THIS case seems to be worthy of being recorded on account of the unusual weight and size of the heart. The patient was a man, aged 20 years, who was admitted into the Liverpool Poor-law infirmary on Sept. 23rd, 1905, in a collapsed state and suffering from vomiting and hæmoptysis. The physical signs referable to the heart were apical thrill, epigastric pulsation, evidence of failing compensation, double mitral and aortic murmurs, and cardiac dyspnoea. There was no cedema of any part of the body

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... except at the bases of the lungs. The liver and spleen were slightly enlarged ; the urine was normal. The previous history was to the effect that he had an attack of rheumatism a few years ago. The gastric symptoms passed away under treatment but the patient gradually became worse, his dyspnœa, and nausea could not be controlled, and he died on Oct. 15th. At the necropsy his heart was found to be greatly hypertrophied with dilatation. It weighed 35 ounces when full of clot and 30-2L ounces without the clot. The muscular fibres were hypertrophied ; the mitral and aortic valves were a mass of calcareous plaques, and the other organs showed signs of extreme congestion and enlargement. Liverpool. A BRIE reference to what may be called a very perfect example of this rare vestigium will, no doubt, be of interest to some readers of THE LANCET. I met with it in an adult male Indian of Dravidian stock who displayed no other physical defect. This supernumerary eyelid was situated under the right upper eyelid and protruded when the eye was in natural function two millimetres beyond the margin of the natural lid. This exposed part which led to the discovery was darker than the rest of the structure, the latter approximating to the colour of the conjunctiva. It was normally sensitive and cartilaginous to the touch. Of the thickness of a sixpence it evenly and completely followed the contour and movement of the upper lid, lying closely over the globe without fold or corrugation on either surface and with a clean-cut margin at its periphery. From a perusal of the above it will be recognised that the condition was an example of the plica semilunaris or membrana nictitans of birds and reptiles. It will be remembered that the conjunctiva is developed from the surface epiblast and that the membrana nictitans divides the conjunctival sac into two portions in birds and reptiles. I think it will be admitted that this survival is a striking proof, perhaps unique of its kind, of the evolutionary element in nature. Environment, I suppose, would be cited in this connexion. Durban, Natal.