Abbe shows a peculiar aneurysmal varix of the finger in a boy of nine. When a babe the patient had, on the dorsum of the little finger, a small nevus, which was quiescent for many years. He received a deep cut at the base of the thumb, and immediately after this accident the nevus began to enlarge rapidly. But for the local aneurysmal thrill at the point of the scar the condition would have been diagnosed as angioma, but as a bruit could be heard over the entire mass it was called an aneurysmal varix, because it was believed there was a connection between a rather large artery and a vein close to the mass. There is a curious case reported of cirsoid tumor of the ear of a boy of thirteen. Figure 259 shows the appearance before and after operation.

Jessop records a remarkable case of multiple aneurysm. This case was particularly interesting as it was accompanied by a postmortem examination. Pye-Smith reports an extremely interesting case in which death occurred from traumatic aneurysm of an aberrant subclavian artery. The patient fell from a height of 28 feet, lost consciousness for a few minutes, but soon recovered it. There was no evidence of any fracture, but the man suffered greatly from dyspnea, pain between the shoulders, and collapse. The breath-sounds on auscultation and the difficulty in swallowing led to the belief that one of the bronchi was blocked by the pressure of a hematoma. Dyspnea continued to increase, and eighteen days after admission the man was in great distress, very little air entering the chest. He had no pulse at the right wrist, and Pye-Smith was unable to feel either the temporal or carotid beats on the right side, although these vessels were felt pulsating on the left side. Laryngotomy was done with the hope of removing a foreign body, but the man died on the tenth day. A postmortem examination disclosed the existence of an aberrant right subclavian artery in the posterior mediastinum, and this was the seat of a traumatic aneurysm that had ruptured into the esophagus.

Relative to the size of an aneurysm, Warren reported a case of the abdominal aorta which commenced at the origin of the celiac axis and passed on to the surfaces of the psoas and iliac muscles, descending to the middle of the thigh The total length of the aneurysm was 19 inches, and it measured 18 inches in circumference.

A peculiar sequence of an aortic aneurysm is perforation of the sternum or rib. Webb mentions an Irish woman who died of aneurysm of the aorta, which had perforated the sternum, the orifice being plugged by a large clot. He quotes 17 similar cases which he has collected as occurring from 1749 to 1874, and notes that one of the patients lived seven weeks after the rupture of the aneurysmal sac.

Large Uterine Tumors.--Before the meeting of the American Medical Association held in Washington, D.C., 1891, McIntyre a reported a case of great interest. The patient, a woman of thirty-eight, five feet 5 1/2 inches in height, coarse, with masculine features, having hair on her upper lip and chin, and weighing 199 1/2 pounds, was found in a poor-house in Trenton, Missouri, on November 26, 1890, suffering from a colossal growth of the abdomen. The accompanying illustration is from a photograph which was taken at the time of the first interview. The measurements made at the time were as follows: circumference at the largest part, just below the umbilicus, 50 inches; circumference just below the mammae, 35 inches; from the xiphoid cartilage to the symphysis pubis, 32 inches, not including the appendum, which is shown in the picture. Percussion suggested a fluid within a sac. The uterus was drawn up to the extent of from 12 to 14 inches. The woman walked with great difficulty and with a waddling gait, bending far backward the better to keep "the center of gravity within the base," and to enable her to sustain the enormous weight of the abdomen. She was compelled to pass her urine while standing. Attempts had been made six and two years before to tap this woman, but only a few drops of blood followed several thrusts of a large trocar. A diagnosis was made of multilocular ovarian cyst or edematous myoma of the uterus, and on the morning of December 7, 1890, an operation was performed. An incision 14 inches in length was first made in the linea alba, below the umbilicus, and afterward extended up to the xiphoid cartilage. The hemorrhage from the abdominal wall was very free, and the enormously distended vessels required the application of a large number of pressure-forceps. Adhesions were found almost everywhere the most difficult to manage being those of the liver and diaphragm. The broad ligaments and Fallopian tubes were ligated on either side, the tumor turned out, the thick, heavy pedicle transfixed and ligated, and the enormous growth cut away. After operation the woman was immediately placed on platform scales, and it was found that she had lost 93 1/2 pounds. Unfortunately the patient developed symptoms of septicemia and died on the fifth day. In looking over the literature on this subject McIntyre found no mention of any solid tumor of this size having been removed. On April 18, 1881, Keith, late of Edinburgh, now of London, successfully removed an edematous myoma, together with the uterus, which was 42 pounds in weight. In a recent work Tait remarks that the largest uterine myoma which he ever removed weighed 68 pounds, and adds that it grew after the menopause. McIntyre believes that his tumor, weighing 93 1/2 pounds, is the largest yet reported. Eastman reports the removal of a fibroid tumor of the uterus weighing 60 pounds. The patient recovered from the operation.

It is quite possible for a fibrocyst of the uterus to attain an enormous size, equaling the ovarian cysts. Stockard describes an instance of this nature in a negress of fifty, the mother of several children. About twelve years before a cyst in the right iliac region was tapped. The woman presented the following appearance: The navel hung below her knees, and the skin near the umbilicus resembled that of an elephant. The abdomen in its largest circumference measured 68 inches, and 27 inches from the ensiform cartilage to the umbilicus. The umbilicus was five inches in diameter and three inches in length. Eight gallons and seven pints of fluid were removed by tapping, much remaining. The whole tumor weighed 135 pounds. Death from exhaustion followed on the sixth day after the tapping.

Ovarian cysts, of which by far the greater number are of the glandular variety, form extremely large tumors; ovarian dropsies of enormous dimensions are recorded repeatedly throughout medical literature. Among the older writers Ford mentions an instance of ovarian dropsy from which, by repeated operations, 2786 pints of water were drawn. Martineau describes a remarkable case of twenty-five years' duration, in which 80 paracenteses were performed and 6630 pints of fluid were withdrawn. In one year alone 495 pints were withdrawn. Tozzetti mentions an ovarian tumor weighing 150 pounds. Morand speaks of an ovarian cyst from which, in ten months, 427 pounds of fluid were withdrawn. There are old records of tubal cysts weighing over 100 pounds. Normand speaks of an ovary degenerating into a scirrhous mass weighing 55 pounds. Among recent operations Briddon describes the removal of an ovarian cyst which weighed 152 pounds, death resulting. Helmuth mentions an ovarian cyst from which, in 12 tappings, 559 pounds of fluid were withdrawn. Delivery was effected by instrumental aid. The tumor of 70 pounds was removed and death followed. McGillicuddy mentions a case of ovarian cyst containing 132 pounds of fluid. The patient was a woman of twenty-eight whose abdomen at the umbilicus measured 69 inches in circumference and 47 inches from the sternum to the pubes. Before the operation the great tumor hung down as far as the knees, the abdominal wall chafing the thighs. Figure 263 shows the appearance of a large ovarian cyst weighing 149 pounds. The emaciation of the subject is particularly noticeable. Reifsnyder describes a native Chinese woman affected with an ovarian tumor seen at the Margaret Williamson Hospital at Shanghai. She was four feet eight inches in height, and twenty-five years of age. The tumor had been growing for six years until the circumference at the umbilicus measured five feet 7 3/4 inches; 88 quarts of fluid were drawn off and the woman recovered. In the College of Physicians, Philadelphia, there are photographs of this case, with an inscription saying that the patient was a young Chinese woman who measured but four feet eight inches in height, while her girth was increased by an ovarian cyst to five feet 9 1/8 inches. The tumor was removed and weighed 182 1/2 pounds; it contained 22 gallons of fluid. Figure 265 shows the appearance of the woman two months after the operation, when the girth was reduced to normal. Stone performed ovariotomy on a girl of fifteen, removing a tumor weighing 81 1/2 pounds. Ranney speaks of the successful removal of a unilocular tumor weighing 95 pounds; and Wall tells of a death after removal of an ovarian tumor of the same weight. Rodenstein portrays the appearance of a patient of forty-five after death from an enormous glandular ovarian cystoma. The tumor was three feet high, covered the breasts, extended to the knees, and weighed 146 pounds. Kelly speaks of a cyst weighing 116 pounds; Keith one of 89 1/2 pounds; Gregory, 80 pounds; Boerstler, 65 pounds; Bixby, 70 pounds; and Alston a tumor of 70 pounds removed in the second operation of ovariotomy.

Dayot reports the removal of an enormous ovarian cyst from a girl of seventeen. The tumor had been present three years, but the patient and her family refused an operation until the size of the tumor alarmed them. Its largest circumference was five feet 11 inches. The distance from the xiphoid to the symphysis pubis was three feet. The tumor was covered with veins the size of the little finger. The apex of the heart was pushed to the 3d interspace and the umbilicus had disappeared. There were 65 quarts of a thick, brown fluid in. the tumor. The patient recovered in twenty-five days.

(Editor：law)