410 INFLAMMATION OF THE JUGULAR VEIN. 



from without to the wall of the vein (periphlebitis). Such a case 

 has been described by Peters. 



Symptoms. On removing the pin a day or two after blood- 

 letting, the skin wound, instead of being closed and dry, is 

 swollen, and discharges a dark, blood-stained fluid. Within the 

 next few days the oedema increases, and the vein is now found 

 to consist of a round, firm fixed cord, extending a varying 

 distance above and below the wound in the skin. The latter 

 symptom proves the existence of a thrombus. The discharge 

 may proceed from extravasation under the skin, and therefore, 

 it is important to examine the vein. Filling of the vein on com- 

 pressing the vessel at the base of the neck and collapse of the 

 distension on removal of the pressure prove the non-existence of 

 a thrombus. The use of a probe for diagnosis is not only super- 

 fluous but dangerous, because clotting and separation of emboli 

 may thus be produced. The head, held stiffly, appears swollen 

 at the throat, over the cheek, lips and nose of the affected side, the 

 glosso-facial vein and roots of the jugular are distended (venous stasis), 

 and mastication and deglutition may be difficult or suspended. 

 Constitutional disturbance may be absent throughout the duration 

 of a simple case, or there may be a fever temperature, with quickened 

 pulse and respiration. These symptoms continue for four or five 

 days in favourable cases (simple phlebitis), and as soon as the 

 collateral circulation becomes adapted to the altered conditions, 

 the facial oedema subsides and disappears, the cervical swelling 

 diminishes except at the phlebotomy wound, the thrombus undergoes 

 organization, but the vein remains obstructed, hard and resistant, 

 and eventually is converted into a fibrous cord. Exceptionally, 

 according to St. Cyr, a narrow tortuous chaimel is left in the vein, 

 giving passage to a small stream of blood. 



Should infection continue or extend (infective phlebitis), the 

 thrombus undergoes purulent disintegration, the inflammatory 

 process rapidly spreads to the other coats of the vessel, producing 

 miliary abscesses with ulceration and perforation of the venous wall, 

 and externally, centres of suppuration in the perivenous tissues. 

 The infected vein is then transformed into a suppurating channel 

 with lateral fistulous openings. The phlebotomy wound, granular 

 and prominent, gives escape to a plentiful greyish foetid pus. Above 

 this wound cedematous swelling extends to the head, concealing 

 the parotid gland and filling the space between the rami of the jaw, 

 while below the wound there may be little swelling or the oedema 

 may descend to the chest. The patient suffers intensely, is highly 



