ng the vascular cleft the vein was exposed and found to
completely overlie the artery: although it was on the left side
of the neck, the position of the vein was so completely
superficial that there seemed no doubt that it had been
displaced by the development of the aneurismal sac. A striking
appearance was noted on exposure of the vein, the coats of
which vibrated visibly, quivering in exact consonance with the
palpable thrill. On tightening the silk ligature all pulsation
ceased in the aneurism, and the vibratory thrill in the vein
became much lessened.

The patient made a good recovery, only disturbed by a slight
attack of vomiting, and at the end of a week the wound had
healed, and pulsation in the aneurism had completely ceased.
The thrill persisted as before.

Six months later, a small sac still exists beneath the sterno-mastoid.
The pulse still reaches 110-120 in pace. The purring thrill is very
slight. The condition gives rise to little or no trouble. Pulsation is
strong in the external carotid artery, there is little in the common
carotid. The voice is strong and good. This aneurism is either at the
bifurcation of the common carotid, or on the immediate commencement of
the internal carotid. Ligature of the external carotid will probably
cure it.

(11) _Arterio-venous aneurism, probably affecting both
carotids._ Wounded at Paardeberg. _Entry_ (Mauser), at dimple
of chin immediately below mandibular symphysis. _Exit_, at
margin of right trapezius, the track crossing the carotids
about the level of normal bifurcation. The patient was lying on
his back with the head down when struck. Some haemorrhage from
the exit wound occurred at the time, and later on the way to
Jacobsdal this was so profuse as to be nearly fatal. A
considerable haemorrhage also occurred on the tenth day. The
patient made the journey to Modder River safely, and was then
under the charge of Mr. Cheatle. A large diffuse pulsating
swelling developed on the right side of the neck, with
well-marked thrill and machinery murmur. During the next three
weeks the swelling steadily contracted, and the patient was
sent down to the Base one month after receiving the wound, when
the condition was as follows. There is no evidence of any
fracture of the jaw. On the right side of the neck a large
aneuris