THE following case is worthy of record, partly on account of its clinical interest and partly because it reveals a somewhat rare pathological condition. The patient was a woman, aged fifty-eight years, and unmarried. She had always enjoyed good health except that about thirty years ago she had suffered temporarily from albuminuria. Up to the time of her death she was active and free from breathlessness and pain and a few months previously she had taken long walks on the mountains without undue

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... atigue. On Nov. 15th, 1896, while she was at breakfast she complained of a sense of faintness and dizziness'and soon afterwards she was violently sick. When she was seen at 9.30 A.M. she was lying on the floor looking pale and anxious. She complained of pain in the stomach and a feeling of numbness on the right side. The right radial pulse was imperceptible, the left was 100 and was feeble and irregular in force. The præcordial dulness was not increased and the apex beat was not felt ; the heart-sounds were feeble at the apex, and a roughness was noticed with both sounds at the base. The extremities were cold and clammy. Hot bottles and stimulants were ordered and a mustard plaster was placed over the præcordia. Two hours later she was very restless and was unable to express herself coherently. Her face was pale and cyanosed and the right jugular vein appeared full and prominent. The bowels had acted copiously and the sickness was decreasing; she could move all her limbs and only complained of pain at the pit of the stomach. During the afternoon she was evidently getting weaker and less conscious. The right pulse was still absent but on further examination the radial vessel on that side could be distinguished and rolled under the finger, though it was not distinctly hard. The right brachial artery could also be felt but pulseless, and no beat could be distinguished in the right carotid artery. The left pulse was quite distinct, but feeble, irregular, and intermitting slightly with inspiration. At this time it was noticed that on turning the patient over on to the left side to give a nutrient injection the right pulse could be distinctly felt and continued as long as she remained in that position, but disappeared again immediately on turning on to her back. A rapid auscnltation of the back on the right side indicated some tubular breathing at the angle of the right scapula but owing to the patient's condition no further examination could be made. In the evening there were several loose actions of the bowels containing small quantities of red blood. The patient never rallied, but became weaker and died at 2 A.M on Nov. 16th, 17 hours after the first onset of the attack. ' Neeropsy.-At the post-mortem examination the large veins of the neck were found distended and prominent. The pericardium bulged slightly but was covered by the left lung to the normal extent. The pericardial cavity contained about from 5 oz. to 6 oz. of blood and clot. The heart appeared of normal size and weight but the walls were soft and flabby. There was no evidence of any valvular disease. On the surface of the heart near the aorta was a small, opening of the size of the head of a large pin and here there was much extravasation of blood into the muscular tissue and fat and upwards into the fold of pericardium ensheathing the first part of the aorta. The result of this was the production of a swelling which reached so high as to-cause pressure on the innominate artery. There were a few patches of atheroma in the aorta and both coronary arteries were throughout the seat of extensive atheromatous disease. They were both dilated and the left coronary artery was ruptured about a quarter of an inch from its exit from the aorta, the rupture corresponding in situation to the small orifice above described. There was no sign of a small aneurysm of the coronary vessel and the sinuses of Valsalva were normal. The muscular substance of the heart was in an advanced state of fatty degeneration. Remarks.--Rupture of a coronary artery appears to be a rare incident and there are but few recorded cases. In THE LANCET of June 4th, 1887, Dr. J. W. Batterham records a case in which there was a rupture of the coronary artery near the apex of the heart causing hæmopericardium. and in The Medical Times and Gazette of March, 1862, Mr. Osborne describes a case in which the coronary artery was ruptured near its origin from the aorta. The coronary artery is sometimes the seat of a small aneurysm which may rupture, and in the Transactions of the Pathological Society of London for 1871 Dr. Crisp has collected 11 cases, all occurring in males, and in 7 of which rupture took place into the pericardium. The failure of the right pulse beat in this case is very interesting and in the absence cf any other explanation must, I think, be attributed to the pressure of the extravasated blood upon the innominate artery. The swelling produced in this situation was very obvious after death and was probably greater during life as the blood continued to escape into it. While the patient was lying on her back with the head low the pressure was sufficient to obstruct the pulse in the innominate artery, but when she was turned on to the left side the blood in the pericardium flowed towards the apex and relieved the pressure sufficiently for the pulse to return. The tubular breathing heard at the right base behind may have been due to the pericardial effusion, but whether this sign was present on the left side also I am unable to say. Other noteworthy features in the case are the absence of angina and the fact that the patient had been able to take very active exercise in spite of the advanced fatty degeneration of the heart muscle and the extensive atheroma of the coronary vessels. Cambridge.