My assistant at the time treated the case for muscular rheu-
matism. The patient in question had come complaining of
pain in the muscles of the right arm, radiating from the right
pectoral region over the deltoid to the forearm. The history
was simple enough. The patient, while engaged in driving
a hard-mouthed horse, had suddenly felt *' something give
way " in the right pectoral region, or, as he described it, near
the right shoulder joint. From that time he experienced
dull pain of an aching character in both arm and forearm, in
consequence of which he attended at my house and consulted
my assistant, who deemed the case one of muscular rheuma-
tism, and prescribed for him accordingly. No benefit however
accruing, the patient solicited my attendance at his home,
and I found him evidently suffering great pain. I noticed
that his pulse was smaller on the right than on the left
side ; and on further proceeding to examine his heart I found
aortic bruit, and also a pulsating tumour in the second right
inter-costal space near the sternum. This latter feature
of the case was conclusive, clearly indicating an aneurism of
the ascending aorta. The case on the whole presented some
similarity to that quoted by Dr. Scott ; but I may recall here
that on examining the latter case I found kindred symptoms
of cardiac lesion present, but without tumefaction or pain.
Dr. Seymour Taylor : In considering this case we find, in
addition to the cardiac bruits, very strong evidence of aneur-
ism, viz., inequality of the radial pulses, cardiac displacement
downwards and outwards, characteristic thrill, pain, and
certain pressure signs, such as inequality of the pupils.
