320 The Philippine Journal of Science 1921 
Sampson-Handley (39) operation for the establishing of a new 
lymphatic circulation; the second is the Kondoleon(i7) opera- 
tion. 
The first, so far as I am aware, has proved disappointing in 
cases of this kind. It consists in the insertion of silk threads 
leading from the area of lymph stasis into an area above the seat 
of obstruction. Dr. A. F. Cole, late of Ningpo, performed 
several of these operations on cases of this class. In the ones 
that succeeded there was considerable improvement in the size 
of the limb for the time being, but, so far as I am aware, all 
relapsed later. 
The Kondoleon(i7) operation gives more promise of success, 
but so far few operations of this kind have been performed in 
China. One has been reported by Bell, (4) who speaks favor- 
ably of the result, and several have been performed by Dr. E. J. 
Strick of Amoy, with good results ; but hardly sufficient time has 
elapsed for one to be able to judge of the final ending of the 
cases. The principle of the operation is the placing of the deep 
and the superficial lymphatics in connection by the removal of 
a large strip of the deep fascia. The fullest and best description 
of the operation will be found in two papers by Sistrunk, (41) 
of the Mayo Clinic, Rochester. Some of his results are very 
good, but they are in nonfilarial cases, and the amount of ob- 
struction at the back of the abdomen must have its influence in 
determining the final result. At one time it was hoped that 
the injection of fibrolysin would aid greatly in the treatment of 
cases of this class ; but, so far as I know, it has proved unavail- 
ing in producing permanent improvement. The same must also 
be said of the proposed anastomosis of veins and lymphatics 
about the saphenous opening. 
ELEPHANTIASIS OF THE ARMS 
Elephantiasis of the arms is very rare, and I have never seen 
a case in which I could be quite sure of the diagnosis. I have 
seen cellulitis of the. arm, of filarial origin, but the limb was not 
a typical case of elephantiasis, and I have not been able to obtain 
information of a well-marked case in China. 
Treatment is unsatisfactory and resolves itself into bandaging, 
massage, and suitable support. It is possible that the Kondo- 
leon operation might greatly benefit such a case. 
ELEPHANTIASIS OF THE MAMMiE 
Elephantiasis of the mammae also is very rare, and I have 
never met a case. Probably the smaller incidence of filarial 
