To obviate the dangers arising from the flow of blood into the pharynx and larynx, it has been recommended by Prof. E. Rose of Berlin to operate with the head hanging over the end of the table, thereby causing the blood to gravitate into the nose. I have only adopted this suggestion in one or two instances, but in those in which it was tried considerable congestion of the vessels of the head was produced, and the administration of the anæsthetic interfered with. A skilled assistant should to my mind render such inversion unnecessary. ANÆSTHESIA.[87] The importance of efficient anæsthesia during this operation is so obvious that a few suggestions as to the best means of obtaining and maintaining it will not be out of place. First, as to the choice of an anæsthetic, the conditions of the operation are such that chloroform seems the only agent which is conveniently applicable; our patients moreover are generally children, and with such at any rate it may be safely used. It has been recommended and practised by some to produce initial unconsciousness by the administration of the A. C. E. mixture, ether, or nitrous oxide gas, and then to maintain it with chloroform. This plan is quicker, and supposed to be safer, but on either plea the gain, if any, is so slight as to render the extra complication undesirable. As to the method of administering chloroform, the old plan of soaking a piece of lint or towel with the drug and applying it closely to the air passages until anæsthesia is produced ought by no means to be followed in these days of advanced knowledge. It is well known that more than 4 per cent. of the vapour of the drug is dangerous, and hence a safer method must be employed. All plans requiring the introduction of nasal or buccal tubes are undesirable. The best method is that recommended and always followed in the practice of my colleague, Sir Joseph Lister. The corner of a well-starched towel fixed into a hollow oval by a safety pin, sufficiently long to extend from the glabella to the point of the chin, is kept continually moist by chloroform from a drop-bottle. It is held close to the face without actually touching it; and when complete anæsthesia has been induced can be held out of the way of the operator, and yet sufficiently near for the patient to be still affected by the drug. Any opportunity of inserting this adaptable mask into the region of the mouth must be always taken advantage of by the anæsthetist, so that as little delay and inconvenience as possible may be experienced.