Although the above detailed process appears very elaborate, it certainly seems to me the best. Other methods are used by many, and amongst these perhaps the most frequently employed is the “direct” method of Mr. T. Smith. In this the needle (Fig. 71) is double-curved and hollow, and the wire which is wound on a drum in the handle of the instrument can be projected at will from the aperture at the point by a movement of the thumb. Different shapes are used for different parts of the palate. The needle is passed from below upwards through one side of the cleft, and without withdrawing it through the other from above downwards; the wire is now protruded from the point of the needle, grasped by forceps, paid out from the drum, and the needle withdrawn as it entered. Mr. Smith’s usual practice is to stitch from the uvula upwards, tying each stitch as it is inserted, and making use of the ends of one stitch to steady the palate whilst introducing the next. The advantage claimed for this method, viz. the saving of time, is more than counterbalanced in my opinion by the following drawbacks; first, the strain exercised upon one of the palatal flaps in order to pass the needle through the other; second, the occasional and not infrequent hindrances to the smooth working of the wire by its kinking; and, thirdly, the difficulty often experienced in seizing the end of the wire. STAGE IV.—_Relief of Lateral Tension._ The palate having been thus satisfactorily sutured, the relief of lateral tension and the division of the levator palati have now to be undertaken; for however well the parts may appear to lie, it is never safe to omit this. A narrow-bladed probe-pointed bistoury is introduced through the lateral aperture on either side, and carried directly backwards through the soft palate. It is useful to introduce the left index finger into the lateral opening to ascertain if any fibres of the muscle still remain undivided. This plan was first introduced and practised by Mr. Pollock in mild cases of cleft palate, where the fissure extended through the velum only.