398 DISEASES OF BLOOD-VESSELS. • 



this purpose the openmg of the sinus must be enlarged, and, by means of 

 a sterilised or very clean syringe with a curved nozzle, the parts washed 

 out daily with warm boiled water, followed by an antiseptic injection 

 containing 2 per thousand of iodine, 3 per cent, of carbolic acid, or, 

 better still, glycerine containing 1 per thousand of sublimate. 



If in spite of this treatment the phlebitis extends towards the origin 

 of the jugular or mammary vein, a counter-opening may be made at the 

 point where the clot still remains adherent, and a strip of iodoform gauze 

 saturated with tincture of iodine or with blistering ointment diluted to 

 one-eighth with oil may be passed. Needle firing is also of value. 

 Finally, as a last resource, a ligature may be applied to the vein above 

 or beyond the clot. 



This operation, which in the horse is confined to hpemorrhagic 

 phlebitis, is especially applicable to phlebitis of the mammary vein in 

 the cow. As the vein is subcutaneous, the operation may easily be 

 performed in the standing position ; the successive stages are as 

 follows : — 



The patient is firmly secured and its hind limbs hobbled by passing 

 a rope around the hocks in a figure of eight. It is steadied on one 

 side by an assistant who presses on the quarter. 



One cubic centimetre of a 10 per cent, solution of cocaine is sub- 

 cutaneously injected on each side of the vein at the point chosen. Ten 

 minutes later a button-hole incision is made through the skin and a loop 

 of thick catgut passed around the vein by means of a curved needle. 

 The ligature is tied firmly with a surgical knot and the little wound 

 afterwards covered with a mass of cotton wool secured by collodion. 



INTERNAL INFECTIOUS PHLEBITIS (UTERO-OVARIAN PHLEBITIS). 



The internal forms of phlebitis of parasitic or infectious origin are as 

 yet little understood, but mention may be made of phlebitis of the utero- 

 ovarian veins which frequently follows parturition and post-partum in- 

 fection. This is probably in many instances the real cause of the post- 

 partum paraplegia without gross or apparent material lesions. 



This form of infectious phlebitis may extend to the large internal and 

 external iliac veins and produce embolism and septicaemia, as is shown 

 by recorded cases. 



The mechanism of the disease is easily understood. The infective 

 agents penetrate the veins of the uterine mucous membrane and pass 

 from the lumen into the wall of the vein. Here they cause inflammation 

 of the vascular endothelium, followed by the deposit of a fibrous clot of 

 cylindrical form, which sets up partial thrombosis of the vein. This 

 thrombosis becomes complete by the formation of a central clot due 

 to venous stasis. 



