The question of the treatment of elephantiasis has been a puzzling one for many years. The decision as to method is not greatly influenced by consideration of the etiologic factors of the disease, which is always due to an obstruction of the normal lymph channels and subsequent swelling of the extremity. For the purpose of classification, lymphedema may be stated to be due (1) to filariasis; (2) to inflammatory or scar tissue obstructing the normal lymph channels, as occurs commonly after radical operations on the breast, and (3) to some obscure lesion that obstructs the lymph channels. The last, which may be called idiopathic, is a very small class. The kind following phlegmasia alba dolens is not considered here, as this is far more venous than lymphatic in origin.
The problem of surgical treatment in cases of lymphedema has long taxed the ingenuity of surgeons. The subject assumes greater importance