Inflammation of veins is a very unmanageable disease; the exhibition of
purgatives and antimonials will be prudent, in order to evacuate the
bowels, produce diaphoresis, and diminish the force of the circulation;
the pain will also be much relieved by the application of warm
fomentations to the affected part. General depletion is not admissible
unless at the very commencement of the disease, and local bleeding
must be had recourse to with very great caution; for by copious
abstraction of blood, gangrene may be induced, or at least hastened.
The limb must be altogether disused and elevated, the patient being
kept in a state of complete rest, and not exposed to any excitement or
anxiety. Blisters have been employed, but with no good effect. If the
vein is much distended, and it is evident that it contains a confined
accumulation of pus, it ought to be treated as a common abscess, the
matter evacuated by an incision, and various dressings employed,
according to circumstances. Such practice I have found successful, and
not followed by any untoward symptoms. The abscess is often limited at
each extremity by the deposition of lymph in the canal of the vessel;
and after the evacuation of its contents, the cavity contracts, and the
portion of the vessel which has been the seat of suppuration becomes
completely impervious.
Inflammation of a vein is also occasionally followed by the sudden
appearance of a purulent depôt in some part of the body, external or
internal, at a distance from the inflamed part. Thus, in inflammation
of a vein in the forearm, it is not unusual to find an abscess formed
suddenly in the axilla on the opposite side; after amputation, or other
capital operation, the patient is often suddenly affected with violent
symptoms of disease in the chest, and, on examination, abscesses will
probably be discovered in the substance of the lungs, the existence of
which had only been suspected a short time previous to death. Possibly
some pus globules, the seeds of disease, may be arrested in their
course through the capillaries of these organs, and thus a foundation
be laid for mischief. A very satisfactory explanation of these
phenomena cannot readily be given.
It has already been noticed, that the softening of coagulated fibrin
must not be confounded with suppuration. The fibrinous pulp has
commonly been called pus, though erroneously; and when occurring
in the veins, as it frequently does, has been generally described
as inflammation and suppuration of the vessel. The distinction is
important; first, because many of the so-called cases of phlebitis are
shown to be of a different nature, and secondly, as to the theory of
suppuration, on which subject many writers in this country have been
engaged in making commentaries on, and compilations of, the French
doctrines, which are not deserving of much regard.
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