Too often from an over anxiety to heal the wound inflicted in phlebotomy, it is dressed the day fol lowing the operation, the consequence of which is, that the process of adhesive inflammation is dis turbed, and too great a degree of inflammation is excited, which either spreads all over the arm, con fining itself to the skin, and assuming commonly the erysipelatous type, or involves the subjacent cellular tissue, forming erysipelas phlegmonodes, or extends to the fascia of the arm, or affects the lymphatics, or the vein itself.
Inflammation of the vein is also said to arise from foul lancets, which however appears to he very seldom the case; nevertheless, a vein ought never to be opened by one which has been employed in opening a syphilitic bubo, or in performing vac cination. When a patient requires to be bled twice in the course of twenty-four hours, a common practice is to abstract the second quantity of blood from the same orifice, by applying another bandage round the arm above or proximad to the wound, until the veins become swollen, then removing the first bandage, and tearing away the compress ad hering to the wound, when the blood commonly springs out; but if not, the wound is forcibly open ed either with the fingers, or by squeezing the blood along the vein onwards to the orifice, or by insert ing a probe or lancet; such teazing steps are even pursued in a third bleeding, if performed in twenty four hours. If there is not much inflammatory ac tion present, and the second bleeding is performed within twelve hours of the first, this plan may be adopted; but if otherwise, it is extremely liable to produce inflammation, as the adhesive process takes place very quickly between the lips of a vein and so small a wound in the skin. It is therefore prefer able to open a vein of the opposite arm. The same vein is sometimes opened close to the first wound in the course of twenty-four hours, which is also an improper practice; and neither this, nor opening the same wound twice, should be adopted in hospital practice, particularly in thoracic inflammation, as the veins are more liable to be inflamed, when lanced in this, than any other disease.
Inflammation of the vein is characterized by tu mefaction of the arm, pain in the wound darting to the axilla, and even to the thorax, accompanied with difficult respiration and inflammatory fever, which advances rapidly to typhus. The vein to the touch feels hard, is very tender, and sometimes in flamed both upwards and downwards; the lips of the wound are everted, swollen, and occasionally pus or sanies, mixed with blood, can be pressed out from it. Not 'infrequently there is an (edematous boggy
feeling in some parts of the arm, with more or less inflammatory discolouration of the integuments. On dissection, the vein is found so thickened in its coats, that it has all the appearance of a nerve; and coagulable lymph and pus are deposited in its cavity, sometimes to the extent of plugging it up; the internal coat is of a reddish purple colour, re sembling claret. There is more or less effusion of purulent matter in the contiguous cellular tissue, and even in that entering into the formation of the muscles, and in some instances the two pectoral and the contiguous intercostal muscles are infil trated with pus. The pleura is often found in flamed, with abscesses forming in the lungs; and sometimes the right auricle and ventricle will also be inflamed, with even pus in the pulmonary artery. Inflammation of a vein proceeds with great rapidity, and as veins circulate their contents onwards to the heart, the inflammatory action is conveyed to this viseus with alarming celerity, frequently proving fatal between the fifth and tenth day. The coagu lable lymph and purulent matter effused into the veins, must also be carried onwards to the heart. From these alarming consequences, it is evident that the treatment of this disease must be very prompt. The patient should be bled to syncope by opening a vein of the neck or opposite arm, and this ought to be repeated in four hours, or whenever he rallies, and until all inflammatory tendency has been subdued; and as there is a disposition to in flammation in the venous system, the same vein ought never to be opened twice. Together with active blood-letting, should be combined tobacco enemata, brisk cathartics, warm bath, a profusion of leeches to the part affected, or scarifications with the bistoury, represented in Fig. 2, Plate DXV, followed by large anodyne poultices, or fomenta tions, with low diet and perfect quietness. When scarifications are made with the bistoury, the wounds should be plugged with lint, after a requisite quantity of blood has been abstracted. If these local applications do not seem to arrest the exten sion of the disease, large blisters should be applied. The general treatment in all these affections is the same with that recommended for inflammatory fever. John Hunter and others have recommended pressure on the vein both above and below the wound; but we should rather consider, that the compression would increase the inflammation; Mr. Abernethy proposes the division of the vein, a line of practice certainly preferable to that of Mr. Hunter.