1911 Encyclopædia Britannica/Phlebitis

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PHLEBITIS (from Gr. φλέψ), inflammation of a vein. When a vein is inflamed the blood in it is apt to form a clot, or thrombus, which, if loosened and displaced from its original position, may be carried as an embolus towards the heart and there be arrested; or it may pass through the cavities of the heart into the lungs, there to lodge and give rise to alarming symptoms. If the thrombus is formed in the inflamed vein of a pile it may pass as an embolus (see Haemorrhoids) into the liver. If an embolus is carried through the left side of the heart it may enter the large vessels at the root of the neck and reach the brain, giving rise to serious cerebral disturbance or to a fatal paralysis. The thrombus may be formed in gout and rheumatism, or in consequence of stagnation of the blood-current due to the slowing of the circulation in various wasting diseases. When a thrombus forms, absolute rest in the recumbent posture is to be strictly enjoined; the great danger is the displacement of the clot. An inflamed and clotted vein, if near the surface, causes an elongated, dusky elevation beneath the skin, where the vein may be felt as a hard cord, the size, perhaps, of a cedar pencil, or a pen-holder. Its course is marked by great tenderness, and the tissue which was drained by the branches of that vein are livid from congestion, and perhaps boggy and pitting with oedema. If, as often happens, the inflamed vein is one of those running conspicuously upwards from the foot—a saphenous vein (σαφής, distinct)—the patient should be placed in bed with the limbs secured on a splint in order to protect it from any rough movement. Should the clot become detached, it might give rise to sudden and alarming faintness possibly even to a fatal syncope. Thus, there is always grave risk with an inflamed and clotted vein, and modern surgery shows that the safest course is, when practicable, to place a ligature on the vein upon the heart-side of the clotted piece and to remove the latter by dissection. When, as sometimes happens, the clot is invaded by septic organisms it is particularly liable to become disintegrated, and if parts of it are carried to various regions of the body they may there give rise to the formation of secondary abscesses. In the ordinary treatment of phlebitis, in addition to the insistence on perfect rest and quiet, fomentations may be applied locally, the limb being kept raised. Massage must not be employed so long as there is any risk of a clot being detached. (E. O.*)