2. That, under ordinary circumstances, the immediate operation is dangerous to life, and should only be undertaken in desperate cases as a means of saving it,[72] _i. e._ in double cleft of the lip and palate, where suction is impossible and swallowing difficult. 3. That experience shows that the sixth week may be taken as an average at which operations can be safely performed; but that if the child be very weakly, it is better to defer such treatment for a few days, until careful spoon-feeding has improved our little patient’s condition. 4. That association with cleft palate in no way invalidates the previous propositions. In many cases of slight cleft without alveolar complication the child is able to take the breast, and as it is desirable to maintain this after the lip has healed, care must be taken that the lacteal secretion is not checked. The child is often able to suck five to seven days after operation; during that period the mother’s milk must be drawn off by a breast-pump when necessary, and should be given to the child by spoon. Any mammary inflammation is thus avoided, and the child’s diet is not changed. In many cases of severe deformity, where the child is unable to suck from the first, an early disappearance of the milk has of necessity entailed spoon-feeding. When such an infant is taken from home into hospital it is well to wait for a few days before operating until acclimatised to the change of surroundings and of diet. The general state of health should be as satisfactory as possible, and every effort must be made to ensure this; it is often politic to defer operation on this account for a short period. Any aphthous condition of the mouth should be treated by swabbing with a weak boracic solution (1-40) or by the application of mel boracis. Anæsthesia is now-a-days invariably employed, chloroform being the agent used. Care must be taken by the anæsthetist to prevent any drop coming in contact with the wound, such an occurrence being liable to interfere with primary union. With regard to the position of the patient, some difference of opinion appears to exist. The practice adopted years ago and described by the late Sir W. Fergusson in his manual[73] consisted in the surgeon and nurse sitting opposite one another, the latter holding the child with its head on the surgeon’s knee. To quote his own words: “A cloth should be wrapped round the chest so as to confine the arms; a pillow-case answers the purpose well, as the legs can then be secured by slipping the patient into it. Then the child should be held by an assistant with its head resting face uppermost between the surgeon’s knees; if he puts on an apron of waterproof cloth, it will answer the double purpose of keeping his trousers free of blood, and preventing the child’s head falling too low; a little pressure with the thighs will enable him to keep the head more steady.”