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Mepa, platee, charts, etc., mey be filmed at different reduction ratioa. Thoae too large to be entirely included in one expoaura ara filmed beginning in the upper left hand comer, left to right and top to bottom, aa many framee aa required. The following diagrama illustrate the method: Lee cartae. pianchea, tableeux, etc., peuvent dtre filmte k dee taux da rMuction diff Grants. Lorsque la document eat trop grand pour itra reproduit en un seul ciichA, il eet film* A partir da I'angia supArieur gauche, de gauche k droite, et de haut ti baa, an prenant la nombre d'Imegea nAcassaira. Laa diagrammes suivants illuatrent la m^thoda. 1 2 3 1 2 3 4 Ol 6 Extriictpd from The Americiiii Jfiurnal of tho Medical Sciences for June, 18(t0. TJIK FURTHER HISTORY OF A CAHK OF ANEURISM OF THE THORAIUO AORTA OF UNUSUALLY LA ROE SIZE, ATTENDED WITH LOCALIZED UNILATERAL SWP:LLIN0. By R. L. MacDonnei-l, B.A., M.D., CROFERHOR (ip CI.INICAI. MKIIII'INK IN MCnil.I. IINIVBHIJITV ; I'llYSlCIAN Td THE MONTREAL liENEIlAI. MIIHriTAL, In this JoruNAL for March, 1888, I reported a ca.se of aneurism of the tlioracic aorta, in which sweating ever a limited area of the chest wall had been repeatedly observed. At the time of the publica- tion of that report the patient was in very good condition and had left the Montreal (Jeneral Hospital, where he had spent the winter of 1885-86, and had gone to resume his occupation as the proprietor of a small eating house. Die relief to the symptoms and the manifest diminution in the force of the pulsations in the area between tho scapulse where the tumor reached the chest-walls wa;^ attributed to the persistent use of the iodide of potassium. The case has been under my observation for the last four years, though an interval of a year (1888-89) elapsed without my having seen him. In the winter of 1887-88 he was in fair health and there was no increase in the area of percussion diilness in the left inter-scapular region, but he had lost weight to a considerable extent. There was no more dyspno'a, and he could sleep with comfort when lying down. There was very little cough. During the last winter (I88i>-!H)) he began to suffer from paroxysms of coughing and from very severe pains in the chest. On November 21, I88!», I made a carefuT physical examination, comparing every point with the rei)ort already published \n TiiK Amkhican Joirxaf, ok the Mkiucal Scikncks. He had been taking the iodide of potassium in ten-grain doses twice daily for four years. Tlie pul.se at botli wrists was eijual, but it had entirely lost its collapsing character and there was no longer any visible pulsation in the vessels of the neck. There was no percejUible bulging in the upper part of the chest. The systolic murmur, which was audible four years previously at the back of the chest, was no longer perceptible, 'i'here was absolute silence at the ba.se of the left lung up to within two inches of the angle of the scapula. During the month of November, 188!l, the pulsation in the back was so feeblv marked that, in order to demonstrate its existence to the students"of mv clinical class. 1 had to resort to the device of gumming upright slips ()f j)aper to the skin to render more evident the movements of tl^e surface. Hut, as the winter advanced, there Wius a great increase in the thoracic pain, and the patient began to experience the semi- iiiiiliititBi'i *r* ,.. ■*rag|Ma*?«#«*«'««»^ 2 MACDONNELL, ANEURISM OF THE THORACIC AORTA. anginal attacks previonaly described. At this time he reported to me a recurrence of the sweating; in the left side of the chest, which he hr.d noticed for the fii-st time since he had letl the hospital in 188«). The whole of his brown skin wjw very dry, except over the area in the left chest corresjMUuling to the neighborhood of the fifth and sixth ribs. This limited area could be seen and felt to be moist, while the skin on the corresponding area on the other side was (piite dry. Closer observation convinced me that this moisture appeared whenever the pain became severe, and that when the patient was comfortable and free from pain the skin of the left chest wjis perfectly dry. In December, 1889, the |)atient t'Utered the hospital for the last tinie. There wa< then great pain on movement and great muscular weaknt^ss. The sweating on the chest was distinctly visible for a few days after admis- sion. Owing to the great pain on movement a complete examination of the chest was not practicable. After some days the pain dinunished and it became i.o longer necessary to "idminister morphine. The sweating never reappeared. .V great change was olwerved in the area of pulsation. On the 30tli of December, after he had l>een in the hospital a week, this area was tiiund to be extending. Fornjerly it might have been covered by a circle two inches in diameter, but now it measured 7x4 inches, and the pulsation was ccmipanitively very forcible. During the f(»llowiug fortnight there wa.s much less suflTering. A remarkable change look place in the l)ack. The pulsating area now became pruniinent and protruded a good two iiuhes from tlu' general MAC DONNEIiL, ANEURiaM OF THE THORACIC AORTA. 3 level of the surface exteii