line, and the precordial dulness was
somewhat increased. The pulse numbered 80 to 84. The muscles supplied by
the ulnar nerve were very weak, but not much wasted, and ulnar sensation
was imperfect.

The aneurism had considerably altered in form and outline; its walls
were dense and firm; it extended 2-1/2 inches upwards in the line of the
carotid artery, beneath the sterno-mastoid, but projected beyond the
posterior border of that muscle. The larynx was displaced 1/2 an inch to
the left of the median line; the voice was still husky, although much
stronger than it was; the anterior jugular vein was dilated. The purring
thrill was very superficial, and chiefly palpable over the subclavian
vessels. The machinery murmur was still loud, but much less widely
distributed than before; it was still audible to the patient when he lay
on his right side.

This case was of much interest from the diagnostic point of view. When I
first saw the patient I considered the injury to have implicated the
innominate vessels. Later, from the facts that the thrill was
imperceptible in the episternal notch, and that the main part of the
tumour was situated in the posterior triangle, that the wound was of the
root of the right subclavian vessels.

It now appears that, at any rate, the root of the right carotid is the
artery implicated.

In spite of the continued existence of a large aneurism, the
localisation of the sac, which had taken place, was very striking,
considering that the man had been walking about freely, and living an
ordinary life, except that he had undertaken no work.

(15) _Popliteal arterio-venous aneurism_.--Wounded at
Paardeberg. _Entry_ (Mauser), at lower margin of patella.
_Exit_, at centre of back of thigh. Perforation of lower end of
femur. The patient was lying down with crossed knees when the
injury was received. Much oedema of the foot and leg followed
the injury, and on the third day a thrill was discovered. Three
weeks later there was still some swelling of the calf, the
posterior tibial pulse was imperceptible, the anterior very
small. An aneurism was palpable at the inner part of the top of
the popliteal space, about the size of a pigeon's egg; a strong
thrill was to be felt, especially when the knee was flexed, and
with this expansile pulsation and a loud machinery murmur. The
entry wound was firmly healed; the exit still furnished
blood-