This disease does"not appear to be of very frequent occurrence in temperate climates. Mr. White states that out of 1897 women delivered at the Westminster General Dispensary, five only were attacked with it; and of 8000 women delivered at the Manchester Lying-in Hospital, and their own houses, no more than four were seized with it; and Dr. Thomas states that during a practice of fifty-five years, he had only met with three cases.

Phlegmasia Dolens generally takes place on one side of the body only, at first, and commonly begins about the hip or top of the thigh, and the labium pudendi on the same side. It is usually preceded by shivering, and a certain amount of fever. The patient perceives a sense of pain, weight, and stiffness in the parts which are increased by every attempt to move that portion of the body or the lower limb. If the parts are carefully examined, they will generally be found rather fuller or hotter than natural, and tender to the touch, but not discolored. After a little time the pain increases, always becomes severe, and in some cases highly excruciating; it extends along the thigh, and at length the top of the labium pudendi becomes greatly swelled and distended; but, on this happening, the pain is usually somewhat alleviated in these parts. It however, extends down to the knee, and is usually most severe on the inside and back of the thigh. When it has continued for some time, the whole thigh becomes in its turn swelled, and the pain extending down to the leg and foot, these parts also swell; but, on the swelling taking place, there is a considerable abatement of pain, and the patient does not experience much, except she moves the limb.

The limb being now swelled from the groin to the foot, appears perfectly or nearly uniform in size, and is not perceptibly lessened in size by a horizontal position, like a dropsical limb. It is whiter than the natural colour, is hotter than usual, excessively tense, and exquisitely tender when touched. The swelling of the limb varies both in degree, and in the space of time requisite for its fall formation. In most instances it arrives at double the natural size, and in some instances, at a much greater. In lax habits, and in patients whose legs have been very much affected with dropsy during pregnancy, the swelling takes place more rapidly than in those who are differently circumstanced. In the former class of patients it sometimes arrives at its greatest extent in twenty-four hours, or less, from the first attack.

After some days, generally from two to eight, the feverish symptoms diminish, and the swelling, heat, tension, weight and tenderness of the limb begin to abate; first, about the upper part of the thigh or knee, and afterwards in the leg and foot.

The fever having gradually disappeared, the tenderness of the limb being much relieved, and the swelling and tension considerably diminished, the patient is much debilitated, and the limb feels stiff, heavy, benumbed, and weak. It seldom, if ever, returns to its former size, but usually is considerably enlarged for the remainder of life, being always more easily affected by cold than the other, and after exercise it will be more stiff and weak than the sound limb. It sometimes happens that, after the disease abates in one limb, the other is attacked in a similar way, goes through the same stages, and continues much about the same time as the first.

Phlegmasia Dolens is often slow in its progress, and tedious in its course; but it is rarely followed either by suppuration or gangrene; and still more rarely does it terminate fatally.

Treatment

Should the disease be complicated with any other, such as Erysipelas, Dropsy, Inflammation in the Chest, Puerperal Fever, or Inflammation of the Peritoneum, the measures recommended under those heads must be resorted to, in addition to the proper treatment of the disease itself.

If the patient is of a robust, plethoric habit, a few ounces of blood may be taken from the arm; but if she is delicate, a few-leeches may be applied to the swollen labium. The bowels should be opened by a gentle laxative, which may be repeated every second or third day. The following mixture may be taken:

Solution of Acetate of Ammonia...............One Ounce.

Antimonial Wine..................................One Ounce;

Sweet Spirit of Nitre..............................One Ounce.

Syrup.................................................Half an Ounce.

Camphor Mixture, sufficient to make........Half a Pint.

A tablespoonful may be taken every four hours.

And ten grains of Bromide of Potash may be taken night and morning.

The patient must be confined to bed, and kept moderately cool.

The swollen parts may be fomented with flannels wrung out of hot vinegar and water, in the proportion of one part of vinegar to six or eight of water. Much benefit is said to have been derived from surrounding the limb with a soft poultice, composed of Bran, Olive Oil, an Ounce of Laudanum, and a sufficient quantity of hot water to give it proper consistence, renewing it morning, noon, and night.

After the inflammation has subsided, one of the Liniments prescribed in this work, may be rubbed on the affected limb, for half an hour at a time, night and morning. And to strengthen the constitution of the patient, she may take the Tonic Mixture, No 11, or the Citrate of Iron and Quinine in five grain doses. And she may take beef tea, boiled chicken, boiled fresh fish, and a little boiled mutton; with light puddings.

Notwithstanding every attention, the complaint often leaves considerable weakness in the leg, requiring a laced stocking or roller applied round it from the bottom to the top, avoiding at the same time much standing or walking. At the same time friction may be continued to be employed, either with Liniments, or with the hand or flesh brush.