larger trunks the lymph may escape in considerable quantity as a
colourless, watery fluid--_lymphorrhagia_; and the opening through which
it escapes is known as a _lymphatic fistula_. This has been observed
chiefly after extensive operation for the removal of malignant glands in
the groin where there already exists a considerable degree of
obstruction to the lymph stream, and in such cases the lymph, including
that which has accumulated in the vessels of the limb, may escape in
such abundance as to soak through large dressings and delay healing.
Ultimately new lymph channels are formed, so that at the end of from
four to six weeks the discharge of lymph ceases and the wound heals.

_Lymphatic Oedema._--When the lymphatic return from a limb has been
seriously interfered with,--as, for example, when the axillary contents
has been completely cleared out in operating for cancer of the
breast,--a condition of lymphatic oedema may result, the arm becoming
swollen, tight, and heavy.

Various degrees of the conditions are met with; in the severe forms,
there is pain, as well as incapacity of the limb. As in ordinary oedema,
the condition is relieved by elevation of the limb, but not nearly to
the same degree; in time the tissues become so hard and tense as
scarcely to pit on pressure; this is in part due to the formation of new
connective tissue and hypertrophy of the skin; in advanced cases there
is a gradual transition into one form of elephantiasis.

Handley has devised a method of treatment--_lymphangioplasty_--the
object of which is to drain the lymph by embedding a number of silk
threads in the subcutaneous cellular tissue.

#Wounds of the Thoracic Duct.#--The thoracic duct usually opens at the
angle formed by the junction of the left internal jugular and subclavian
veins, but it may open into either of these vessels by one or by several
channels, or the duct may be double throughout its course. There is a
smaller duct on the right side--the right lymphatic duct. The duct or
ducts may be displaced by a tumour or a mass of enlarged glands, and may
be accidentally wounded in dissections at the root of the neck; jets of
milky fluid--chyle--may at once escape from it. The jets are rhythmical
and coincide with expiration. The injury may, however, not be observed
at the time of operation, but later through the dressings being soaked
with chyle--_chylorrhoea_. If the wound involves the only existing main
duct and all the chy