For the simpler forms of lymphangitis the wound should first be thoroughly cleansed and disinfected. Washing with soap suds, or carbonate of soda will remove any greasy agent which would prevent a thorough antisepsis. Then it may be washed with the antiseptic lotion:—carbolic acid solution (1:20), or mercuric chloride solution (1:500), or zinc chloride (1:400) or potassium permanganate (1:160). If the infection has been introduced by a small or punctured wound, the sting or bite of an insect, or the prick of a sharp instrument it should be freely cauterized to its depth with lunar caustic incising it if need be to reach the whole of the poison, and the surface afterward dressed with antiseptics.
The diet should be light but nutritious and laxative, and the free action of the bowels and kidneys should be maintained by salines. When fever runs high give quinine, or salicylate of soda. When a large wound has to be dressed it may be requisite to use a non-poisonous agent like acetate of aluminium or boric acid to irrigate it thoroughly. In some such cases packing the irrigated wound with iodoform gauze has often an excellent effect.
When there is a firm inflamed cord, hot and painful, a fly blister along its course followed by mercurial ointment often gives excellent results. Or they may be repeatedly painted with tincture of iodine.
Foci of suppuration must be promptly opened and thoroughly and persistently disinfected.
With suppuration in multiple abscesses or large open sores liberal feeding must be enjoined and iron and other tonics should be resorted to.
The persistent swelling of the part must be met by active rubbing or kneading, by exercise and by uniform compression by a flannel or elastic bandage.
LYMPHANGIECTASIS. DILATED LYMPHATICS.
Result of lymphangitis, of heart disease, of pulmonary arterial thrombosis, of external jugular plugging. Causes, obstruction to lymph flow, compression, increased venous blood pressure, fibrinous lymph coagula, action of sensory nerves, of lymphadenitis, anæmia. Symptoms like dropsy if in plexus, in large lymphatics, moniliform swelling, sacculation, wounds discharge lymph, hyperplasia of connective tissue, fatty deposits, lipomata. Treatment, elastic bandage, cold, astringents, iodine, punctures, ligatures, cauterizations, tonics.
The most striking cases of dilatation of the lymphatics in the lower animals are met with in horses that have suffered repeatedly and severely from the lymphangitis of plethora. Then the lower part of the shank and the pastern are enormously thickened to perhaps two or even three feet in circumference, and skin and connective tissue are the seat of a general dilatation of the lymphatic plexus and vessels with great thickening of their walls. Nocard and Barrier record cases of general dilatation of the lymphatics in dogs in connection with heart disease, also the case of a horse with old standing thrombosis of the pulmonary arteries, hypertrophy of the right heart, and dilatation of the thoracic duct to the size of the arm and of the lymphatics of the mesocolon to the diameter of half an inch to nearly an inch. Nocard records two cases in the horse, one of a reticular lymphangioma of the sheath, and the other of dilatation of the lymph vessels accompanying the saphena vein on the inside of the thigh. This formed small, soft, fluctuating, extremely irregular tumors, completely covering the vein for a space of about four inches.
In both cases the dilatations were surrounded by a thick layer of connective tissue filled with liquid. Virchow records a case of a new-born calf in which a thrombosis of the external jugular vein caused obstruction of the mouth of the thoracic duct, and a consequent extreme distension of all the splanchnic lymph vessels with a slightly sanguinolent fluid. The intestines especially were covered everywhere with broad, bead-like canals, arranged so closely together that the intervening tissue could be scarcely recognized.