ON the night of May 10th, 1879, I was asked to see E. P-, a stout, healthy-looking female child, aged nine years, said to he suffering from severe cold and sore-throat. On visiting the house I found the patient in bed, feverish, and complaining of slight pain in the region of the pomum Adami. There was difficulty of breathing, and a croupy cough. The throat and lungs were healthy. I ordered the air of the room to be kept warm and moist, and poppy-head fomentations to be applied to the throat. I

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... prescribed a strong calomel and jalap powder, and a febrifuge mixture containing bromide of potassium, with light diet. On the following morning, finding the symptoms aggravated, I prescribed a second calomel and jalap powder, which, like the first, acted freelv. May 11th.—The cough, difficulty of breathing, and fever had increased. In the evening the patient became delirious. Respiration was greatly obstructed, lungs congested, cough smothered, and higher temperature. During the latter part of the day the child had suffered from frequent severe attacks of spasm of the glottis, requiring two attendants to prevent her jumping out of bed. I now decided to perform laryngo-tracheotomy. With the assistance of a neighbouring practitioner, the child was placed on a table, and, chloroform being administered, the operation was completed in the usual way. On recovering from the chloroform, and being replaced in bed, the child breathed freely and easily. 13th.-The patient appeared much better. She had slept well, and the delirium had passed off. Ordered bromide of potassium mixture to be continued; diet, milk and beeftea. During the day she continued to improve. The cough and respiration were easier, and the temperature lower ; collection of mucus troublesome. On the 14th and 15th the child continued to improve, and on the 16th she seemed so much better that I removed the tube, and allowed respiration to be carried on through the opening remaining in the windpipe. Ordered the wound to be frequently sponged with warm water containing a little Condy's fluid. Full diet. On June 2nd the wound had completely closed; the child was out of bed, and able to eat, drink, and talk well. Nulla ailtem est alia pro certo noscendi via, nisi quamplurimas et morbomm et dissectiortim historias, tum aliorum tum proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caitt. Morb., lib, iv. Proœmium. CASES OF AMYOTROPHIC LATERAL SCLEROSIS. (Under the care of Dr. FERRIER.) UNDER the title ″Sclérose lateral amyotrophique," Charcot has classified an assemblage of symptoms depending on symmetrical sclerosis of the lateral columns, and atrophy of certain motor nuclei of the medulla oblongata and anterior horns of the spinal cord. The symptoms usually commence in the upper extremities with paresis followed by rigidity, and ultimately by muscular atrophy more or less extensive. The lower extremities are -also affected by paresis or paralysis and rigidity, but muscular atrophy is absent or slight. The last stage is the occurrence of bulbar paralysis. The cases of this affection already on record are not so numerous as to render others at all superfluous, and more particularly as Charcot's nosography has been disputed by some. Leyden holds that there is nothing to warrant the differentiation of a separate class from those of the typical bulbar paralysis of Duchenne, with more or less extensive muscular atrophy elsewhere. In particular, he denies the fact of antecedent paresis or paralysis, and the occurrence of contracture or rigidity of the limbs. The following two cases confirm in all main points the association of symptoms described by Charcot. They do not, however, conform to the usual march of the disease. In both the bulbar symptoms were the first to attract attention, if not actually the first indications of the disease. The course of the symptoms is not, however, regarded by Charcot as an essential feature, and he refers to two cases in which also the disease commenced with bulbar svmntoms. CASE 1.—A. W-, aged thirty-eight, admitted on Oct. 15th, 1880. The patient had enjoyed good health, and never had specific disease. The present illness came on a year and a half ago. The morning after a long railway journey he found that his speech was affected so that he could not speak plainly. He also noticed some difficulty in swallowing liquids. He was treated at this time for relaxed throat. He thinks also that some mention was made of a polypus in the nose, owing doubtless to the nasal tone of his voice. Six months after the occurrence of the throat symptoms, about Nov. 1879, he observed that he had difficulty in turning a key in the lock, and about the same time that he had difliculty in walking. Dr. Robertson Lewis of Bristol, who had seen him in February, 1880, stated in a note that at that time there was very perceptible weakness in the arms. He had difficulty in writing, he could not raise his arms, and complained of pains in his shoulders. The legs were spe. cially observed to be weak a month later. The arms and legs gradually became more weak and stiff. Decided wasting of the ball of the thumbs was observed in May. Present state.-The patient is helpless, and unable to stand or walk, being obliged to lie in bed or sit propped up in a chair.-Face: The facial furrows are distinct, but not accentuated. He can purse up his lips somewhat, but cannot whistle or blow. He can inflate his cheeks if the nostrils are compressed, but cannot purse his lips sufficiently close to whistle. His voice is very nasal, there being a nasal souffle with all explosives. He pronounces "grub" " as "ngrum," &c. The soft palate does not rise during inspiration or phonation, but contracts actively on being touched. The tongue is protruded straight, but is very tremulous and corrugated from muscular wasting. He keeps his head generally bent on the chest, but he can turn it to the right or left freely, though he cannot turn it back so far as normal. There is no marked rigidity in the muscles of the neck. Upper extremities.-The upper arms are kept usually closely approximated to the chest, and the hands resting on the abdomen or thighs in the pronated position. He cannot raise the upper arms from the chest. Can only shrug the right shoulder a little ; the left more readily. Can bring thE left arm across the chest, and touch the right ear with thE left hand, but cannot make a similar movement with the right. The movements are very slow and feeble, and accompanied with pain. Cannot cross the hands behind the back. Passive movements of the shoulder-joint indicate considerable resistance and rigidity, and cause great pain. The deltoids are much wasted. The trapezii are the seat of fibrillar tremors. The arms generally are emaciated, and fibrillar tremors are more or less general in the muscles. Can flex and extend the elbow joints. Can pronate and supinate the left hand, but cannot supinate the right. Can extend the left wrist feebly, and to the radial side only, but not the right. The muscles of the thenar and hypothenar eminences and the interossei are much wasted. Abduction and adduction of the fingers and apposition of the thumb impossible. The first metacarpal bone of the left hanel is on a level with the second-the monkey thumb, and the basal phalanx of the forefinger hyper-extended. The wasted muscles are the seat of fibrillary tremors and subsultus. There is no reaction of degeneration to galvanic exploration, and the muscles react to the faradaic current, except the left thenar muscles. Lower extrernities.-There is no perceptible atrophy in any of the muscles of the lower extremities. There is marked rigidity and resistance to every movement, flexion, extension, and particularly to separation of the knees, which spring together forcibly when released, owing to the excessive con-! traction of the adductors. The feet bend to equino.varus