PHLEBITIS, or INFLAMMATION OF. THE VEINS (Gr. phlebs, a vein), although seldom an original or idiopathic disease, is a frequent sequence of wounds, in which ease it is termed traumatic phlebitis (from the Greek trauma, a wound), and is not uncommon after delivery. The disease is indicated by great tenderness and pain along the course of the affected vessel, which feels like a hard knotted cord, and rolls under the fingers. The hardness is, however, sometimes obscured by the swelling of the limb beyond and about the seat of the disorder, partly in consequence of the effusion of serum caused by the obstruction to the return to the venous blood (which thus gives rise to a local dropsy), and partly in consequence of the propagation of the inflammation to the surrounding tissues. The inner surface of the inflamed vessel is supposed to throw out fibrinous fluid, which coagulates in layers, and finally closes the tube. If the vessel is'small, the consequences of its obstruction may be of little importance, but when a large vein is affected, the consequences are always dangerous, and may 'be fatal.
There are two modes of recovery: solution of the coagulated fibrine may take place, and the vessel may again become pervious; or, as is more commonly the case, the obstruction may continue, but a collateral venus circulation may be established, and the circulation thus carried on through a circuitous route. With the return of the circula tion—ill whichever of these two ways it is accomplished—the swelling sobs-ides, and the patient gradually recovers. If, however, the disease advances, suppuration takes place within the coagulant, and one of two things happens; either abscesses are formed along the vein, or the pus gets into the current of blood and contaminates the circulation, giving rise to the perilous disease known as pycenia (q.v.). Either condition is dangerous; the latter pre-eminently so.
Phlebitis generally originates in some local injury of a vein, and the inflammation, when once established, is readily propagated along the course of the vessel. Sometimes
very slight injuries give rise to it. It occasionally occurs after venesection, especially with a dull lancet, or one soiled by contact with diseased matter, Women are peculiarly liable to this disease after delivery, as the •veins of the womb am apt to become inflamed, and to commLnicate the inflammation to the venous trunks connected with them. See Pit LEGMASIA.
There is considerable difference of opinion as to the treatment to be pursued; some high authorities (Dr. Wood, for e:ample) recommending " the very free use of leeches along the affected vein," and that they "should be repeated over and over again if the symptoms of inflammation shodid persevere," the subsequent application of cold lotions, and the internal use of mercury- " pushed to a moderate salivation ;" while others question the utility of such treatment, and recommend "rest, warm fomentations, and poultices, early incision of abscesses, cvacutiou of bile and feces by one or two doses of calomel, opium to relieve pain and insure quiet of mind and body, and wine, especially if there has been great loss of blood."—Druitt's Surgeon's Trade Mecum, 8th ed. p. 326. The latter is in most cases the preferable mode of treatment. During convalesceuse, the patient must be satisfied if the swelling goes down slowly. Time is required for the enlargement of the veins by which the collateral circulation is to he carried on, and active counter-irritation, such as the application of ointments of iodine or mercury, if employed incautiously, frequently does halm by increasing the inflammation, With care, how ever. they are useful appliances; and if, after giving them a fair trial, much swelling should remain, the practitioner must have recourse to carefully regulated bandaging, and the use of diuretics.