184 
PATHOLOGY: W. S. HALSTED 
Proc. N. a. S. 
the advent of the swelHng which occurs after an interval the discovery 
would undoubtedly have been made long ago of the relationship of in- 
fection to the swelling of the arm. But an infection quite negative in 
external manifestations other than swelling may I believe exist and suffice 
to produce the further blocking which in my opinion is essential to the 
production of the swelling. 
In a word, then, I have thought it unlikely that the excision of the axil- 
lary contents, lymphatics and veins, could alone be responsible for the 
swelling of the arm which is observed after the radical operation for cancer 
of the breast in non-recurrent cases.** 
Thirty-five years ago (in 1887) I successfully transplanted the hind leg 
of a dog from one side to the other, leaving however the main artery intact 
for a few days — until union between the muscles and other divided tissues 
had taken place. And in more recent times (1907) Carrel, with the aid 
of his vascular suture, made the remarkable discovery that the leg from 
one dog can be transplanted to another. 
The operative work in the current experiments has been done by my 
assistants. Dr. F. L. Reichert, Dr. Mont Reid and Dr. C. Y. Bidgood. 
The arterial and lymphatic injections, the preparation of the specimens, 
the X-ray studies are all the work of Dr. Reichert. 
At the outset of our experiments I had it in mind merely to determine 
the amount and duration of the swelling which would follow the division 
of all the lymphatics and veins of the thigh. At the primary operations 
all the soft tissues except the femoral artery and vein and the sciatic nerve 
were divided and immediately reunited by suture. On the second day 
after the replantation the femoral vein was tied in two dogs; in one of 
these gangrene promptly followed the ligation. Then on the fourth day 
after replantation the experiment of ligating the femoral vein was twice 
made; gangrene resulted in one of these dogs. Ligations on the 5th, 
6th, 7th, 9th, and 11th days and at later periods have not been followed 
by gangrene; and if performed as late as the 9th day, by Uttle or no in- 
crease in the size of the limb. Replantation and simultaneous ligation 
of the femoral vein was invariably followed by gangrene — 6 cases. 
In one case the femoral artery and vein were ligated simultaneously 
with the replanting — gangrene followed. Both femoral vessels may be 
safely ligated on the 6th day, and probably earlier. 
In one instance the replantation was successful notwithstanding the 
fact that the femoral artery and vein had become totally obliterated by 
ligation of these vessels 7 months previously. 
As the possibility of an anastomotic circulation by way of the bone and 
sciatic nerve naturally occurred to us. Dr. Reid, in one dog, divided these 
structures as well as the others. The replantation was successful. 
To Dr. Reichert and Dr. Bidgood belongs the credit for the discovery 
