Circulatory disturbances are comparatively rare symptoms in cases of cervical rib. According to the figures published by Adson and Coffey,1 they were present in seventeen of 303 cases (5.6 per cent). Four of these seventeen occurred among 100 patients who presented only mild complaints which did not necessitate surgical intervention, while the other thirteen belonged to a group of thirty-six patients on whom operation had been performed. Thus circulatory disturbances were nine times as frequent in those patients with characteristic symptoms. Other symptoms also occurred more often in the group subjected to operation, the figures for muscular atrophy being 12 and 22 per cent for the two groups. The greater increase in the incidence of circulatory disturbances seems to suggest their importance as an indication for surgical treatment. These vascular phenomena vary from a slight discoloration of the hand to gangrene of one or more fingers. In his monograph