constitutional condition of such patients is extremely unfavorable for plastic work. Although I have myself repeatedly attempted the closure of apertures in the hard palate, I cannot recall a single case in which complete success was attained when the operation was performed on middle-aged individuals. On the other hand, small holes in the soft palate can in many instances be successfully dealt with, and I should not hesitate to attempt the closure of a small opening in the hard, provided that there was a reasonable prospect of gaining sufficient tissue to be brought together without tension after paring the edges, and that no external manifestation of local or general disease was present. When any such operation is decided on, the only hope of success consists in an absolute freedom from all tension, gained by extensive lateral incisions. The application of lunar caustic or nitric acid for the purpose of closing small foramina is of doubtful utility on account of the feebleness of the tissues dealt with.