of the prolonged operation or operations interfered in a serious manner with the vitality of the patients. These are, perhaps, somewhat scanty facts to argue from, but they tend to show that there is a greater risk associated with operations performed at an early period of life, although we have the authority of many well known surgeons for attempting them. Thus Billroth has operated at the age of four weeks, Roye of Lausanne at eight days; but my own experience is certainly in favour of deferring operation until the child is at least three years old, or as soon after that period as possible if it is at all of a tractable disposition; the moral control at this age is usually sufficient for our purpose. As to whether the whole cleft should be dealt with at one operation or not, the practice of surgeons differs considerably; and indeed each case needs to be decided upon its own merits. Where the cleft merely involves the soft palate, or possibly extends but for a short distance into the hard, one operation will usually suffice; but in extreme cases of complete cleft of the hard and soft palate with wide separation of the edges, it may be advisable to deal at different times with the hard and soft, some preferring to close the hard at the first operation, and others the soft. This must depend upon the surgeon’s confidence in himself and in his patient. Personally I always prefer, if practicable, to obtain union in the hard palate at the first operation; then if after taking the necessary steps for loosening the muco-periosteal flaps the parts appear to come easily together, the edges of the whole cleft can be pared, and the whole process completed at one sitting. I cannot too strongly insist on the paramount importance of obtaining firm union in the anterior part of the palate, for if the smallest opening be left in that situation, distinctness of speech in after-life will be seriously impaired. PREPARATION OF PATIENT. The state of the health and the local conditions of the mouth, nose, and pharynx must be carefully examined before the operation is decided on. The little patient’s general condition must be as satisfactory as possible, and a course of tonic preparatory treatment (including possibly a change to the seaside) is often advisable. Sources of infection from measles, &c., should be carefully avoided, and for a few days prior to the operation they should be kept under observation and at rest, to prevent any likelihood of catarrhal developments.