398 DISEASES OF BLOOD-VESSELS. ^ 



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

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

 out daily wdth 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 i 

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

 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 i 

 or beyond the clot. ; 



This operation, which in the horse is confined to haemorrhagic I 

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

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

 performed in the standing position ; the successive stages are as j 

 follows : — I 



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

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

 side by an assistant who presses on the quarter. j 



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

 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 j 



afterwards covered with a mass of cotton wool secured by collodion, j 



I 



INTERNAL INFECTIOUS PHLEBITIS (UTERO-OVARIAN PHLEBITIS). \ 



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



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



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



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



partum paraplegia without gross or apparent material lesions. \ 



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



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

 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 j 



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



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



thrombosis becomes complete by the formation of a central clot due ; 



to venous stasis. ' 



