It is impossible to lay down any hard and fast rule as to the period when the stitches should be removed. In the majority of cases where the course has been satisfactory the stitches in the velum may be safely removed on the sixth or seventh day; those in the hard palate, if causing no irritation, had better remain a little longer. If there is any doubt as to the firmness of the union, the sutures should not be touched till later, as they seldom of themselves give rise to any trouble. It occasionally happens that a child refuses to open its mouth, and renders removal of the stitches without the chance of damaging the palate impossible; an anæsthetic must then be administered. AFTER-COMPLICATIONS. In spite of every precaution taken both at the time of the operation and subsequently, it occasionally happens that the process of repair does not proceed satisfactorily. This is mainly due either to a low state of vitality on the part of the patient, or to the development of some febrile or catarrhal condition, or to a septic contamination of the wound. Cases have occurred in which diphtheria, measles, or scarlet fever have shown themselves a few days after the operation, and, under such circumstances, there is a great probability of complete failure of union, the stitches ulcerating through, and even a portion of the soft palate being destroyed by a necrotic process. Such a result, however, does not necessarily ensue, for in one of my cases good union was obtained throughout the greater part of the palate in spite of an attack of measles. In the majority of instances where defective union occurs there has been some neglect in the observance of the precautions upon which stress has been laid above. The most common errors are as follow: _a._ Inefficient relief of lateral tension. Of late years I have become more than ever convinced of the paramount importance of the use of free incisions, and also that the vascular supply of the palate is amply sufficient to allow of these being made without any danger of sloughing, or of hindering primary union. That sloughing has occurred in the practice of others is undoubted; but this is more likely to have been due to a septic contamination and bruising of the tissues than to the extent of the incisions. I would again refer my readers to what has been already written (p. 118) as to the separation of the palatal tissues from the hamular process, and the complete detachment of the muco-periosteal flaps from the point of junction of the hard palate with the soft, where the tissue is thinner than elsewhere. _b._ Defective paring of the edges of the cleft. This probably occurs from want of skill on the part of the surgeon, who fails to remove in one strip the mucous membrane from the margins.