ACCIDENTAL PHLEBITIS. 397 



undergoes suppuration, and the phlebitis is then said to become suppura- 

 tive. The clot may even become entirely detached, transforming the 

 suppurative phlebitis into a very grave form of haimorrhagic phlebitis. 



The jugular is the commonest seat of adhesive phlebitis, the mam- 

 mary vein of suppurative phlebitis. 



Symptoms. The symptoms are easy to recognise. The accidental or 

 instrumental wound is the seat of a painful cedematous swelling. It dis- 

 charges a reddish offensive serosity, or exhibits blackish-violet bleeding 

 granulations surrounding a little central sinus. 



The affected vein, whether the jugular or mammary, soon becomes 

 swollen, is sensitive to the touch and very rapidly becomes indurated 

 in the direction of its origin for a greater or less distance. 



Phlebitis has then set in, and according as one or other compUcation 

 predominates, it is described as suppurative or hemorrhagic. 



Diagnosis and prognosis. The diagnosis presents no difficulty. In 

 phlebitis of the jugular the neck is held stiffly, and the jugular furrow is 

 partly obliterated. 



The prognosis is somewhat serious, particularly in phlebitis of the 

 mammary vein, for obliteration of the vein interferes with the function 

 of the venous plexus from which it springs, and, although there may 

 be a limited vicarious circulation, the secretion of milk is indirectly and 

 secondarily checked owing to difficulty of irrigation. 



The extension of phlebitis of the jugular towards the head and the 

 venous sinuses of the cranial cavity, is quite exceptional. 



"When the mammary vein is inflamed it appears collapsed in the 

 direction of the heart and swollen, indurated, and painful in that of 

 its origin in the mammary gland. 



Treatment. The first jjoint requiring attention is so to fix the 

 animal as to prevent the clot from being pressed upon or crushed, 

 though, unfortunately, this cannot always be properly done. The diffi- 

 culty is obviated l\y applying vesicants, which cause swelling and pain, 

 and so reduce natural movement of the parts to a minimum. 



At first, when the parts surrounding the operative wound are simply 

 swollen and phlebitis is threatened, repeated application of tincture 

 of iodine or a liquid vesicant is useful, and may prevent the disease 

 developing. 



In existing cases a blister applied over and around the whole of 

 the hardened tract may prevent the mischief from proceeding beyond 

 the adhesive stage. In such case the clot becomes organised, the vein 

 remains obliterated, and recovery follows. 



Similar treatment may also be employed in suppurative phlebitis, 

 but as the clot gradually breaks down in consequence of the action of 

 bacteria it is useful and almost indispensable to disinfect the vessel. For 



