The usual method that I am accustomed to adopt for cases of simple unilateral harelip is as follows:—Standing behind the patient’s head, and my assistant holding the right side of the lip between the finger and thumb of his right hand, so that the index finger is in the mouth, and so holding the lip forward and inward at a sufficient distance from the margin to enable me to remove the requisite amount of tissue without difficulty, I enter the knife with its edge downwards either at the apex of the cleft, or in a complete case at the margin of the nostril as high as desirable, and cut in a curved direction downwards until the muco-cutaneous junction is reached. The edge of the knife is then turned so as to cut through the mucous membrane of the lip in a direction practically at an angle of 60° to the former incision. Then grasping the left side with my own left thumb and forefinger, and thus making it tense, I make an exactly corresponding incision, dealing with the muco-cutaneous margin and mucous membrane in a similar manner (Fig. 46 A). Having approximated the edges and fitted them together, we are now ready to undertake— [Illustration: FIG. 46 A.—Author’s method of preparing edges of cleft, showing semilunar incision as far as red margin of lip, and oblique upward cut on either side to form the prolabium. FIG. 46 B.—Shows flaps in position, and the nostrils symmetrical. The wide stitch lines represent the position of the wire sutures, the narrow those of the catgut.] STAGE III.—_Union by Sutures and Application of Dressing._ Many surgeons still retain the plan first introduced and figured by Ambrose Paré[74] of uniting the edges by means of harelip pins and figure-of-8 sutures; but this has been largely superseded by the use of silver wire and intermediate fine sutures. Good results undoubtedly followed the old plan of treatment, and it had the advantage in pre-anæsthetic days of being more rapidly accomplished. But success could not be depended on for the following reasons: it was more difficult to adjust the edges with exactness, and the muscular movements of the lip were liable to cause them to slip, and being hidden by the coils of superjacent suture the displacement was undetected until the removal of the pins. Moreover the track of the pins, especially if they were retained beyond the fourth day, was liable to become the seat of suppuration, and unsightly cicatrices resulted. In some instances the pins cut their way out of the lip, leading to still more evident cicatricial deformity, and the liability to septic infection of the wound was of course much greater. At the same time I have no desire to detract from the one great and acknowledged advantage of pin-transfixion and figure-of-8 suture, viz. the steadying and accurate approximation of the deeper parts, when efficiently inserted; but I maintain that the same advantages can be secured by the use of silver wire as detailed below.