76 
PATHOLOGY: W. S. HALSTED 
With reference to the other Watson planets it may safely be asserted that 
excepting the need of further observations of Andromache for reasons stated 
above, all of these planets may be stricken from any observing program for 
decades to come, since they may readily be identified if science so demands, 
on the basis of the orbits and perturbations determined under the auspices of 
this academy. 
CONGENITAL ARTERIO-VENOUS AND LYMPHATICO-VENOUS 
FTSTULAE. UNIQUE CLINICAL AND EXPERIMENTAL 
OBSERVATIONS. 
By William S. Halsted 
Medical School, Johns Hopkins University 
Read before the Academy, November 18, 1918 
A. Advance of proximal arterial dilation conforming to shifted position of 
fistula. — Thanks to the assistance of highly competent secretaries I have ab- 
stracts of about 400 cases of arterio-venous fistula. These have been studied 
with special reference to occasional observations on the dilation of the arteries. 
In 52 instances proximal dilation of the arterial trunk has been noted. I am 
quite sure that in almost every instance in which the fistula had existed for 
two or more months proximal dilation of the artery would have been demon- 
strable if looked for. 
Congenital arterio-venous fistula is rare, particularly so when unassociated 
with naevus. We have been able to find reports of only 3 cases without and 
6 with naevus. Of the former none has been cured, unless we except a case 
(von Eiselsberg's) in which an attempt to cure a fistula between the popliteal 
artery and vein was followed by gangrene, necessitating amputation of the 
thigh. 
The following case, unique in several particulars, is reported to record the 
arterial changes observed at 2 operations, the second performed six and one- 
half years after the first. The patient, a girl aged eleven years, was operated 
upon November 15, 1911, for a congenital arterio-venous fistula below the 
angle of the jaw on the right side. After the removal of enormously dilated 
veins (lantern slide) it was found that the fistula was between one of these 
and the external carotid artery near the bifurcation or ventricle of the com- 
mon carotid. Fortunately a careful note was made of a very small anoma- 
lous, ascending branch given off from the external carotid just proximal to 
the fistula (lantern slide). There was great dilation of the common carotid 
artery and of the external carotid proximal to the fistula, whereas the internal 
carotid was surprisingly small (lantern slide). The vessels concerned in the 
fistula formation were excised, the aberrant artery happily being spared. The 
child was relieved by the operation of very distressing symptoms, but a few 
