-Fat-embolism in its lesser degrees is speedily and spontaneously re covered from. When the symptoms are severe, the chances of recovery are slight.
If the patient survives for forty-eight hours, recovery is probable.
— To prevent this acci dent to any great degree is the first indi cation. To this end the injured part should be immobilized, and free drainage should afford relief from any undue ten sion. The vital powers, especially the heart-action, are best sustained and stim ulated by alcohol, digitalis, and strych nine in full doses.
Phlegmasia Alba Dolens.—Phlegmasia alba dolens (milk-leg; white leg; marble leg) is the term applied to a swelling of one or both lower extremities, beginning either at the ankle and ascending or at the groin and extending down the thigh, occurring usually between the tenth and twentieth days after confinement, and characterized by pain, tension of the skin, and a milk-like whiteness of the surface. The popular name "white leg" was received from its color when it was supposed to be due to a metastasis of milk. As the surface is glossy, as well as white, resembling that of polished mar ble, the disease is sometimes called "mar -As a rule, this affection is preceded by a slight access of febrile phenomena, but its onset may, as an ex ception, be announced by a chill or dis tinct rigor. Sometimes an indefinite feeling of malaise, with gastric disturb ance, anorexia, coated tongue, and consti pation, will be present for a day or two, before the pain in the limb is complained of. Another premonitory symptom may be present, namely: pain and tenderness in the region of the womb, especially marked on that side corresponding to the limb about to become affected. The first characteristic symptom is the develop ment in the limb of a dull, dragging pain, which is increased by motion. This soon develops, as a rule, into acute pain along the course of the femoral vein, in the calf, or above the ankle, according to the locality in which the affection originates. In these situations the thrombosed veins can frequently be felt, but not invariably, for the tenderness or the swelling may prevent its being made out. The pain and tenderness extend all over the af fected parts, which may be the whole limb, causing a feeling as of aching in the bones. The pain is sometimes along
the internal saphenous vein, which may be traced till it dips to join the femoral.
Concurrently with the appearance of pain, or within a day or two after it, swelling is observed, which gradually spreads and increases in hardness. This swelling does not resemble ordinary oedema or anasarca as to the sensation it communicates to the hand of the phy sician, or in the history of its commence ment and progress. When it first appears, and again, as it disappears, it may be soft and may pit on pressure; later, when it is fully developed, a few days after its appearance, it is very tense and resilient, nearly as hard as a solid India-rubber ball, and does not pit on pressure. The swelling may spread at once all over the limb, but frequently it either commences above at Poupart's ligament and spreads downward or at the ankle and ascends. It is not often that the lower portion of a limb alone is affected; involvement of the upper parts alone is likewise very rare. The swelling affects all parts of the limb evenly, and rounds off its figure, but does not distend the skin or destroy the form as in anasarca. Coagulable lymph exudes if the skin be pricked. An erythematous blush is occasionally no ticed over parts of the limb, but this is not common, and may be confined to a narrow path along the course of a sub cutaneous vein or a lymphatic vessel.
The limb may be kept in a state of ex tension or of slight flexion. Movement of it causes considerable suffering, and the power of voluntary motion is almost completely lost while the disease con tinues. The ordinary termination of this disorder is by absorption of the thrombus, with restoration of the circulation.
At the expiration of from five to ten days the symptoms begin to abate, the pain and swelling diminishing. The rate at which this proceeds varies greatly, be ing probably more or less directly in pro portion as the permeability of the vessels is restored. In a favorable case it may be several weeks before the disease disap pears; in other cases further or even in definite delay may occur. The febrile movement in this disease is not usually severe; the temperature rarely exceeds 102° F., and is often less.