Treatment.
—It is difficult to separate the treatment of phlebitis from that of lymphangitis, which generally accompanies it. The first essential is physiological rest for the part involved, such as confinement in bed, and the least possible disturbance of the inflamed area, which should be placed in the most restful position and handled as little as possible. Local soothing and evaporating lotions may be used, or, as seems to the writer preferable in most cases, applications of a 10 per cent. ichthyol-mercurial ointment, or of the Credé silver ointment, neither of which should be rubbed in, but spread upon the skin and covered with an impermeable material. These will, after a few days, prove irritating, and a substitution of something milder may be required; but in the acute stage they will render greater service than anything else. A phlebitis which has been provoked and is perpetuated by the presence of septic material cannot be successfully treated so long as its provoking cause remain. Puerperal sepsis which results in pelvic phlebitis calls for thorough curetting of the uterus, while an abscess in the jaw or about the mouth, resulting from diseased teeth, necessitates the extirpation of the latter, providing the jaws can be separated sufficiently to permit of it. What may be needed in cases of thrombophlebitis of the cranial sinuses has just been mentioned.
In any part of the body a vein which is filled with a breaking-down clot can be promptly and judiciously treated by exposure and removal of the involved part, or by free and open incision, with suitable after-treatment.
A chronic phlebitis that produces such lesions as varices will be dealt with under its proper head.
INJURIES OF VEINS.
Rupture of Veins.
—Rupture of small veins is the inevitable consequence of every injury sufficiently serious to be in any sense disabling, its visible expression taking the form at least of ecchymosis, sometimes of distinct hematoma. Again, after long-continued pressure by which return of venous blood is prevented, certain degenerations take place in the vein walls which lead to their yielding on apparently trivial provocation; thus veins situated distally to large aneurysms sometimes give way, while the frequency with which they rupture in large varices of the limbs and in hemorrhoids is everywhere recognized. In the days when venesection was so frequently practised, usually at the bend of the elbow, a traumatic communication between the artery and the vein was frequently produced, with consequent anastomosis. When this was direct, the vessels being in contact with each other, it was an aneurysmal varix. When there was more or less of an intervening sac, through which the blood flowed from one to the other, it was spoken of as a varicose aneurysm. Save in rare cases produced by puncture or gunshot wounds such lesions are curiosities. Should operation be required the sac, if there be one, may be extirpated, or the vein may be ligated above and below the communication. (See [above].)
Air Embolism.
—Air embolism may follow injury to the large venous trunks, especially about the head and neck. This term implies the entrance, by aspiration, of air into the veins, its bubbles being carried along to the right side of the heart, where they are supposed to more or less interfere with its action. Sometimes at the instant of the accident a sucking or gasping sound may be heard. Formerly the condition was considered alarming, but now it is almost a bugbear. It is probable that minor degrees of the accident often occur without perceptible alteration in heart action. Serious disturbance, however, is possible, especially if the longitudinal sinus or the common jugular be extensively opened, and the patient’s head is above the level of the body at the time. Such an accident might call for artificial respiration, and it has been suggested to aspirate the right side of the heart. When its danger can be foreseen precautions should be taken by pressure on the proximal side of the injury. Air embolism is said also to have followed parturition, and even exposure of veins in the stomach by the ulcerative process. (See [p. 38].)