VENOUS HYPEREMIA Venous hypertemia (engorgement) is characterized by the excessive dilatation of the veins of the skin and the engorgement of VCIIOUS blood occasioned by a larger supply of blood than can be carried off. These engorgements are caused by anomalies of the circulation (cardiac insuf ficiency, etc., pressure of tumors upon veins, etc.), and the atony of the vessels, i.e., the veins, following the preceding hypermmia.
The first signs of freezing in infants as in adults arc shown at the extremities (hands, dorsal surface of the feet, extensor surface of the fingers and toes) and at the peripheral portions of the face (nose, ears). Red or bluish red swellings of a doughy, (edematous nature appear which itch considerably and burn still more. They are popularly known as chilblains (perniones). After they have existed for some time, they become harder and more painful, vesicles form on them, or the surface undergoes ulcerous degeneration. If the cold is excessive or of long duration, the second stage of congelation immediately appears. Vesicles develop which are transformed into badly healing deep ulcers. The third and most severe degree of congelation sets in if a gangrene or necrosis of the deeper tissues spreads to the bones. The frozen part dies off with demarcated inflammation. In this way entire phalanges or large portions of the extremities may perish.
Anatomy.—Under the influence of great cold there is always an injury to the venous tonus which results in anaemia. As the effect of the cold ceases, the anaemia is followed by Itypenemia. The blood flows forcibly into the atonic vessels and a localized VC1101IS engorgement remains which is shown by its coloration. If the freezing continues the hypermnia increases and finally leads to a continuously increasing transudation into the tissue. In the second and third stages of congela tion hyaline and leucocyte thrombi arise (IIodara) and finally there is the picture of gangrene (Recklinghausen).
pathological condition arises also in healthy children through the influence of abnormally low temperatures or long continued cold, but in weakly, ansunic children it takes place much more easily than in the healthy. In children it nearly always occurs in the shape of chilblains, and nnless there is sufficient attention paid to it, it becomes more difficult to handle from year to year. This condition
should be energetically treated from the beginning and the general constitution constantly improved, as otherwise the affection returns every year.
prognosis of congelation is therefore not very favorable on account of its great tendency to relapses. The chilblains may recur in midsummer, in July and August in damp, cool \veather, and it requires the unflagging energy of the attending physician and the patient's family if the condition is not to become one of long duration.
Treatment. —The object of the therapy is in the first place to restore the lost tone of the vessels; in the second place to remove the affected parts by local treatment: thirdly, to improve the general con dition to such an extent that the possibility of renewed attacks is dimin ished, and fourthly, to take prophylactic measures to keep injurious influences at bay.
1. Hot haths are most beneficial in order to influence the tone of the vessels. Hot water baths may be applied in the shape of hand and foot baths; or hot sand baths or medicated hot baths may be employed. The latter are prepared by adding decoctions of oak bark or walnut leaves (from a few handfuls boiled in hot water), alum, vinegar Or glue. An exceedingly good effect in improving the tone of the vessels is obtained by changing hand and foot baths from hot to cold and vice versa (allowing the feet to remain a few minutes in the hot w-ater and a somewhat shorter time in the cold water, the whole procedure to be repeated for a quarter to half an hour). This should be done every evening before the actual local treatment is commenced. In the morn ing I always prescribe rubbing with spirits of camphor in order to exert an influence upon the circulation. Electric baths have also been recom mended in recent times, one pole to be applied to the body and the other to thc affected hand or foot. The hands and feet should always be kept bandaged, at night perhaps provided with gloves and stockings. During the day the hands should be protected by comfortable soft woolen gloves, the wrists by warming cuffs, and the feet by well fitting stockings which should be frequently changed (luring the day on account of the perspira tion. Narrow shoes are forbidden in order not to interfere with the circu lation and to avoid pressure on sensitive places.