The local conditions, too, must be satisfactory. There should be no excessive secretion from the naso-pharyngeal mucous membrane, as such is usually associated with an œdematous infiltration of that structure, most unfavourable to the attainment of primary union; and, moreover, this excess of mucus tends to insinuate itself between the edges of the flaps. If present, it should be treated by rest in a warm mean temperature, bland diet, and the application locally of gargles of boracic acid and chlorate of potash, combined with the careful use of astringents such as tannic acid and alum; the tongue also should be clean. The state of the tonsils should be looked to, and when greatly enlarged they ought to be previously removed, for they may materially interfere with the union of the palate, either from their size, or from the possible supervention of inflammation; when only moderately enlarged there is, I believe, no necessity for their removal; on the contrary they subsequently assist in closing the aperture between the nose and mouth during speech. Similarly post-nasal adenoid growths should not be interfered with, unless absolutely necessary (p. 70). For the _immediate_ preparation of the patient it is advisable that the bowels should be moved the day before operation, that no food be administered for at least six hours previously, and fluids only for some hours prior to this. The patient should be placed on a suitable narrow table in such a position that the light falls well into the mouth. Where practicable, a graduated head piece capable of being raised and lowered, in order at one time to throw the light on the soft, and at another on the hard palate, is desirable; but in private houses this is usually attained by a due adjustment of pillows. To prevent any sudden movement on the part of the patient the hands should be fixed to the side, and my usual method of accomplishing this is to pass a leather strap around the thighs immediately below the trochanters, and to this the wrists are attached by means of leather bracelets locking on to the circular strap by spring hooks. This plan of fixing the arms enables the patient to be turned from side to side to allow blood to pass out of the mouth when respiration becomes embarrassed by an accumulation in the pharynx. If the patient is strapped down to the table, this cannot be accomplished, and the plan just indicated will be found of great practical value. For it must not be forgotten that the anæsthesia is not always so deep as to prevent sudden reflex movements of the hands, which might jerk the operator’s knife and cause serious mischief.