In some instances tension of the velum is no doubt the cause of the persistent nasal twang, but in many others habit is the principal factor, and this can alone be got rid of by a suitable education. The reluctance to breathe through the mouth, and the unwillingness to open it sufficiently during articulation, are conditions very liable to persist after operation. Such patients also speak too rapidly and run the words into one another, the velum evidently not being under control. The most difficult letters to pronounce are _t_, _b_, _d_, _k_, _g_, _s_, _z_, and _l_. The best means of dealing with the defective breathing is to make the patient undergo a course of “respiratory gymnastics.” Thus he should be made to practise deep abdominal breathing with the mouth wide open; he should stand in front of a looking-glass, and breathe with his mouth open and his tongue voluntarily depressed. He should next repeatedly exercise the movements of his tongue and lower jaw; this is often productive of great improvement in the facial expression. These exercises should be followed up by others directed to the improvement of speech. The distinct production of the various vowels and consonants and of all the sound combinations must be a matter of daily practice. He should be made to speak and read aloud according to the recognised laws of elocution, and by so doing obtain proper modulation of the voice and fluency of speech. Compression of the nasal apertures during these exercises is also advantageous. The physical condition of the hard palate after the operation of uranoplasty is a subject of considerable interest. Langenbeck[101] claimed that a new formation of bone really occurred about three or four weeks after the operation, and attained in time considerable solidity. From experiments, however, by M. Marmy on the palates of dogs, doubt was thrown on the correctness of this assertion; and M. Ollier, so well known as an authority on subperiosteal work, declares that “if there may be doubt as to the ossification, all must admit that it forms a very resisting surface, which has the strength and takes the place of bone.” Opportunities for post-mortem investigation do not seem to have been taken advantage of for deciding this question; but clinical experience seems to indicate that no new bone is actually formed, the central portion of the palate consisting merely of dense fibro-cicatricial tissue covered with mucous membrane. In operating after a lapse of several years for the closure of oval apertures in the hard palate in patients in whom a previous operation had been but partially successful, I have never found osseous tissue, either when paring the margins or when detaching the flaps through lateral incisions.