Its cost is an objection. The other forms of tracheal tube need but passing mention. The bivalve canula of Fuller is made in two lateral segments, fastened to a collar and tapering when closed to a point, so that introduction of the apparatus through the tracheal wound is made easy. Once introduced, an inner complete canula is slid into its place, thus separating the two outer halves and rendering the whole round and compact. It has been criticised unfavorably on account of the danger of hemorrhage that it is likely to cause through pressure on the tracheal walls by the sharp edges of the outer canula. In Gendron's canula the same lateral blades are separated after introduction by means of a screw fastened on a transverse bar. Soft-rubber canulas were introduced to the profession not long since by Morrant Baker for subsequent use after the operation of tracheotomy, the usual tube having been worn meanwhile for a few days. Being soft and flexible, they are certainly safe and comfortable for the patient, but their thickness and the absence of any inner tube are, especially the latter, serious disadvantages. They are not, I believe, generally used. Finally, the long, flexible tracheal tube of König was devised by its author to meet the indications in cases where the trachea is compressed from without by tumors, and where a long canula that is flexible, but at the same time rigid enough to resist pressure, becomes a necessity. It is made in the form of the ordinary tracheal canula, only larger, some three or more inches of the centre of the descending portion of the tube being constructed of spirally-twisted silver wire. It may not be out of place to remind at this point that a tracheotomy is not infrequently performed, of necessity, very hastily, and in the absence not only of a tracheal tube, but likewise of other and even more essential instruments. The lack of the former need never be a barrier to the prompt performance of the operation, for the ready wit of the true surgeon will show him various ways out of his temporary difficulty. A thick goosequill fastened by threads passed through its outer end makes an efficient improvised canula. A bit of elastic catheter answers the same purpose. Retractors for the edges of the tracheal wound, made of wire--silver if it be at hand, a couple of hairpins if it be not--and connected together by an elastic tape which passes around the neck, will not only answer a good temporary purpose in holding the tracheal wound dilated, but have been recommended by Martin--in a more elegant form, it is true--as a proper method of treatment after opening the trachea. Finally, one or more stitches passed through the cartilaginous edges of the wound, and attached to the soft parts beyond it, will serve to secure its patency, at least temporarily.