The following are the terminations of phlebitis: it may end in resolution; in chronic inflammation, with persistent thickening; in coalescence of the vein with contiguous structures; and in dilatation, in persistent obliteration, or in suppuration of the vein.

1. The Termination In Resolution

The Termination In Resolution (or perfect recovery) is by no means rare in slight cases of phlebitis, even where there has been a general infection, like that occurring in endocarditis, which, independently of the local residua, very frequently assumes a similar favorable character, notwithstanding the pre-existence of general infection. The coagulum obstructing the inflamed vein is gradually absorbed into the blood in a finely comminuted state, and being dissolved like the originally absorbed exuded substance, the diseased vein becomes again free.

Condition Of Chronic Vascularity Of The Coats Of The Vein

2. In some cases there remains a condition of chronic vascularity of the coats of the vein, with bulging, which is not unfrequently accompanied with a rusty-brown or slate-gray discoloration, with paralysis and dilatation of the vein. In this condition there are often acute relapses, more especially in the veins of the lower extremities. It finally leads to hypertrophy of the coats of the vein, in consequence of the continued accumulation of the exudation in their tissue; to rigidity of these coats; to permanent dilatation, and by means of the sclerosis of the surrounding cellular tissue, to permanent immobility of the vein, and coalescence with the neighboring structures - as, for instance, aponeuroses, muscular sheaths, the general investments, the periosteum, etc. The latter condition further predisposes to the formation of new layers of lining membrane from the blood, in consequence of the retarded flow of the blood-current.

3. Termination In Obliteration

Termination In Obliteration is induced by means of the coagulum, which obstructs the inflamed vein. This coagulum, which is formed by the absorption of a so-called plastic exudation (that is to say, an exudation capable of being metamorphosed into tissue), undergoes a gradual decoloration and is converted into a whitish fibroid band, which is very commonly interspersed with rusty-brown or black pigment. After this metamorphosis, the coagulum becomes shrivelled.

This string or band is attached to the wall of the vein, either at all parts of the circumference, or only at separate points, by means of a cellular structure, formed by the metamorphosis of a portion of the exudation on the inner surface of the vein. If the wall of the vein participate, in the former case, in the shrivelling of the coagulum, the vessel is rendered impermeable, and becomes finally atrophied, and completely obliterated. But if, on the other hand, the wall of the vein does not generally participate in the shrivelling of the coagulum, in consequence of the latter being attached merely by partial adhesions, or if the blood forces its way into the obstructed vein notwithstanding the total adhesion of the coagulum, the structure by which the shrivelling coagulum is attached to the wall of the vein becomes torn into threads and laminae, which gradually acquire an investment of recently formed lining membrane from the blood; and the vein being in consequence only partially obliterated exhibits the following appearances:

The vein is either occupied by a fibroid, roundish string, which adhering only to a portion of the wall of the vessel leaves the latter free and permeable in other parts.

Or, in addition to this connection of the fibroid string with the vessel, thread-like bridges, or membranous partitions, which are more or less perforated - the torn adhesions above referred to - are also attached to the free portion of the wall of the vein, while its tube is broken up into numerous straight or oblique canals or divisions.

Or the fibroid string is attached at various parts to the interior of the vessel, by means of adhesions, arranged in the most irregular manner.

The coats of the vein are thickened, the vessel itself being more or less firmly imbedded in a cellular stratum in a state of sclerosis; the free portion of the wall is dilated and elongated, so that the vessel describes intestine-like coils round the resistant fibroid string, or twists itself around it as around an axis, as the former changes the points of its adhesion. This condition gives rise to a special form of varicosity. The vessel at the same time presents some analogy in its calibre with the structure of the sinuses of the dura mater, more especially with the superior longitudinal sinus.

This fibroid string within the vein may ossify in the progress of time, constituting a form of central ossification.

This condition has been more especially observed in the cutaneous veins of the lower extremities - on the trunk and ramifications of the saphena veins. We noticed it in one case, together with the products of intense peritoneal inflammation, on the whole system of the mesenteric veins; and on account of its rarity, we will give a brief history of it.

The body of a girl, aged 13 years, exhibited the following appearances, in addition to an excessive degree of emaciation, and a pale decoloration of the general investments. The abdomen was swollen, and felt hard and board-like to the touch; the linea alba presented the resistance and the appearance of a cartilaginous layer, and was a line and a half in thickness; the same character was generally exhibited by the aponeurotic portions of the abdominal wall. The peritoneum of the abdominal wall was invested by a pale slate-gray, cartilaginously tough pseudo-membrane, a quarter of a line in thickness, which extended to the intestinal canal and the stomach, which it covered. It contained a yellowish-white purulent fluid. The mesenteric vein, with its ramifications, was partly thickened and callous, while its canal was divided by numerous bridge-like partitions, which were perforated at different spots, and whose margins were torn, and was partly contracted by detached structures of this kind. The walls of the portal vein were uniformly thickened. The coats of the hepatic, cystic, and common bile-ducts were swollen, whilst their mucous membrane was covered with numerous, and generally suppurating, villous growths; the ducts contained an ichorous, brownish fluid. A similarly colored dark fluid was also found in the stomach and the intestinal canal. The patient, in addition to general indisposition, had suffered from chocolate-colored discharges, both by stool and vomiting, and had also, throughout her illness, vomited light-red, pure blood, which proceeded from the gall-ducts.

Cheesy matter, and a substance resembling moist chalk or mortar, are, moreover, occasionally found in veins that have been obliterated, and are either the disintegrated remains of the coagulum which had obstructed the vessel, or inspissated pus.

4. The Termination In Suppuration

The Termination In Suppuration, and in an acute purulent fusion and necrosis of the coats of the veins, corresponding to the previous (acute) course of the disease, is, on the whole, somewhat rare. The dilated vein is filled with a large quantity of purulent exudation, mixed with blood, and all its coats, besides presenting a dirty-red tint from imbibition, are infiltrated with pus, and tear with great facility and almost like tinder; while the inner coats peel off from the cellular sheath in the form of a crumbling pipe or tube, and the cellular tissue surrounding the vein is in a state of suppuration. This process sometimes occurs at individual spots, so that, after the solution of the venous wall, circumscribed abscesses are occasioned in the adjacent cellular tissue. This acute suppuration of a vein usually only occurs when the highest degree of pyaemia has been developed. A more frequent occurrence is a protracted suppuration in sequestrated varicose veins, which had originally suffered from chronic inflammation, a subject to which we shall again recur. The phlebitis induced by the coagulation of blood often terminates in gangrenous suppuration and fusion.

From what has been already stated, both in reference to the exudation and the last two modes of termination, it follows that the phlebitis of which we have already treated is sometimes adhesive and sometimes suppurative.