on accidentally in a man admitted
into the hospital for other reasons. The patient remarked: 'For heaven's
sake, sir, do not say anything about that. I have had it many years, and
it has never given any trouble. If it is known, I shall be worried to
death by people examining it.'

None the less it must be borne in mind that beyond enlargement of the
vein dilatation of the artery above the seat of obstruction does occur,
and gives trouble in some situations. Again the disturbance of the
general circulation already adverted to shows that the existence of this
condition is sometimes of importance in its influence on the cardiac
action.

Under these circumstances the treatment varies with regard to the
vessels affected, and the degree of disturbance the condition gives rise
to.

With regard to locality, experience appears to have shown clearly that
communications between the carotid arteries and jugular veins usually
give rise to so little serious trouble that, in view of the grave nature
of the operation and its possible after consequences on the brain,
interference is as a rule better avoided. I should, however, be
inclined to draw a distinction between operations on the common and
internal carotid arteries in this particular, and should regard varix of
the latter vessel and the internal jugular vein as especially
undesirable for interference.

The vessels at the root of the neck are probably to be regarded from the
same point of view, as to surgical interference.

The arteries of the upper extremity are the most suitable for operation,
and the axillary may perhaps be the vessel in which interference is most
likely to be useful. In this relation it may be of interest to include
here a case of a man who took part in the campaign when already the
subject of an aneurismal varix of the axillary artery.

(20) Twenty years previously the patient suffered a punctured
wound of the left axilla from a pencil. A varix developed, but
was only discovered by accident ten years later. The patient
was seen by several surgeons, and treatment was discussed; the
balance of opinion was, however, in favour of non-interference,
and nothing was done beyond giving injunctions as to care in
the use of the limb. Up to the time of discovery of the varix
no inconvenience had been felt, although the patient was of
athletic habits. Subsequently, the patient himself was positive
that a swelling