The treatment of phlebitis consists in complete rest, in the use of such constitutional means as may be necessary to allay the irritation of the system, and locally in the application of leeches and warm fomentations. If, on the other hand, the local temperature is very high, the use of ice may be indicated.
Nonat, in cases of commencing phlebitis from venesection, tried the use of flying blisters over the part affected. Obtaining good results, he extended the treatment to phlebitis following typhoid fever, etc., and the morbid phenomena were at once arrested.5
5 Gaz. des Hôp., No. 86 (Med. Times and Gaz., Aug. 7, 1858).
Much disturbance of the parts, either in examining them or in the use of frictions, etc., is to be avoided, as there are not a few instances on record in which portions of thrombi have been detached in this way, and, floating off in the current of the blood, have resulted in pulmonary and even cardiac embolism, the latter causing immediate death.6 The tendency to oedema will be lessened by placing the affected part in a position that will favor the return of the blood by the collateral circulation.
6 Lyon Médicale, June 18, 1876 (N.Y. Med. Rec., Sept. 2, 1876).
As an internal remedy the calcium sulphide is worthy of trial.7 The administration of ammonia is thought to lessen the tendency to the formation of coagula and to promote their absorption if already formed. Abscesses occurring in superficial localities should be promptly opened, antiseptic precautions being observed. The strength of the patient should be maintained by every possible means, the danger of an extension of the mischief being proportioned to the lowering of the vital forces.
7 "Report of N.Y. Therapeutical Society," N.Y. Med. Journ., June, 1882.
As already stated, acute phlebitis plays a very important part in the affection known as phlegmasia alba dolens or white leg. Indeed, many writers consider that it is the only essential factor in the affection. This view is strongly insisted upon by Hervieux, but the researches of Mackenzie,8 Simpson,9 Barker,10 and others have shown that something more than phlebitis is embraced in the disease. Tilbury Fox claims that there is an association of lymphangitis with the phlebitis. At all events, whatever may be the exact pathology of the affection, it appears to be certain that an abnormal condition of the blood, favoring the formation of coagula in the veins, is an essential prerequisite.
8 Pathol. and Treat. of Phleg. Dolens, London, 1862; Med. Times and Gazette, Aug. 22, 1866.
9 Med. Times and Gazette, Jan. 14 and 18, 1859.