Electro-physiology and electro-therapeutics : showing the best methods for the medical uses of electricity / By Alfred C. Garratt.

chain of pathology. There remains another, to which I must now draw your special attention : it is the medulla oblongata, with its pneumogastric nerve. I have already adverted to laryn- gismus as giving to epilepsy, and to convulsions generally, its most formidable character. This form of laryngismus is spas- modic or convulsive, and excited through the spinal system. " But there is another form of laryngismus to which I refer. After a severe epileptic convulsion, the patient is left in a state of coma, or, as it may be termed, of simple apoplexy. This condition may prove fatal. The respiration becomes stertorous, that is, there is laryngismus. But this laryngismus is very dif- ferent from that just before described. This is less complete, but more persistent; it is, indeed, permanent. Some one has said, in rather familiar phrase, *' the patient snores his life away." This laryngismus is not like the former, which was spasmodic, but is paralytic. It is owing to compression or congestion — an apoplectic state—of the medulla oblongata, and paralysis of the pneumogastric nerve, in which every branch of it, as well as the recurrent laryngeal, is implicated. There is, then, complete apoplexy of the medulla oblongata, and paralysis of the pneumogastric nerve! " What phenomena do we observe as occurring in the coma, or simple apoplexy, seen after a severe epilectic seizure ? We see paralytic laryngismus, impeded respiration, augmented apo- plexy. We also observe — or rather I have observed — a dif- fused bronchial rattle, the effect of paralysis of the bronchial and pulmonary nerve branches from the pneumogastric ! " Here a most interesting phenomenon presents. The cerebrum is not essential to animal life. How, then, does apoplexy, simple, cerebral apoplexy, destroy life ? It does not do so. Apoplexy only destroys life indirectly, as when by its congestion from downward pressure it implicates the medulla oblongata and its pneumogastric nerve. It is by the apoplexy of this medulla, and the paralysis of this nerve, that life is finally, in effect, destroyed ! " Generally, such a patient dies of paralytic laryngismus, or of laryngeal asphyxia. From this danger the patient may be res- cued by early tracheotomy. But if the tracheotomy be per-