Jonnesco’s method, according to his latest communication on the subject, is different. He always employs the premastoid route where only the superior ganglion is to be removed, reserving the postmastoid for the excision of the entire chain. The carotid sheath is split, the internal jugular vein and sternomastoid drawn outward by a retractor; a second retractor draws the vagus and internal carotid inward. In the space made the superior ganglion is found. The deep vertebral fascia is opened, all the branches of the ganglion isolated and cut by blunt, curved scissors; when this has been done the ganglion is attached only by nerve strands above, a strong pull is made, and the ganglion gives way. The excision is then completed by cutting the inferior strands. In closing the wound, he uses both deep and superficial sutures. He mentions a transient dysphagia and pain in the cranio-mandibular joint as occurring after this operation. EFFECTS OF EXCISION OF SUPERIOR CERVICAL GANGLION. The effects of removal of this ganglion are immediate and remote: The immediate are relief of pain, lachrymation and conjunctival injection, together with a discharge from the corresponding nostril, unilateral sweating, and contraction of the pupil. Often there is an immediate reduction in intra-ocular tension. These effects are noted within five minutes after the excision. The remote effects are ptosis, which appears on the third or fourth day, improvement of vision, and in some instances a tardy contraction of the pupil and a tardy reduction of the intra-ocular tension. To these there must also be added a slight sinking of the eyeball into the orbit, and a feeling of heaviness in the head. What I have just written applies particularly to cases of glaucoma. In exophthalmic goiter, after the excision of the ganglia, the exophthalmus and tachycardia are said to improve almost immediately and a reduction of the goiter soon follows. Although Jonnesco speaks of the immediate reduction of the intra-ocular tension, yet this does not always occur. In my second case, at the end of eight days the tension was + 2. On the sixteenth day the tension was normal. In my first case reduction of the tension was immediate. The relief from pain in the first case was immediate and lasting. This patient had not been free from pain for two months previously. The slight ptosis following sympathectomy is to be attributed to paralysis of Müller’s muscle. Sinking of the eyeball is no doubt due to paralysis of the unstriped peribulbar fibers found in Tenon’s capsule. Contraction of the pupil is usually an immediate result; it may, however, appear tardily. Thus in my first case the pupil was unchanged until the fourth day after the operation; and it did not become at any time as markedly contracted as in the other two patients. In the third case—that of optic-nerve atrophy—the pupil was markedly contracted within five minutes after the excision.