DIAGNOSIS.—The diagnosis of this dis order is usually easy, if the history of the disease is carefully considered. (Edema with phlebitis or accompanying varicose veins may resemble it, but the history of the case will usually differentiate them.
ETIOLOGY.—This disorder is most fre quently observed during pregnancy and the puerperal period. Its appearance is probably favored by the hydrtemic con dition of the blood which prevails during the former period, and on the natural formation of thrombi in the uterine sinuses at its termination. Other condi tions favor the appearance of phlegmasia dolens: convalescence from fevers—espe cially typhoid, dysentery, disease of the rectum, malignant uterine disease, uter ine fibroids, arrest of the menses, and gen eral malignant or tubercular disease. The disease has frequently been observed to affect the leg on the side correspond ing with a previously-commenced pleu risy. When this disease occurs in con nection with malignant disease of the uterus, it often assumes a light and chronic form.
Twelve per cent. of one hundred and thirty-five soldiers treated for typhoid fever in the Pennsylvania Hospital suf fered from milk-leg. This is six or eight times as frequent an occurrence of this complication as has generally been no ticed. No sufficient reason could be as signed for this. This trouble has usually been ascribed to phlebitis, but there is not necessarily any inflammation of the vein antecedent to the thrombosis. Da Costa (Inter. Med. Mag., Jan., '99).
—In some eases this dis order may be considered as the extension of an inflammatory process from the genitalia to the perineum, the nates, and the upper portion of the thigh. If this be confined to the subcutaneous and in termuscular cellular tissue, the vessels may not become affected. If, however, the morbid changes follow the sheaths of the vessels, the walls of both veins and lymphatics become thickened, and in most cases secondary thrombosis results. In other cases thrombosis is apparently the initial lesion. It may occur spon taneously from a retardation of the blood current; the presence of varicose veins will favor thrombosis. The crural and
its branches, the tibial and the peroneal veins are the vessels usually involved. The intravenous coagula may, however, take their origin at the placental site, and, extending along the pampiniform plexus to the hypogast•ic vein. may thence occlude the crural vein to Pou part's ligament, or, passing upward by the spermatic veins, they may obstruct the vena cars. In some instances the occlusion of one crural vein is followed by occlusion in the other; in that case phlegmasia develops in both extremities. From our present information, no theory of the disease can be regarded as absolute, definite, or exact.
— Among the less grave complications of this disease are in flammation and suppuration of the in trinsic joints of the pelvis, erysipelas, limited abscesses of periphlebitie origin, diffuse suppuration of the connective tis sue, and gangrene of any part or of a varying amount of the entire lower por tions of the affected limb. The more fatal complications are embolism and pyremia. The former is consequent upon the detachment of a thrombus in the femoral, or in still larger veins, or of a slower breaking up of blood-clots into debris, more or less puriform, which en ters the circulatory current, and induces a general toxaemia, septic or non-septic, according to the conditions under which the clots suppurate.
—The most frequent sequel of this affection is persistent aching of the limb, which is increased by cold, dampness, derangement of the health, and exercise; more or less persistent oedema of the ankles, deficient muscular power, and even wasting of the limb have been observed. As a rare exception, great hypertrophy of the cellular or con nective tissue has been noticed, simul taneous with muscular atrophy; this cel lular hypertrophy may be associated with more or less extensive and intractable ulceration, which probably result from permanent destruction of large vascular areas (Duncan and Gervis).