LYMPHANGITIS, OR ANGEIOLEUCITIS.
Inflammation of peripheral lymphatic vessels is always septic, and must be treated upon the lines followed in acute adenitis or lvmphadenitis. Attention should be at once directed to any injury or wound which has been the starting-point of the affection. This should be treated by antiseptic poultices (Spirit or Boric under oiled silk), and the free evacua tion of any collection of pus by proper incisions. Where the lymphangitis is superficial, and the red, tender, painful and swollen lymphatic vessels can be discerned extending from the wound in the direction of the lymphatic glands, benefit can he got by painting over the inflamed area with strong Tincture of Iodine, and prescribing absolute rest to the affected limb. Extract of Belladonna and Glycerin may be employed when the pain is very severe, followed afterwards by an evaporating or a warm spirit lotion. Where tension and pain are prominent, a large hot poultice may afford relief and even diminish the chance of suppuration, but the moment signs of pus make their appearance, incision must be resorted to to allow the escape of pus or to lower tension.
Bier's elastic ligature or Klapp's suction-bell sometimes cuts short the inflammatory action by bringing about an increased blood-supply and flushing the part with a healthy lymph stream bearing increased amounts of the natural antitoxins.
In chronic and recurring lymphangitis a vaccine prepared from a culture of the causal micro-organism should be resorted to.
The remote result of a severe lymphangitis sometimes shows itself in the presence of a permanent solid or brawny oedema owing to obliteration of the peripheral lymphatic vessels. This condition may be successfully met by the operation introduced by Handley, which consists in the introduction of sterilised thick silken threads which are made to traverse the cedcmatous region, being embedded permanently in the tissue of a contiguous region whose lymphatic channels are healthy. The strands of silk drain the affected area by capillary attraction, and thus act as new lymphatic vessels, and will withstand absorption for many years.
Lymphangioplasty has also been employed with success in elephantiasis in conjunction with vaccine therapy, and in the great cedema which sometimes follows the operation of total excision of the breast.