ntact with or near the vagus.

In a case of aneurismal varix of the femoral artery of three years'
standing, which was under the charge of Mr. Mackellar, the pulse rate
was normal. In this instance great dilatation of the vessels had
occurred.

These observations raise the interesting question whether the irritable
circulation which has been classically considered one of the
predisposing causes of spontaneous aneurism should not rather be
regarded as a result of the condition.

(_b_) _Local._--In none of the cases of varix was the period of
observation long enough to allow me to determine the development of
dilatation of the arterial trunk above the point of obstruction. This,
however, is the common sequence, and no doubt will occur in those
patients who resume active occupation without operation.

The effects of either condition on the distal circulation were
remarkably slight. The distal pulses were little, if at all, modified in
strength or volume, and signs of venous obstruction, if present at
first, disappeared with much rapidity. In one case (No. 15) of a large
arterio-venous popliteal aneurism there was considerable swelling of the
leg, but in this case the sac was large and situated at the apex of the
space, and no doubt exercised external pressure on the vein.

In the case of the carotid aneurisms, especially that probably on the
internal carotid, transient faintness was a symptom in the early stages
of the case. All three of the cases recorded here, however, had been the
subjects of very free haemorrhage, either primary or recurrent.

(10) _Carotid arterio-venous aneurism._--Wounded at Paardeberg.
_Entry_ (Mauser) to the right side of the Pomum Adami, _exit_
at anterior margin of left trapezius, two inches below the
angle of the jaw. There was some haemorrhage at the time from
the exit wound, but no haemoptysis; about four hours later,
however, in the Field hospital bleeding was so free that an
incision was made with the object of tying the common carotid.
During the preliminary stages of the operation bleeding ceased
and the wound was closed without exposing the vessel. The
patient remained a week in the Field hospital, and then made a
three day and night's journey in a bullock waggon to Modder
River (40 miles), and fourteen days later he was transferred to
the Base hospital at Wynberg, when the condition was as
follows. Operation an