arteries had developed. There was no headache and the man
himself did not notice the bruit. Evidence of mediastinal
haemorrhage existed in the presence of subcutaneous
discoloration of the abdominal wall, below the ensiform
cartilage and extending slightly over the costal margin of the
thorax. In the absence of an aneurismal swelling, or of the
development of any further symptoms, the patient was sent home
to Netley in January.

I saw this patient in Glasgow a year later. He was employed as a
lamplighter, and was able to do his work well, only complaining of
attacks of shortness of breath on exertion. He said these were apt to
come on each evening about 6 P.M. The pulse was 100 when the erect
position was maintained, and 84 to 88 in the sitting posture. The right
pupil was still dilated, reacting for accommodation but little to light.
The palpebral fissure was normal in size and there was little, if any,
diminution in strength of the right radial pulse.

On inspection no pulsation was visible; in fact, the pulsation of the
normal left subclavian was more apparent in the posterior triangle of
that side. The sterno-mastoid was prominent, also the sternal third of
the clavicle. On firm pressure some pulsation was palpable beneath the
sterno-mastoid, but no definite evidence of the presence of a sac could
be detected. Purring thrill and machinery murmur were still present, but
the former was slight, and palpable only with the lightest pressure. The
machinery murmur had ceased to be audible to himself, and was by no
means loud or very widely distributed.

The condition had, in fact, steadily improved, and become far less
obvious. The prominence of the sterno-mastoid and clavicle still present
was difficult of explanation, except on the theory of an injury to the
bone, or that an aneurismal sac had consolidated spontaneously.

(14) _Arterio-venous aneurism, root of right carotid._--Wounded
at Magersfontein. _Entry_ (Mauser), centre of right
infra-spinous fossa. _Exit_, 3/4 of an inch above clavicle,
through point of junction of the heads of the right
sterno-mastoid muscle. Range 200-300 yards. When wounded the
man ran two hundred yards to seek cover. There was no serious
external haemorrhage, but the injury was followed by some
difficulty in swallowing, and haemoptysis, which lasted for the
first two days. The right radial pulse was noted