PHLEGMASIA ALBA DOLENS.
This should be regarded as a septic phlebitis with plugging of the femoral vein, which must he on the principles mentioned in the preceding article.
It is usually met with as a complication of the puerperal state. and the general condition of the lying-in patient should receive careful attention, and no harm can come of the physi( ian insisting upon thorough irrigation of the vagina, and in special cases of the uterus, with some mild and un irritating antiseptic solution as weak Condy's Fluid or Boracic Acid, if such have not already been employed, provided always that its application does not interfere with the chief measure— i.e., rest. This is to be as complete and thorough as possible. If the patient has already got up and moved about she must be put again to bed, and kept lying on the back with the limb elevated by raising the foot of the bed with blocks.
Fever should be met by full doses of Quinine, or a diaphoretic mixtc re containing 3 mins. of Tincture of Aconite and 3 or 4 mins. of Solution of Morphia, with Spirit of Nitre and Mindererus Spirit, should be prescribed. A good routine treatment will be to put the patient upon a pill consisting of 3 gr. Extract of Opium, and ..21- grs. of Quinine every six or eight hours. A smart Saline purgative should be administered from time to time, and in severe cases the child should be weaned.
Local treatment should not he too active; any method of treatment necessitating frequent manipulations or changes of posture of the affected limb is to be owing to the danger of dislodging clots or thrombi. The best method to pursue is that just mentioned under the head of Phlebitis. The limb is to he carefully covered from the toes to the groin with a uniformly thick layer of absorbent cotton-wool. after which one large piece of thin mackintosh is to be used to cover the entire limb, so as to permit of no part of the wool being visible. Over all a broad, soft. many-tailed bandage is to be evenly applied. This dressing need not be disturbed for several days if the effect of a poultice be desired, and when it is removed the skin of the limb will be found moist and wrinkled as if after long immersion in water. As a rule, where pain or tension is not very great, this maceration of the limb is not necessary. and the wool may be changed daily. In the great majority of cases the above treatment
is all that is required, and if commenced at the earliest stages much pain and tension will be prevented. When the case is not seen till the swelling and discomfort are at their height, relief may be more quickly obtained by enveloping the limb in a double layer of flannel bandage wrung out of hot water, over which the mackintosh may be adjusted and kept in position by a light calico or stocking-web bandage. Belladonna, Chamo mile, decoction of Poppy heads, or other anodynes may be added to the hot water, but they are seldom required.
As the acute stage passes off the wool is to be retained. but the mackin tosh covering may be dispensed with when the firm, painless, doughy swelling has become established, the wool being firmly but comfortably bandaged by a woven fabric.
At a later stage, a soft dry flannel bandage may be applied and renewed morning and night, the limb being occasionally sponged over with a little tepid water, but friction with oils or liniments is to be forbidden for the reasons already mentioned. The patient may now be permitted to leave her bed for a comfortable couch, but exercise of the affected leg is to be very cautiously permitted till all danger of detaching clots has passedaway.
After the patient begins to move about, if the swelling remains, there is no remedy so valuable as the India-rubber bandage applied every morning before getting out of bed, and taken off after she goes to bed at night, when a thin flannel roller may be substituted. This continuous elastic pressure will he found to speedily and permanently remove doughy swelling which had existed for ninny months. The rubber bandage is more valuable than the old-fashioned elastic stocking, which should be discarded. The woven rubber bandage may be used to great advantage in preference to the pure India-rubber bandage.
The continuous current is now of considerable use, and Massage may he most valuable, with the occasional use of Iodine applications for a few days, while the patient keeps her bed. Friction, with the Lin. Pot. lod. cum Sapone, is also of great use. Occasionally a weak mercurial application may be tried, under a firm bandage.
Douches, sprays or other form of hydropathic treatment and sea-bathing are suitable in very chronic cases.