The great art in clearing the pharynx consists in letting the sponge slide over the dorsum of the tongue, and then by a rotary movement of the wrist the clots are entangled upon its surface and easily removed. In this manipulation the sponge should not touch the palatal structures more than is absolutely necessary, as any friction or bruising of the edges when pared is highly injurious. Vomiting, moreover, is readily excited by too frequent sponging, especially about the uvula and soft palate. INSTRUMENTS. [Illustration: FIG. 57.—T. Smith’s gag with tongue plate (_Arnold_).] [Illustration: FIG. 58.—Mason’s gag.] [Illustration: FIG. 59.—Rose’s gag, double ended. Large end for adults; small end for children. Sliding ring-catch fixing instrument in position.] An efficient _gag_ is one of the most important requisites for a rapid and successful performance of this operation. In the selection of such appliances the choice will lie between those which merely separate the jaws and those which, in addition, command the tongue. The latter are represented by such as T. Smith’s (Fig. 57) or Whitehead’s gags; but with either the tongue is apt to curl up at the back of the plate which is intended to repress it, and severely embarrass, if not altogether interfere with respiration, necessitating a hurried readjustment. Any gag with a tongue plate is not only more difficult to adjust, but also to remove in an emergency. I am inclined on the whole to think that it is better to leave the tongue free, the assistant depressing it, when necessary, with an ordinary spatula. The apparatus should be as simple as possible, unilateral, and easily moved from one side of the mouth to the other, and constructed with a minimum amount of metal and projections which might obscure the field of operation, or cause delay by entanglement of the stitches. These conditions are, I believe, fulfilled as nearly as possible in my own adaptation of the late Mr. Francis Mason’s gag, generally used by Sir Wm. Fergusson (Figs. 58 and 59). As will be seen from the drawing, the gag is unilateral, provided with a sliding ring-catch easily thrown in and out of position, and so made that by reversing ends it can be used either for an adult or a child. The portions inserted between the teeth are covered with rubber tubing or fine twine, thus protecting them from injury, and in some measure preventing the gag from slipping. I admit that the supervision of an assistant is needed to maintain its position, but contend that this is rather an advantage than otherwise, and the breathing is less likely to be interfered with. It is inserted closed between the lateral incisors, and is gently pushed back until between the molar teeth, when it is opened to a sufficient extent, and fixed in that position by the sliding catch.