existed, but he pursued his usual work. In
1899-1900 he took part in the operations in South Africa as a
combatant, and during this time was subjected to very hard
manual work. During this he was seized with sudden pain in the
left side of the head and neck, and in consequence invalided.
No restriction in the movements of the upper extremity, and no
subcutaneous ecchymosis developed, but the patient was positive
as to the tumour having greatly enlarged.

Four months later the condition was little altered. A pulsating
swelling 1-1/2 inch broad existed along the line of the upper
two-thirds of the axillary artery, and along the subclavian in
the neck, rising some 1-1/2 inch into the posterior triangle.
Pulsation was visible; the murmur was audible when sitting
beside the patient, and widely distributed over the whole
chest, the neck, and upper extremity on auscultation. The pulse
rate varied with the mental condition of the patient, which was
excitable, between 96 and 120. There was neuralgic pain in the
neck and scalp, and down the distribution of the brachial
plexus. The pupils were equal, but flushing of the face and
profuse sweating followed any exertion. I concluded the tumour
in this case to be mainly due to dilatation of the trunk above
the point of obstruction on account of its outline, the absence
of any restriction of movement in the upper extremity, and the
non-occurrence of subcutaneous ecchymosis at the time of the
attack of severe pain. Difficulties arose as to undertaking any
active form of treatment for this patient, which, to be
satisfactory, needed an antecedent period of absolute rest, and
he passed from my observation. I think, however, operation by
ligature above and below the communication would have been
possible. The case affords a good example of the course the
condition may sometimes take if precaution is neglected.

The vessels of the arm or forearm may in almost all cases be interfered
with, but in many instances an absence of any serious symptom renders
operation unnecessary.

With regard to the femoral varices, I would refer to the remarks below,
and those on the treatment of varicose aneurism as indicating that a
certain amount of caution should be exercised in interfering with them.

The same remarks in a lesser degree apply to the poplite