13 patient was seized with a convulsive attack, which the iriends described as a fit of ague, and died somewhat suddenly. Only a very limited post-mortem examination was allowed. A large rounded tumour was found on the front of the abdominal aorta, communicating with it by a large opening. It was situated just below the liver and ,close to the pylorus. The sac had ruptured into the stomach, the opening being large enough to admit a finger. The stomach was full of dark coagulated blood, some

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... 'being found in the intestines. Notwithstanding the fact that this tumour had been gradually developing for two years, and that the patient had also suffered from what he termed " lumbago of the spine," he had no idea of the nature ,of his complaint, though his brother afterwards told me that he suspected aneurysm the last time he saw him previously to his fatal illness. I think there can be no doubt that in this case the sac had partially ruptured before I first saw the patient. A clot probably formed and plugged the opening until it was -displaced on the occasion of the subsequent haemorrhage. This would disprove the view, held by some physicians, that 'in cases of aortic aneurysm there are no preliminary hæmorrhages, but that the rupture of the sac takes place suddenly, followed at once by bleeding and death. I may also -mention a case I saw in Professor Fraser's wards in the Edinburgh Royal Infirmary in the winter of 1881-82, in which preliminary haemorrhages occurred. At the clinical lecture delivered upon the case the post-mortem specimen was shown. There was a large aortic aneurysm which had .pressed upon the œsophagus, interfering greatly with deglutition. The sac ruptured into the gullet through two openings, causing haemorrhage and death, but I am unable to state if one opening formed sooner than the other. It would seem somewhat remarkable that a large vessel like the aorta could rupture without causing immediate death, .and yet there can be no doubt of it from this case. Further, in THE LANCET of Oct. 30th, 188G, page 814, there is a case described by Dr. W. A. Holmes, in which a rupture fiveeighths of an inch in length apparently occurred threequarters of an hour before death, and the pericardium was 'found on post-mortem examination to be filled with coagulated blood. In his remarks upon the case Dr. Holmes .n,dds : " I have seen a specimen where the aorta ruptured, and the patient recovered and lived for months after, but -died from a subsequent rupture." It is interesting to note that in the case of my patient there were hardly any of the -secondary effects or evidences of pressure developed. There was a certain amount of emaciation, but no signs of dropsy or displacement of organs. This was no doubt due to the development of the sac in the abdomen, where there is room 'for large tumours to appear gradually, without much alteration of viscera. In the thorax there would, of -course, have been interference with respiration and other symptoms of pressure. Bilston. ______________ .