=Intranasal Surgery.=—Intranasal abnormalities, such as deflected septum, spurs on the septum, hypertrophied turbinates, polypi, etc., which materially reduce the breathing space, usually demand surgery. Nasal surgery, carefully and properly done, is always a great aid and often absolutely essential to the successful treatment of hay fever and asthma, but nasal surgery carelessly done frequently does more harm than good. The correction of a deflected septum or the removal of a spur on the septum by submucous operation often aids materially in the prevention of pressure irritation, increases the breathing space and normalizes drainage from the sinuses. Surgery is therefore very essential in many cases of hay fever, but surgery is never the all essential part of the treatment, because if the proper after treatment is not given, the surgery alone will seldom result in either temporary relief or cure. =Focal Infection.=—The importance of focal infection of the sinuses, tonsils, teeth and occasionally other parts, such as the nasal cavities, epipharynx, middle ear and mastoid cavities cannot be overestimated. Such conditions may be effective in causing hay fever, by causing direct infection of the membranes of the nasopharyngeal tract or by auto-intoxication. =Digital Surgery,= for the removal of adhesions in the posterior nares and pharynx, is in my opinion, very essential, and this work should be done thoroughly. Massage of the soft palate or pharyngeal walls is of no particular value. All adhesions and adenoid tissue must be removed because this removes an effective source of constant irritation and focal infection and tends to normalize the direct and reflex nerve mechanism. The practice of the radical intranasal technique as originated by J. D. Edwards, D. O., is indicated, I believe, in some cases in which the crushing of cellular middle turbinates, or the breaking of adhesions is indicated, but I am not yet ready to accept this theory of “curetting” the mucous membrane by radical digital technique. The fracture of the turbinates is not necessarily a bad technique provided they are properly readjusted as Dr. Edwards does it, but to fracture and not readjust is a dangerous practice. The efficiency and safety of any method depends upon the operator’s definite knowledge of what needs to be accomplished and how it is to be done. There are contraindications to digital, as well as any other kind of nasopharyngeal surgery, such as: (1) Acute infection of any part of the nasopharyngeal tract; (2) evidence of sinus involvement; (3) septal deflections, spurs and hypertrophied turbinates, which would not permit such work without undue trauma. There are certain other precautions such as thorough cleanliness of the parts to be treated; aspiration of the sinuses before and afterward, and the use of a finger of sufficient size which will not produce undue trauma. In my opinion very few doctors have such fingers.