m fills the carotid triangle, extending from the
mid-line backwards to the margin of the trapezius, and from the
level of the top of the larynx upwards to the margin of the
mandible. The wall is fairly firm, pulsation is both visible
and palpable, and a well-marked thrill and machinery murmur are
present. The latter annoys him by its buzzing when the head
rests on the right side. The pupils are equal. Pulse somewhat
irritable, about 100. The voice is weak and husky, and there is
difficulty in swallowing solids. The actual swelling is
somewhat remarkable in outline, on the one hand following up
the course of the external carotid and facial arteries, and on
the other extending backwards in the line of the wound track
towards the exit. The patient was kept on his back with
sandbags around the head during the next fortnight. For the
first eight days such change as occurred was in the direction
of localisation and contraction, but during the last six,
evident extension occurred both backwards and downwards; this
extension was accompanied by severe pain in the cutaneous
cervical nerve area of the neck. The larynx became pushed over
3/4 of an inch to the left of the median line, and the
extension beneath the sterno-mastoid downwards raised a doubt
as to whether the common carotid could be exposed without
encroaching on the walls of the sac. Owing to indisposition I
had not been able to see the patient for some days, but now,
after consultation with Major Simpson and Mr. Watson, it was
decided that the best plan would be to expose and tie the
common carotid as high as could be safely done. The operation
was performed six weeks after the injury, and somewhat to our
surprise offered little difficulty. The carotid was exposed at
the upper border of the omo-hyoid, only a small amount of
infiltration having occurred in the vascular cleft. No
dilatation of the jugular was noticeable, and when a silk
ligature was applied to the artery all pulsation was
controlled, and the thrill in the vein disappeared completely.
The after progress was satisfactory, but four days later the
wound was dressed, as the patient's temperature had risen above
100 deg.. The tumour was consolidated: no pulsation could be felt,
but there was little apparent diminution in its siz