, but under the influence of rest it
steadily contracted and localised. During this period the
patient was seen several times by Mr. Cheatle, who noted
considerable temporary enlargement of the thyroid gland.

At the end of eight weeks he had been allowed up some days, and
travelled 570 miles to Wynberg. The aneurism was about 1-1/2
inch in diameter, smooth and rounded, extending just beneath
the left clavicle and nearly the whole width of the
sterno-mastoid, but well defined in all directions. There was
well-marked expansile pulsation, purring thrill along the
jugular vein and over the tumour, and loud machinery murmur
widely diffused along the whole neck and into the thorax. The
voice was still weak and husky, but there was no dysphagia or
dyspnoea. The left pupil was larger than the right.

The patient acquired enteric fever at Wynberg and when
convalescent was sent to Netley, whence he returned home. The
aneurism caused little discomfort. It may possibly have been of
the inferior thyroid artery.

(13) _Innominate arterio-venous varix_.--Wounded at Modder
River. _Entry_ (Mauser) posterior margin of left
sterno-mastoid, close above the clavicle. _Exit_ in anterior
axillary line one inch below the right anterior axillary fold.
Soon after the injury a considerable amount of blood was
coughed up, and occasional haemoptysis persisted for the next
four days. The patient was moved from the Field hospital by
train to Orange River, a journey of 55 miles and some four
hours' duration, on the fourth day. When examined there was
slight fulness over an area roughly circular and about 2-1/2
inches in extent, of which the sterno-clavicular joint lay just
within the centre. Over this area there was faint pulsation
with a strongly marked thrill and loud systolic bruit. The
radial pulses were even, the right pupil larger than the left.
No pain, and no dyspnoea. The right eye was partially closed,
but could be opened by the levator palpebrae superioris. The
patient was shortly afterwards sent to the Base, and when seen
there twenty-five days after the injury, there was little
change in the condition except that the fulness had
disappeared, the thrill was more marked, and a typical
machinery murmur transmitted along both carotid and subclavian