INFLAMMATION OF THE JUGULAR VEIN. 409 



VI.— PHLEBITIS. INFLAMMATION OF THE JUGULAR VEIN. 



In former times, when bleeding was much more general, horses 

 and cattle frequently exhibited this sequel of the operation. As 

 a rule, the wound in the vein, caused by a clean lancet or fleam, 

 closes by the edges coming together and uniting, imposition is 

 favoured by the negative blood pressure in the jugular, and usually 

 no visible alteration is left in the vessel. The skin wound, if closed 

 by pin suture, commonly heals by first intention. Occasionally, 

 however, a small parietal thrombus forms at the point of puncture 

 and results in slight thickening of the venous wall ; or in other cases 

 infection occurs producing phlebitis and obstructive thrombosis of 

 the wounded vein. 



Two forms of phlebitis — adhesive or simple and infective — are 

 recognised. Probably they represent two degrees of a single in- 

 flammatory process, the difference being due to the greater or less 

 intensity of infection. At the outset in both there is endophlebitis 

 with thrombus formation, but in the simple form, the process, after 

 a time, may terminate by adhesive cicatrisation and permanent 

 obstruction of the vein ; while in the other the thrombus breaks 

 down, and the infective process rapidly involves the other coats 

 of the vessel, producing ulceration, perforation and suppuration. 



Jugular phlebitis is caused by infection contracted at the time 

 of operation, or subsequently during the healing process ; or it may 

 arise from wounds or bruises of the neck involving the jugular groove. 

 Certain accessory causes, which are not always avoidable, may be 

 mentioned : the venous wound, if made with a blunt fleam or lancet, 

 and not smoothly cut, but torn through, may be followed by 

 phlebitis and coagulation of blood on the bruised surface. The 

 same occurs when, owing to repeated use of the instrument, a double 

 wound has been formed. Phlebitis may arise from any circumstance 

 which prevents proper approximation of the edges of the venous 

 wound ; and from the formation of a clot between the skin and 

 vein. Extensive extravasation at the point of bleeding may be 

 produced by pressure of the collar on the unhealed wound, by 

 animals leaning against the manger, by those with disease of the 

 feet continuously lying, or by openings made into the vein for the 

 introduction of drugs ; in these cases infection takes place through 

 the medium of the subcutaneous clot which extends to the vein. 

 Phlebitis of the jugular seldom occurs without a wound of the vessel, 

 though it must be allowed that inflammatory processes may extend 



