PHLEBITIS.
Rest of the affected limb as the patient lies in bed is essential. Where the veins of the leg are involved, the entire limb from the toes to the trunk should be kept in a state of repose by sand-bags or, if necessary, by splints. The limb should be elevated by raising the foot of the bed, the mattress or palliasse. In mild cases strong Tincture of Iodine brushed over the course of the inflamed vein often affords speedy relief. In severe cases Iodine in weaker solution may be once brushed over the course of the affected vein, after which hot fomentations a few hours later on may be tried if the pain be very acute. The best routine method of treating severe cases of extensive phlebitis, arising out of varicose veins, is to envelop the entire leg in warm absorbent wool, over which a layer of thin mackintosh is spread so as to cover completely at every point the wool from the toes to the groin. This dressing is kept in accurate position by the even pressure of a many-tailed bandage, and once in every 24 hours is quite enough for changing the dressing.
Poultices and fornentations are certainly much inferior to this method. and should only be applied when suppuration occurs. When the pain remains severe, much comfort may be obtained by painting the skin over the inflamed veins with a cream made of Green Extract of Belladonna rubbed up with twice its weight of Glycerin. Friction and massage must not be employed, the great danger in simple non-septic cases being detachment of the thrombus, which may be swept onwards to the heart.
Fischer applies Zinc Gelatin, and over this a bandage is very firmly applied. Embolism during the application of the bandage is prevented by pressure of the finger on the vein. He states that notwithstanding the enormous pressure of the bandage it is astonishing how it is borne without pain, even where there had been great tenderness. The patient is permitted to move about next day.
Ammonia possesses a solvent power upon the blood-clot, and it may be given in the following form: mmonire Garb. 3ij.
Spiritus Ammon. Ar.
Potassii lodidi 3ij.
Hazelini Glycerini et Aqucv ad 5vj. Misce.
Fiat mistura. Signa.—" Two teaspoonfuls in a large wine glassful of water four times a day, after food." In the case of simple phlebitis of the leg where an operation is indicated otherwise, it may be undertaken after the inflammation has settled down provided the removal be begun by a ligature of the internal saphenous vein and that no instrument be used within the lumen of the vessel.
Where the phlebitis is septic the great danger is that of pyrnic infection from septic emboli. To prevent this the vein should be ligatured well above the inflamed spot. This having been done, the diseased patch may be excised. or if this he inadvisable it may be opened and the septic clot removed. Abscesses must be freely incised as they appear, and attention should be directed to the antiseptic management of any ulcer, wound or injury to which the phlebitis is secondary. Amputation of a limb may be the only resource open to the surgeon in order to save life.
After 3 weeks' rest, cedema and local thickening may be removed by the pressure of an india-rubber bandage. This is much to he preferred to the ordinary elastic stocking. Strapping the limb with Mercurial Plaster hastens the absorption of effused inflammatory products, and benefit may be obtained from the internal administration of large doses of Iron, Quinine or Iodides. The rubber bandage should be worn till long after the disappearance of all thickening, and in the case of varicose veins it should be used daily for the remainder of the patient's life, unless a radical operation for the removal of the veins be carried out long after the subsidence of the phlebitis.
In phlebitis of the lateral sinus from suppurative disease of the middle ear the first step must always be the ligature of the internal jugular vein, and then the mastoid cells should be freely opened up and all diseased tissue and thrombi removed.