le escapes, the patient suffers from intense thirst,
emaciation, and weakness, and may die of inanition; but if, as is
usually the case, only one of several collateral channels is implicated,
the loss of chyle may be of little moment, as the discharge usually
ceases. If the wound heals so that the chyle is prevented from escaping,
a fluctuating swelling may form beneath the scar; in course of time it
gradually disappears.

An attempt should be made to close the wound in the duct by means of a
fine suture; failing this, the duct must be occluded by a ligature as if
it were a bleeding artery. The tissues are then stitched over it and the
skin wound accurately closed, so as to obtain primary union, firm
pressure being applied by dressings and an elastic webbing bandage. Even
if the main duct is obliterated, a collateral circulation is usually
established. A wound of the right lymphatic duct is of less importance.

_Subcutaneous rupture of the thoracic duct_ may result from a crush of
the thorax. The chyle escapes and accumulates in the cellular tissue of
the posterior mediastinum, behind the peritoneum, in the pleural cavity
(_chylo-thorax_), or in the peritoneal cavity (_chylous ascites_). There
are physical signs of fluid in one or other of these situations, but, as
a rule, the nature of the lesion is only recognised when chyle is
withdrawn by the exploring needle.

DISEASES OF LYMPH VESSELS

#Lymphangitis.#--Inflammation of peripheral lymph vessels usually
results from some primary source of pyogenic infection in the skin. This
may be a wound or a purulent blister, and the streptococcus pyogenes is
the organism most frequently present. _Septic_ lymphangitis is commonly
met with in those who, from the nature of their occupation, handle
infective material. A _gonococcal_ form has been observed in those
suffering from gonorrhoea.

The inflammation affects chiefly the walls of the vessels, and is
attended with clotting of the lymph. There is also some degree of
inflammation of the surrounding cellular tissue--_peri-lymphangitis_.
One or more abscesses may form along the course of the vessels, or a
spreading cellulitis may supervene.

The _clinical features_ resemble those of other pyogenic infections, and
there are wavy red lines running from the source of infection towards
the nearest lymph glands. These correspond to the inflamed vessels, and
are the seat of burning pain and tenderness. The associated glands are