Up to the present time excision of the cervical sympathetic has been performed for the following diseases: epilepsy, exophthalmic goiter, glaucoma, and optic-nerve atrophy. The question naturally arises: How extensive an operation is necessary in these affections? This I will attempt to answer: In epilepsy it is necessary to excise the entire cervical chain on both sides for the reason that, according to Jonnesco’s theory, it is necessary to convert a state of cerebral anæmia—which he assumes is the condition in epilepsy—into one of cerebral hyperæmia. Since the carotid plexus is formed by branches from the superior ganglion, and the vertebral plexus arises from branches which have their origin in the inferior cervical ganglion, it is evident that the entire cervical sympathetic must be removed. In exophthalmic goiter, although Jonnesco in his first operation excised only the superior and middle ganglia, he now believes it necessary to remove the inferior as well, for this reason: from the superior ganglion the ocular fibers arise; from the inferior the vasodilator, cardiac-accelerator, and, probably, the secretory nerves of the thyroid gland. If eye, thyroid, and cardiac symptoms are to be relieved the entire chain must be excised. In glaucoma removal of the superior ganglion alone is necessary. All of the sympathetic fibers of the eye, with the exception of those which pass directly from the cerebrum by way of the trigeminus, are connected with the superior ganglion. In optic-nerve atrophy, if it should be proved that noninflammatory atrophy of the optic nerve can be improved by sympathectomy, removal of the superior ganglion alone will be necessary, for reasons already given. If the glaucoma is unilateral, it is necessary to remove only the corresponding ganglion. HISTORY OF SYMPATHECTOMY. In 1889 Alexander of Edinburgh resected the superior ganglion on both sides. In 1892 Jacksh resected the vertebral plexus and cut the cord connecting the middle and inferior ganglion. The third operator was Kummel, who excised the superior ganglion on one side only. In 1893 Bojdanik made a bilateral resection of the middle ganglion. In 1896 Jaboulay made a bilateral section of the sympathetic cord, above and below the middle ganglion. These operations were all made for epilepsy. In regard to exophthalmic goiter, Jaboulay made a simple section of the sympathetic early in 1896. In September of the same year Jonnesco excised the superior and middle ganglia. Jonnesco was the first, in 1896, to do a bilateral resection of all three cervical ganglia, though it is claimed by a Polish surgeon, Baracz, that he proposed the same in 1893. To Professor Jonnesco furthermore belongs the credit of having first excised the superior ganglion for glaucoma in September, 1897. Ball of St. Louis was the first to remove the superior cervical ganglion for optic-nerve atrophy. The date of this operation was June 24, 1899.