until the uvula is reached, the anæsthetist and assistant guarding the loops and ends of the silk by placing their hands on them at the sides of the face. This is especially needed if much sponging is called for, or if vomiting occur. The uvula need not be dealt with until the silver sutures have been tightened. [Illustration: FIG. 69.—Loop method of passing sutures in palate operations. (_Mason._)] The silver wire must next be substituted for these loops, and this is effected by taking a six-inch length of the former and doubling half an inch of one end into a hook over the loop; gentle traction on the free ends of the silk will easily draw the wire through into its place. A small piece of sponge lightly dabbed on the edges of the cleft at the point of suture removes any adherent blood-clot or mucus. The ends of the wire are crossed and the wire-twister (Fig. 66) applied, and in this way the suture is tightened until the margins of the cleft lie accurately in apposition, without undue mutual pressure or folding in of the edges; experience and practice can alone decide the requisite amount of tension. When this has been accomplished, the twisted ends are cut off with scissors, leaving a sufficient length visible to allow of easy removal when necessary. It is better to deal in this way with each wire separately, in order to prevent entanglement or confusion. To stitch the uvula, a double-curved semicircular needle (Fig. 63) may be advantageously employed, and passed through both sides before withdrawing it; as previously stated, no substitution of wire is advisable (p. 114), but the silk is drawn tight by means of a slip-knot made fast in the usual way (Fig. 70). Two of these silk sutures may often with advantage be inserted in the uvula, but this should be accomplished with the greatest possible delicacy of manipulation, as any rough handling with the forceps may result in bruising, œdema, and subsequent non-union. The sutures, moreover, must be so placed that the circulation in the uvula is not interfered with when they are drawn tight, or strangulation and sloughing may follow. [Illustration: FIG. 70.—Method of tying slip-knot for uvula stitch; formerly used in each suture. (_Fergusson._)] [Illustration: FIG. 71.—T. Smith’s palate needle (_Arnold_).]