The further clinical history and signs are as follows. A local swelling is found, usually at first diffuse, often commencing to develop with cessation of the external haemorrhage. It increases, for the first few days maintaining its diffuse character. If near the surface, it may be superficially ecchymosed. At the end of this time a tendency to localisation, as evidenced by increasing firmness and more definite margination, takes place, and this is followed by general contraction and rounding off of the tumour. The latter process may be continuous, and eventually the sac may become small and stationary or ultimately disappear and a pure varix be the result. The latter is only likely to be the case under the most satisfactory of the conditions enumerated above. Occasionally an opposite course may be followed, and fresh extension take place, as evidenced by enlargement of the tumour, disappearance of sharp definition, softening, and pain. The natural termination of such cases in the absence of interference would no doubt be rupture, and possibly death in some positions, loss of the limb in others. The former I never saw. _Purring thrill._--This, the pathognomonic sign of either condition, was always present in the fully developed stage, and is probably present from the first unless a temporary thrombosis obstructs the vascular openings. It was noted as early as the third day in case 13. In many of the other patients it was palpable only with the subsidence of the primary swelling attendant on the injury. In some of the forearm and calf aneurisms, and in some of the popliteal, it was only discovered by accident some weeks even after the injury, but this often because no serious vascular lesion had been suspected. The thrill was widely conducted, often apparently superficial on palpation, and much more pronounced with light than with forcible digital pressure. In case 10 the _visible_ vibration in consonance with the thrill when the vein was exposed during the operation of ligature of the carotid was a novel experience to me. _Murmur._--The typical 'bee in the bag,' or 'machinery' murmur was present in every case, and was often very widely distributed, especially over the thorax. (Cases 13, 14, and 20.) In all three carotid cases the murmur was troublesome, being audible to the patient at night when the head was rested on the side corresponding to the aneurism. _Expansile pulsation._--Pulsation in combination with the existence of a tumour is the main feature in the diagnosis between the conditions of pure varix and varicose aneurism. It was not always existent or prominent in the earliest stages, probably from temporary blocking of the artery, or from the diffuse and irregular nature of the cavity offering conditions unsuitable to the satisfactory transmission of the wave. When localisation had occurred it was always present. EFFECTS OF ANEURISMAL VARIX OR VARICOSE ANEURISM ON THE CIRCULATION