e. A loud
blowing murmur was audible, especially at the posterior part of
the swelling.

On the morning of the fifth day the patient mentioned that he
again heard the whirr during the night. There had been no sign
of any cerebral disturbance and the pupils had remained equal
throughout.

A week after the operation the stitches were removed, there was
evidence of some blood clot in the lower part of the wound, and
this later liquefied and was let out on the eleventh day. At
that time a slight bubbling thrill could be felt at the upper
part of the tumour, also slight pulsation in the line of the
external carotid and at the most posterior part of the sac. The
latter was much contracted, diminished in size and apparently
solid, so that it was hoped that such pulsation as existed was
communicated. Ten months later, no trace of the aneurismal sac
exists. Neck normal, except for purring thrill. Voice strong
and good. Pulse 100. Following his usual work.

(12) _Carotid arterio-venous aneurism_.--Wounded at Paardeberg.
Aperture of _entry_ (Mauser), at the posterior border of the
left sterno-mastoid, 1 inch above the clavicle; _exit_, near
the posterior border of the right sterno-mastoid, 2 inches from
the sterno-clavicular joint. The injury was followed by very
free haemorrhage, mainly from the wound of entry, some 'quarts'
of blood escaping; at any rate his clothes were saturated. The
voice was hoarse and weak, and there was much difficulty in
swallowing; for the first twenty-four hours he could swallow
nothing, but gradual improvement took place. The patient was
carried two miles to the Field hospital, and three days later
travelled 36-40 miles in a bullock waggon to Modder River.
Thence he travelled to Orange River 55 miles by train on the
next day. A swelling was first noted when the wound was dressed
some seven days after the injury. No evidence was ever existent
of gross damage to either trachea or oesophagus beyond the
initial dysphagia. The hoarseness of voice due to left
laryngeal paralysis slowly improved, and was probably the
effect of concussion or contusion of the left recurrent
laryngeal nerve. During the patient's stay at Orange River a
large pulsating swelling with a strong thrill developed. This
was at first diffuse