WOUNDS. 453 



will now consider something further than the mere integu- 

 mental inflammation, and come at once to the point we 

 set out at — the inflammation of the substance of the vein 

 itself, which is either communicated from the integuments, 

 or originates within the vessel from the puncture, that is 

 supposed to occasion a peculiar inflammation of the inner 

 coat of a wounded vein. It is prohable that a predisposi- 

 tion to a certain form of inflammatory action is inherent in 

 the veins so afi'ected, and that this is called forth by some 

 state in the parts themselves ; which at one time confines 

 inflammation to the integuments, and at another carries it 

 upward within the interior of the vessel. 



The symptoms of the injury appear about the third or 

 fourth day usually, when the lips of the cut begin to gape, 

 and a little lymph is thrown out ; the next day the edges 

 are more cast back, as well as more red and expanded ; a 

 sanious discharge issues, or perhaps heemorrhage occurs : 

 the tumefied vein now feels corded, hot, and tender ; and 

 if the progress of the inflammation be not stopped, the 

 tumefaction extends along the course of the vein : if in 

 the jugular, it proceeds towards the head ; and if it occur 

 in any of the other veins of the body, as the saphena and 

 plate vein, it extends towards the heart, hardening the 

 vessel into a cord-like substance ; this appears to be the 

 consequence of the inflammatory action, by forming the 

 contained blood of the venous trunk into a firm coagulum, 

 and therefore all attempts to save it afterwards fail. Sup- 

 puration of the tumour now often appears ; though some- 

 times the immediate punctured part will present little more 

 than a spongy mass, from which a grumous liquid distils, 

 while abscesses form in various situations around the course 

 of the vessel. As the morbid action extends upwards, it 

 frequently involves the whole neck, and often affects the 

 side of the head, from which results hinderance to motion ; 

 and often some difficulty is experienced in eating and drink- 

 ing likewise. There is commonly constitutional disturbance 

 also : in some cases the symptomatic fever runs very high. 

 The pulse has been above ninety ; and the excess of irrita- 

 bility brought on has destroyed even life. 



Treatment. — The course to be pursued will much depend 

 on the state of the disease. It is of importance to keep 



