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It is common knowledge that after the lapse of two years and in patients who have attained certain age, operations upon tendons and joints are often desirable in order to rid them of the need for braces, to make their brace needs simpler, or to correct deformities which have been permitted to develop. Patients sometimes present themselves at such time and under such conditions and who are now being submitted to expert care for the first time in their experience. The temptation is strong, under these circumstances, to proceed with planning for such operations under the impression that nothing else will help. Experience has shown that this is unwise in many cases, to say the least. Unless one is convinced that the patient has had the benefit of truly efficient physiotherapy under skilled supervision, it is not possible to be sure that muscles may not be salvaged by such treatment until an effort has been made to do so. It must be sufficiently long continued to be convincing and it must be supplemented by such aid of mechanical character as to assure the expert orthopaedic surgeon of the ultimate possibilities in the way of muscle development. Only when this has been done is it tenable to proceed with a plan for help by operative procedures. I have formed this opinion after long experience and after having seen the results of operations which were shown to be either needless or unwisely planned. On the other hand, operations which have been done after such a course of preparation, in this class of cases, have quite uniformly proved to be most satisfactory both to patient and surgeon, but above all, to the patient a great and lasting benefit. Whereas some patients resist the proposal of operation when it has been advanced with wisdom and conservatism, there are some who seek it looking for a cure-all. The surgeon needs occasionally to combat this attitude with quite as much firmness as is required to convince him who opposes an operation which has been proposed with utmost wisdom.