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fasten a catheter into the orifice of the canula. One advantage to be derived from this proceeding was the being enabled, by the application of cloths dipped in hot water to the tube, to raise the temperature of the air inspired by the patient. The other will be better understood from what follows. The fatality attendant upon operations of laryn. gotomy and tracheotomy, whether performed by the surgeon or the suicide, has not been explained. In the latter case, the moral depression which leads to the action has been advanced as producing a fatal result in ever so slight an injury. But I have seen a patient who, with the deliberate intention of selfdestruction, jumped out of a lofty window, recover from a compound fracture in both extremities. In the case operated upon by Mr. Wainwright, the appearances immediately and for several hours after the operation were as favorable as in the present, yet labored and stertorous breathing came on, with inability to expectorate the mucus, and the patient sunk during the night, with all the appearances of suffocation. On a post-mortem examination there was found no trace of inflammation, but passive congestion of the lungs, and serous effusion into the pleura, as we find in persons who have died of any disease after a prolonged agony. These appearances have, I believe, been generally found in all cases which have sunk after the operation of bronchotomy. In Mr. W.'s case some of this might be attributed to the delay of two hours, rendered necessary by a difference of opinion in the consultation preceding it. At that time the explanation which I am going to offer, of the dangers arising from this operation, occurred to me, and its correctness has, to my mind, been confirmed by the phenomena observed in the present case. Isidor Bourdon, a French physiologist, first, I believe, drew attention to the important part performed by the glottis in the mechanism of respiration. The movements of the glottis were directly observed by another pathologist in the case of a suicide, and direct experiments have been made upon animals to illustrate these move. ments. The glottis dilates during inspiration, and is contracted during expiration; and there is an obvious reason for this. The expiration should be as much under the influence of the will as the inspiration. The duration of a natural expiration is nearly the same as that of an inspiration, but the only muscles by which an expiration can be regulated are the constrictors of the glottis. The act of expiration, as it was for the first time and satisfactorily explained by my late father, Dr. Carson, is simply mechanical, produced by the elasticity of the lungs, the weight of the walls of the chest, and the elastic apparatus of the joints of the ribs. Take away the check of the contracted glottis, and the chest collapses immediately with a rapidity proportioned to the respiratory aperture, and not in the slow graduated manner observed in natural respiration. The necessary consequence of such a rapid collapse would be a diminution of the duration of time in which the air introduced into the lung is kept in contact with the aerating surfaces, diminished aera. tion of the blood, and, in consequence, gradually progressing sanguineous congestion. In addition to this inconvenience derived from theremoval of the influence of the glottis upon expiration, there is a still farther evil perhaps of greater consequence tending to produce the same result. In ordinary respiration the walls of the chest are expanded and contracted into positions intermediate between the medium capacity of the chest, and the positions of extreme dilatation and contraction. The glottis is the only check by which an ordinary expiration is prevented from becoming at all times an extreme expiration. The glottis gradually contracting during expiration, opposes a resistance to the exit of the air by diminishing the passage, and thus affords a period of repose to the powerful muscles which dilate the chest. As a necessary consequence of the extreme collapse, the dilatation of the chest would require an iniereased exertion of the muscular power by which it is usually effected, and during the first part of the dilatation an exercise of this power at an extreme mechanical disadvantage. The exhausting influence of this extraordinary exercise of muscular power so often repeated, would soon knock up the most powerful individual, and these two consequences of the removal of the influence of glottis united appear to me satisfactorily to explain the sinking and gradual suffocation, which have so often carried off patients after the operations of tracheotomy and laryngotomy. To obviate them in the present case, I directed an elastic tube to be inserted into the orifice of the canula, and to be compressed by the patient or an assistant during expiration, thus substituting an artificial glottis. If the tube be of sufficient length, the friction of the air in its exit will be sufficient to regulate the expiration, and so do away with the necessity of the artificial glottis. Had the epiglottis and glottis been cauterised by the nitrate of silver when the patient entered the hospital, as recommended, I believe, by Dr. Corrigan, perhaps this might have obviated the necessity for the operation. It ought certainly to have been done immediately after; and, instead of tartar emetic, calomel and opium have been freely administered to moderate ptyalism. I remain, Gentlemen, Your obedient servant, JAMES CARSON.

Case of Hemiplegia: Illustrative of the Efficacy of Strychnia Endermically Employed