510 



OPERATIONS ON THE CIRCULATORY SYSTEM. 



only superficial. By this peculiar mode of firing the absorption 

 becomes greatly stimulated, and the resorption of the tumor very 

 rapid. Cauterization, however, if beneficial in chronic, is not so in 

 acute cases, having in the latter a tendency to be followed by sup- 

 puration, 



2d. Snppuratwe Phlebitis. — For this form of this serious af- 

 fection several modes of treatment are pro2:)osed. 



{a) Expectant Treatment. — This is the plan by which the j)hy- 

 sician or surgeon, administering palliatives only, trusts to the vis 

 conservatrix for cure, watching meanwhile the development of the 

 disease, and waiting for and expecting the guidance of nature in 

 respect to his own interference. 



(J) Simple Incision. — This is the simplest of surgical inter- 

 ferences, and means nothing more than the opening of the abscess, 

 the enlargement of the fistulous tract, and the formation of an 

 exit for the pus and coagulated blood which it contains. This is 

 done with an ordinary bistoiuy, guided by a probe or grooved 

 director. 



(c) Injections. — The fistulous tract which exists on the phle- 

 bitic tumor is washed with a detersive injection of solutions of 

 tincture of iodine, or perchloride of iron ; or of corrosive subli- 

 mate, from 5Uff to TTsVff. These are intended not only to remove 

 any remaining clots softened by the suppuration, but also to 

 stimulate the granulations and the cicatrization. 



{d) Enlargement of the Fistula and Introduction of a Seton. 

 — An S probe is introduced into the fistula, and when it has 

 reached the upper part of the swelling formed by the vein, close 

 to the obturating clot (which must not be disturbed), an incision 

 is made over its blunt end to enable it to pass out through the 

 skin. The fistulous tract is then enlarged with the straight bis- 

 toury from below upward to a small extent, and between the two 

 openings a small seton is passed by means of the probe, and se- 

 cured in place by knotting the ends. The movement of the seton 

 by drawing it to and fro, effects the removal of such portions of 

 the clot as may remain in the wound. 



{e) Enlargement of the Intra Venous Fistxda in its Whole 

 length. — This consists in opening the tract from its commence- 

 ment to its superior cul de sac, as far as the adhesion between 

 the clot and the vein extends, the incision sometimes reaching 

 below the ojDening made by the fleam. Thus exposed, the tract 



