less acutely in cases where there is no apparent lesion of the nerves, 
as in late pregnancy and after parturition. Such a case has been 
recorded by Geppes (1) and is quite typical in character. The 
symptons appear at times when the individual exhibits lack of mus- 
cular tone and they disappear as the muscular tone returns. The 
effect of the tonic contraction of the trapezius is to support the weight 
of the limb and to prevent it falling on the chest and so interfering 
with thoracic respiration. The habit of resting in an arm-chair is, 
as Professor THORBURN pointed out to me, intimately connected with 
this function of the trapezius. When, through fatigue, the action of 
the muscle is less marked, considerable relief and at the same time 
increased respiratory movement is obtained by resting the weight of 
the upper limbs on the arms of the chair. It is for a similar reason 
that a patient suffering from heart-disease sits forward in bed resting 
his folded arms on his lap. Sir CHARLES BELL pointed out that the 
trapezius (together with the sterno-mastoid) is an important respira- 
tory muscle in that by its tonic action it converts the shoulder into 
a fixed point from which the more immediate muscles of respiration 
may act. (2) This function of the trapezius is called into play with 
every inspiration but is much more pronounced in exaggerated breath- 
ing. In cases where the diaphragm and thoracic muscles are para- 
lysed the trapezius and sternomastoid may take on the entire control 
of the respiratory movements. A striking case illustrating this point 
was recorded in Brain by THorBuRN and GARDNER. (3) In this case 
the inspiratory movement was performed by the above named muscles 
raising an almost passive chest and assisted only by a meagre action 
of the diaphragm. Yet the patient lived and was anaesthetised and 
lived on for a considerable time after the operation. 
BERNARD, although opposing the view of Bell, admitted that after 
section of the spinal accessory nerve, dogs and cats exhibited shorter 
respiration and quickly became breathless on running. (4) 
From a base of action formed by their attachment to the ver- 
tebral column and skull (the bones acting as fixed points), the brachio- 
and sterno-cephalic muscles carry the sternum and shoulder forward 
and thus act in harmony with the inspiratory muscles. This has 
been pointed out by Bernarp. Indeed this author has stated that 
there is a harmony between the movements of the shoulder and those 
of the thorax. 
The subject has been reinvestigated by others, among whom 
